Emergency Medicine Advocacy Handbook

Ch. 32 - Getting Involved In The House of Medicine

William M. Ross; Nicholaus Josey, MD; Chet Schrader, MD, FACEP

Emergency medicine continues to see strong growth in the house of medicine, as the specialty expands both in size of workforce and services provided to the public. We must ensure our voice in advocacy expands as well.

Emergency Medicine Residents’ Association

EMRA was founded in 1974 and has more than 16,000 members. It ranks as the second-largest specialty association in emergency medicine, behind ACEP. It is the oldest and largest independent resident organization in the world. The organization works collaboratively with all the EM medical societies and groups to represent the voice of trainees in EM everywhere. EMRA operates under a shared services agreement with ACEP but retains independent operations, budget, mission, and board of directors.

Regardless of the method, we all share a common goal in advancing our specialty so that we can better serve our patients.

EMRA represents trainees to a number of external organizations, including but not limited to the ACGME, ABEM, Emergency Department Practice Management Association (EDPMA), and National Emergency Medicine Political Action Committee (NEMPAC). Additionally, EMRA represents trainees at the ACEP Council, the policy-making body of ACEP. Within ACEP Council, EMRA holds 8 out of 463 seats. Both within Council and to external organizations, EMRA advocates based on the contents of the EMRA Policy Compendium, a living and actively updated document of policies, positions, and operating procedures created by the EMRA Board and the EMRA Representative Council (RepCo). The RepCo consists of resident representatives from all EM programs and convenes biannually to discuss and vote on resolutions concerning new policies, changes to the organization, and to elect new members of the EMRA board.

In addition to policymaking and advocacy, EMRA maintains an extensive array of on-shift clinical publications, invests in national event programming, and offers unique leadership and scholarship opportunities. Many of the projects, publications, and events of the organization are produced by the 19+ different EMRA committees and subcommittees, covering a wide range of interest areas in EM. The committees offer multiple leadership opportunities, ranging from chair and chair-elect to vice chairs in charge of subcommittees or specific initiatives. Not only are there ample committee-level opportunities, but also EMRA sponsors a health policy fellowship elective at the ACEP office in Washington, D.C., a Congressional elective with U.S. Congressman Raul Ruiz, and a mentored position within one of EDPMA’s committees. Through various committees, organizations, scholarships, and benefits, EMRA is an invaluable resource for residents and a unique opportunity to get involved in the house of medicine with like-minded individuals. Learn more at emra.org.

American College of Emergency Physicians

With more than 38,000 members, ACEP is the largest emergency medicine specialty organization in the United States. The College’s formation in 1968 coincided with the establishment of the specialty and was founded to represent the interests of emergency physicians and help develop the field. Today, the organization is active across the legislative, regulatory, and administrative spectrum to help advance the interests of its members and patients. Residents can apply to be appointed to any committee, with multiple advocacy-related opportunities including the Federal Governmental Affairs, State Legislative & Regulatory, Public Health & Injury Prevention, and Quality & Patient Safety Committees. The Young Physicians Section offers residents an opportunity to transition into a group inside ACEP that has a similar perspective. Every state also has a chapter that may offer leadership opportunities for residents. States have their own important advocacy agenda and most have a committee dedicated to governmental relations and advocating for emergency physicians and patients in the state capital. Learn more at acep.org.

American College of Osteopathic Emergency Physicians

Founded in 1975, ACOEP advocates not only for osteopathic physicians’ training, but also for emergency medicine itself. ACOEP has numerous committees and boards that advocate for emergency medicine, such as the Governmental Affairs Committee. This committee reviews and develops policy and legislation that pertains to EM in the United States. Learn more at acoep.org.

Society for Academic Emergency Medicine

By improving research and education in EM, SAEM serves as a strong advocate for the advancement of emergency medicine. With a focus on the academics of emergency medicine, SAEM continually strives to promote our specialty by improving and researching how we practice emergency medicine. Learn more at saem.org.

Emergency Department Practice Management Association

The Emergency Department Practice Management Association is a national trade association involved in advocacy at the state and local level. EDPMA is centered on providing quality, cost-effective care in the ED. Its diverse membership includes not only ED provider groups, but also companies involved in billing, coding, and other supporting organizations. Its members play a role in delivering or supporting the health care for around half of the U.S. emergency department visits each year. They hold an annual conference in the spring called the Solutions Summit. Learn more at edpma.org.

Getting Involved in an Organization

Now that you’ve joined some of these great organizations and have seen the value of advocacy, you may ask, “How can I make a difference?” Within each of these organizations there are multiple outlets to strengthen our field’s presence within the hose of medicine.

EMRA Health Policy Committee

Recognizing that no one individual could perform the task of marshaling all legislative issues, EMRA created its Health Policy Committee in 2008. The committee was founded to support the board on health policy issues affecting its members. EMRA Health Policy Committee members are instrumental in developing the Emergency Medicine Advocacy Handbook, the Health Policy Journal Club articles, and the Advocacy Lecture Series. Resident participation in the committee is ideal for those interested in health policy, politics, or legislation. Opportunities to get involved exist through a number of vice chair positions covering mentorship, advocacy skills, education, resolution writing, social media, and health equity. The committee also has an ongoing partnership with Policy Prescriptions, an organization that advocates for evidence-based health policy, to produce monthly reviews of health services research articles that are often also re-capped in ACEP news channels.

Leadership & Advocacy Conference

The Leadership & Advocacy Conference was created by ACEP to train and develop advocates for emergency medicine. Politicians make legislative decisions that have a long-lasting impact on the practice of medicine. This impact can be either positive or negative, but without a seat at the table of discussion, our specialty’s voice can go by the wayside. Each physician must be an active voice in the political process as fundamental changes to health care delivery, organization and financing are discussed. This conference is an opportunity for physicians to learn from the nation’s experts on legislative and regulatory changes on the horizon and to develop their advocacy skills to further the goal of delivering high-quality acute care. The conference includes visits to legislators’ offices on Capitol Hill to lobby for critical issues relevant to emergency medicine. Past keynote speakers have included distinguished senators, congressmen, political pundits, the Secretary of Health and Human Services, and the U.S. Surgeon general.

EMRA hosts a portion of the conference, the Health Policy Primer, specifically tailored to the interests of residents, medical students, young physicians, and first-time conference attendees. With a track that involves lectures, advocacy training, and receptions with leaders in the specialty, the conference continues to provide a unique educational and networking opportunity for trainee and young physicians. EMRA and many state ACEP chapters also provide travel scholarships for residents to attend the conference.

The 9-1-1 Network

The ACEP 911 Network is one of the easiest ways to become a better-informed physician and more effective advocate. ACEP established the network in 1998 to encourage members to cultivate long-term relationships with federal legislators, convey legislative and regulatory priorities, and affect the final outcome of federal legislation important to emergency medicine.

The ACEP 9-1-1 Network offers several avenues for advocacy participation:

• Weekly Updates. Sent by email to inform participants of the latest legislative, political, and regulatory issues and activities.
• Call Alerts. You can use a toll-free number to call your representative’s or senators’ offices. Often the message is as simple as, “I live in Rep. X’s district and would like him or her to support bill # xxx.”
• Delivery of NEMPAC Contributions. Some NEMPAC (National Emergency Medicine Political Action Committee) contributions are delivered directly by 9-1-1 Network members who reside in the legislators’ districts. It is a simple way to meet your representative and offer yourself as a resource.
• ED Visits. Physicians are encouraged to invite legislators to tour their emergency departments. This provides legislators and their staff the opportunity to witness first-hand the operations of an ED and to meet their constituents.
• Team Captains. The ACEP 9-1-1 Network is organized by a group of team captains who receive focused training and communications, increased resources, and special recognition for their efforts.
• Advocacy Training. Members of the 9-1-1 Network are encouraged to continually develop their advocacy skills. To help improve advocacy efforts, political education training is offered each year during ACEP’s Leadership & Advocacy Conference and during the ACEP Scientific Assembly.

NEMPAC

Founded in 1980, the National Emergency Medicine Political Action Committee (NEMPAC) is a critical advocacy powerhouse that augments the voice of emergency physicians and their patients in the federal election process. National political action committees combine donations from individuals to make meaningful contributions to federal candidates running for a seat in the U.S. House of Representatives or Senate. As physicians, our success as advocates hinges upon our ability to work with lawmakers who share a common vision to improve emergency services. Because health care is at the top of the priority list for many candidates, contributions to NEMPAC will help facilitate the emergency physician’s place at the table.

NEMPAC selects candidates for contributions based on how their political priorities aligns with the legislative and regulatory agenda created by the ACEP Board and ACEP Federal Government Affairs Committee. Another large part of the selection process is the opinion of the state ACEP chapter and the relationship the candidate has been able to form with that group. Other factors include their support of ACEP legislation, their committee assignments, their leadership positions within Congress, and competitiveness of their race. Recent ACEP legislative issues have included bills on the opioid epidemic, EMS standing orders, support for mental health resources, eliminating unnecessary regulatory burdens, medical liability reform, and protecting emergency care as an essential health insurance benefit.

NEMPAC continues to support legislation to expand federal GME funding for emergency medicine residency positions and proposals that would defer student loan payments until after residency and fellowship training. Simply put, the mission of NEMPAC is to use campaign contributions and political advocacy to support candidates who foster the legislative priorities of emergency medicine patients and physicians.

Health Policy Electives

EMRA sponsors a select few residents and medical students each year to participate in a Congressional and an ACEP-based health policy fellowship in Washington, D.C. The Congressional elective is a month-long embedded fellowship for a trainee to work in Rep. Raul Ruiz’s office alongside his staff on Capitol Hill. This is a unique opportunity to see firsthand how a federal legislative office operates. Tasks include developing legislative proposals, attending Congressional hearings, making recommendations on committee
votes, and writing policy research white papers. Another special opportunity is the EMRA/ACEP health policy fellowship. This is also a month-long rotation (or 2 weeks for medical students) for residents to work in the ACEP D.C. office. The program includes training in advocacy and major regulatory issues, lobbying at the Capitol, and working with non-governmental organizations. For those considering advocacy as a part of their life, these are excellent opportunities to get on-the-ground experience in a way that is feasible to with a medical student or resident schedule.

Health Policy Fellowships

For those who are actively involved in health care policy throughout residency, it doesn’t have to end there. Our specialty is dedicated to change at a systems level, and there are numerous fellowships dedicated to teaching residents how to effectively make that happen. Moreover, a number of these fellowships have a health services research focus and offer masters for advanced research methodology training. One such fellowship program is the National Clinical Scholars Program. Formerly known as the Robert Wood Johnson Scholars, this network of 5 academic institutions trains clinicians in policy-relevant research and community partnerships. Learn more about these programs through the EMRA Health Policy Fellowship Directory at emra.org/match/health-policyfellowships.

• Whether it be through, EMRA, ACEP, state chapters, or any of the other various organizations, action is key. Get involved early and become a passionate voice of our field of medicine.
• Encourage your co-residents to get active in advocacy; as residents your voice carries a fresh perspective.
• If you have a passion for building a career in health care advocacy, consider a fellowship in health policy.