Letter from the Editor - 2018 Council Update

This is the tenth year I have had the opportunity to participate as a Tennessee Chapter representative at the ACEP Council meeting. Council is held the two days prior to ACEP Scientific Assembly. This year it was September 29 and 30 in San Diego. To a very large extent ACEP Council determines the college’s priorities and actions. There were 421 councillors this year. Recall, each state chapter starts with one councillor and then has an addition councillor per 100 members. States with large memberships such as California (30 councillors), New York (28 councillors), Texas (22 councillors), Michigan (20 councillors) and Florida (20 councillors) have considerably more influence than the states with small membership such as Alaska and Montana (each with one). Each section has one councillor and then there are a variety of others. This includes but is not limited to Emergency Medicine Residency Association (8) and one each for the Association of Academic Chairs of Emergency Medicine (AACEM), and the Council of Emergency Medicine Residency Directors (CORD).

There were 49 resolutions submitted to the Council this year. One ACEP member may submit a resolution. The resolutions largely reflect priorities for the college and issues that you and I confront on a daily basis. The resolutions are reviewed in one of three Reference Committees. In the Reference Committee meetings individuals representing themselves or an entity (such as the state chapter, section, board etc.) testify in favor or not in favor of the resolutions. The job of the Reference Committee is to modify or condense resolutions to better reflect the testimony provided. They then recommend unanimous consent (approved without discussion at the Council), adoption of existing or modified resolutions, referral of existing or modified resolutions or not adopting resolutions. The Reference Committees present their recommendations to the Council.

Diversity in ACEP leadership was a significant theme in the meeting this year with three resolutions promoting diversity through the Leadership Development Advisory Committee, the nominating committee and the choice of chapter councillors and alternate councillors.

Resolution 9 was submitted by a number of ACEP Doctor of Osteopathic Medicine leaders and the Emergency Medicine Residents’ Association (EMRA) and generated a lot of discussion. It requested that the American College of Osteopathic Emergency Physicians (ACOEP) be allocated one councillor position. It was approved by the Council and because it is a Bylaws resolution it will require a 2/3 affirmative vote of the Board of Directors.

You can imagine with greater than four hundred councillors, management and housing such a large group has its challenges. Resolution 13 was submitted by the Steering Committee to direct the Council officers to appoint a task force of councillors to study the growth of the Council and determine whether a Bylaws amendment should be submitted to the 2019 Council addressing the size of the Council and the relative allocation of councillors. This was approved.

Two resolutions addressed our mental health. Resolution 16 requested that ACEP study the unique, specialty-specific factors leading to depression and suicide in emergency physicians and formulate an action plan to address contributory factors leading to depression and suicide unique to our specialty and provide a report of these findings to the 2019 Council. It is believed that physicians avoid seeking treatment for mental health issues due to the possibility of that being reported to the state medical boards and questions on applications regarding history of mental health issues. Resolution 19 asked that ACEP work with partner organizations to promote a culture where physician mental health issues can be addressed proactively, confidentially, and supportively, without fear of retribution and that ACEP work with the American Medical Association (AMA) and Federation of State Medical Boards to petition state medical boards to end the practice of requesting a broad report of mental health information on licensure application forms. It further resolved that ACEP work with state chapters to encourage state medical boards to amend their questions about the physical and mental health of applicants. This was approved.

The past two years there has been discussion regarding how a federal law known as the Group Purchasing Organization (GPO) safe harbor, provides an environment which contributes to shortages of generic injectable drug shortages. Resolution 27 requests that ACEP prepare a press release calling for the repeal of the GPO safe harbor. This has been referred to the Board.

Resolutions that did not pass included a request that ACEP divest from fossil fuel-related companies and a resolution that would make physician suicide a sentinel event within a hospital.

I find the conversations in the Reference Committees and Council interesting and educational. The Tennessee councilors meet before the meeting, review the resolutions and generally have an opinion regarding our support or not. Not infrequently when we listen to parties on both sides of the issue our opinions shift or change.

If you have an interest in serving as a councillor or alternate councillor next year contact your state chapter and share your interest. ACEP Council will be October 25-26, 2019, in Denver, Colorado.

Thom Mitchell, MD, FACEP
Newsletter Editor, Emergency Medicine Workforce Section