Arlo Weltge, MD

I am often asked by the residents I work with at the University of Houston, 'What is ACEP's policy on this issue?' If I am not sure, I usually look it up on the ACEP web site, print it and then present the inquiring individual with an ACEP Policy Statement on the topic. Once that transaction is complete, inevitably the next question is, How are these policies developed?'

I am always gratified that a resident has asked about a particular policy. I am just as thankful that he or she wants to know more about the process of developing policies because that's my opening to talk about how important it is to get involved in the policy development process.

Policy statements issued by professional medical societies serve a number of important purposes. As emergency physicians, we should be aware of our college's policies, and just as importantly, how we can get involved in the process of developing them. But before we can become involved in the process, we have to ask ourselves two fundamental questions: What is the American College of Emergency Physicians and how do I get involved?'

Technically, ACEP is an individual membership organization. That is, it represents the interests of a specific group of individuals, not companies or businesses. In ACEP's case, those individuals are emergency physicians, emergency medicine residents and medical students.

There is one other group we represent. It should come as no surprise to those of us who have dedicated our lives to this specialty that our professional organization is also dedicated to serving the patients we care for. As emergency physicians, we are the safety net of the health care system. We provide care to all who seek it, regardless of their condition or ability to pay. Therefore, it is only right that our professional organization advocates for our patients as well as for us.

One Member, One Idea

An ACEP Policy Statement is developed through a process used by many other professional organizations, but magisterial in its own way. ACEP actually develops and issues two types of policies. The first are clinical policies, which, as the name implies, deal with the clinical aspects of emergency medicine. The second are practice management policies that deal with the philosophical and administrative aspects of emergency medicine.

The college has more than 80 practice management policies, ranging from "Access to Emergency Medical Care: Emergency Physicians and Uncompensated Care", to "Writing Admission Orders." They cover the full range of practice management issues and give emergency physicians valuable insight and direction on the issues they deal with every day. Their importance cannot be underestimated.

From my perspective, the way policies come about says more about the democratic structure of the American College of Emergency Physicians than any other aspect of the organization. Specific areas are identified and policies are developed because the members of the organization believed that a policy was needed to address an area of concern. It only takes one member to bring forth one idea.

Why it Works

The structure of the college allows this process to work because it is set up to be responsive to the concerns of the membership. The work of representing the college begins at the Council, the deliberative body which votes on policies and positions that direct the college. The Council consists of elected (or appointed) representatives from each chapter and section. The Council meets once a year for two days before the fall Scientific Assembly.

The Council uses parliamentary rules and the Councillors representing their chapter or section debate, refine, and vote on resolutions brought before it from the chapters, sections, board of directors, and steering committee. In fact, it is the Council that elects the board of directors who are responsible for the ongoing management of the college and who ultimately decide on the final form of written policies.

Historically, the Council consisted of representatives of the chapters. Section representatives have only been added in the last few years. Each chapter has its own separately incorporated organization, bylaws and board of directors.

The chapters elect or appoint individuals to represent them at the Council. Each chapter has at least one representative (as does each section). While each chapter tends to vary somewhat, the Councillors are individuals who have been active on the state level and often have served, or are in line to serve, in leadership positions.

Many of the larger chapters have established organizations and a progression of responsibilities and officer positions that results in individuals gaining experience and responsibility on the local level. More importantly, even smaller chapters with fewer members and organizational levels typically are involved in their state medical organization and legislative efforts. As a result, members representing chapters, either small or large, typically come to the Council with years of legislative, leadership and organizational experience.

The Proof

It has been said that the strength of our country comes not from its central government, or its representative form of governance, but rather from the strength of the local and community organizations which foster the common principles of our nation. I believe this is also true of ACEP.

How do you prove it to yourself? I would suggest that you do not need to attend the Council, or even the national meetings, although these are a good place to start. Rather, look first in your state, or if you have a special talent or interest look in your section. More often than not you can find an experienced and dedicated member not far from you (even in Texas where 'far' has a different meaning than some other states!). Some cities even have their own local organization of emergency physicians under the umbrella of their local medical organization.

In 1982 John Naisbitt, in his book Megatrends,predicted the level of decision making would be pushed down from the centralized national level to the decentralized state and local levels. One does not have to follow politics closely to recognize recent efforts pushing more power to the state and local level, whether welfare reform or the increasing power of the organizations of state governors and city mayors. Your future, more often than not, will be decided on a local and state level.

The college is effective because its leaders, as well as a vast number of other members, have honed their skills and gained their experience at the local level. Where do you look to find this strength? I would start with your local medical society directory. The strength of ACEP lies at home in the cities and states where dedicated emergency physicians are spending their time and efforts caring for the sick and injured as well as representing emergency medicine and the patients we care for on the local and state level.

Arlo Weltge, MD, MPH, FACEP, is past President of the Texas College of Emergency Medicine and is serving on the ACEP Council Steering Committee. He spends his professional time as faculty of the Emergency Medicine Residency at the University of Texas in Houston.