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AAEM Position Statements
PAs and NPs form a valuable part of the emergency medical team when properly supervised by a board certified/eligible EP. All team members should be referenced by their important roles to recognize individual contributions & provide transparency to those who matter most: patients. The term “provider” in reference to any clinician is vague, inaccurate, and hinders a patient’s ability to make informed decisions. This is why we have updated our terminology in our statement.
The American Academy of Emergency Medicine (AAEM) believes that emergency department (ED) patients should have timely and unencumbered access to the most appropriate care led by a board-certified emergency physician (ABEM or AOBEM). AAEM and AAEM/RSA oppose the expansion of scope of practice regulations at the state and federal level, and do not support the unsupervised or “independent practice” of nonphysician practitioners (NPPs).
Properly trained NPPs may provide emergency medical care as members of an emergency department team and must be supervised by a physician who is board certified in emergency medicine.
As a member of the emergency department team, an NPP must not replace an emergency physician, but rather must engage in patient care in a supervised role to improve patient care efficiency without compromising safety.
The role of NPPs within the department must be defined by their clinical supervising physicians who must know the training of each NPP and be involved in the hiring and continued employment evaluations of each NPP as part of the emergency department team with the intent to ensure that NPPs are not put into patient care situations beyond their clinical training and experience.
Collaborating physicians must be permitted adequate time to be directly involved in supervision of care. They must not be required to supervise more NPPs than is appropriate to provide safe patient care. Furthermore, supervision must not be in name only. Physicians are expected, and must be permitted, to be involved in meaningful and ongoing assessment of the NPPs’ work.
Billing must reflect the involvement of the physician in the emergency visit. If the physician’s name is used for billing purposes, the physician’s involvement must add value to the patient visit.
A physician must not be required to cosign the chart, nor should his/her name be invoked with regard to any patient unless he/she has been actively involved in that patient’s care. NPPs must not supervise emergency medicine residents, nor can they, nor their education be allowed to interfere with the education of, or clinical opportunities for, emergency medicine residents.
Every practitioner in an ED has a moral duty to clearly inform the patient of his/her training and qualifications to provide emergency care. In the interest of transparency, NPPs must not be called “doctor” in the clinical setting.
*This designation includes, but is not limited to the following practitioners:
Acute Care Nurse Practitioner (ACNP) Adult Nurse Practitioner (ANP) Advanced Nurse Practitioner (APN) Advanced Physician Assistant (APA) Advanced Physician Assistant Certified (APA-C) Advanced Practice Registered Nurse (APRN) Advanced Registered Nurse Practitioner (ARNP) Certified Nurse Practitioner (CNP) Certified Registered Nurse Practitioner (CRNP) Clinical Nurse Specialist (CNS) Doctor of Medical Science (DMSc) Doctor of Nursing Practice (DNP) Doctor of Nursing Science (DNS, DNSc) Doctor of Pharmacy (PharmD) Doctor of Science (DSC) Doctor of Science in Nursing (DSN) Emergency Nurse Practitioner (ENP) Family Nurse Practitioner (FNP) Nurse Practitioner (NP) Nurse Practitioner Certified (NPC) Pediatric Clinical Nurse Specialist OR Psychiatric Clinical Nurse Specialist (PCNS) Pediatric Nurse Practitioner - Acute Care (PNP-AC) Pediatric Nurse Practitioner (PNP) Physician Assistant (PA) Physician Assistant Certified (PA-C) Registered Physician Assistant (RPA) Registered Physician Assistant Certified (RPA-C) Women’s Health Nurse Practitioner (WHNP)
Approved: 1/29/2019 Updated: 9/1/2020
Updated Position Statement on Emergency Medicine Training Programs for Non-Physician Practitioners
AAEM has updated our position statement on EM training programs for PAs and NPs to strengthen and clarify our message. We must be clear about the structure of a physician-led team and roles of the team members for the safety of our patients.
The American Academy of Emergency Medicine (AAEM) and the AAEM Resident and Student Association (AAEM/RSA) are aware that academic and other emergency departments sponsor additional training for nonphysician practitioners (NPP), including physician assistants (PA) and nurse practitioners (NP). We believe the following is in the best interest of the patient and our specialty.
Such programs:
Must be clear to the public by prohibiting the use of the following terms: doctor, intern, internship, resident, residency, fellow, and fellowship. The recommended term is postgraduate training program.
NEW Position Statement on the Term “Provider”
We all undergo unique training to contribute to the medical team and need to be recognized for those roles. AAEM opposes the use of the term “provider” when referencing physicians, PAs, and NPs. Read the new position statement. The American Academy of Emergency Medicine (AAEM) recognizes and advocates for the patient’s right to know the credentials of all clinicians being trusted with his/her well-being. Studies repeatedly show that patients in the US healthcare system want to know these credentials and are confused when credentials are not clearly presented.1 More importantly, AAEM believes that credential transparency is a moral obligation. The term “provider” in reference to any clinician is vague, inaccurate, and hinders a patient’s ability to make informed decisions. The education, expertise, and roles of different clinicians vary greatly. The term “provider” removes the ability to distinguish the unique contribution of the physician in not only the clinical setting, but also for purposes of policy and research that directly impact patient care. Physicians complete more education and maintain higher standards than any other healthcare professionals,2 and patients rightfully hold higher expectations for physicians than for any other clinician. AAEM believes that the patient/physician relationship is like no other; physicians spend a decade or more studying to earn—and a lifetime to maintain—patients’ trust. Far from a service to a customer, it is a calling to place in first consideration the health and well-being of the patient, as stated in the Declaration of Geneva. The therapeutic relationship of physician to patient has not changed despite a rapidly evolving healthcare system. Must be structured, intended and advertised as to prepare its participants to practice only as members of a physician-led team. Must not interfere with the educational opportunities of emergency medicine residents and medical students. Potential detriment to resident and student education must be monitored in a comprehensive and meaningful way throughout the existence of the NPP program. Must be initiated with the consultation and approval of the emergency medicine residents and physician faculty.
Approved: February 26, 2020
Updated: September 1, 2020 Best practice calls for clearly informing patients and referring to each healthcare professional by his or her individual title to convey unique roles and responsibilities. The American Academy of Emergency Medicine opposes use of the term “provider” in reference to any healthcare clinician and joins the American Medical Association3 and the American Academy of Family Physicians4 in calling on employers, policymakers, healthcare personnel, researchers, and others to refer to clinicians by their individual, proper titles.
References
1. American Medical Association. Truth in Advertising Survey Results.
Accessed 29 August 2020. Available from: https://www.ama-assn.org/ sites/ama-assn.org/files/corp/media-browser/premium/arc/tia-survey_0. pdf. 2. American Board of Medical Specialties. What is ABMS Board
Certification? Accessed 29 August 2020. Available from: https://www. abms.org/board-certification/. 3. American Medical Association. AMA Policy H405.968. 2019. Accessed 29 August 2020. Available from: https://www.ama-assn.org/system/ files/2019-04/a19-bot09.pdf. 4. American Academy of Family Physicians. Provider, Use of Term (Position
Paper). 2018. Accessed 29 August 2020. Available from: https://www.aafp. org/about/policies/all/provider-term-position.html.
Approved: 9/14/2020
AAEM Position Statement on Emergency Department Visitation Policies during the COVID-19 Pandemic
As the COVID-19 pandemic continues, many EDs have instituted policies that limit or prevent family members and/or loved ones from visiting patients who are being treated for COVID-19. While the initial intent was to limit the exposure of visitors to the virus, the practice has instead led to arguments, despair, and friction between the visitors and the emergency department staff.
From a patient perspective, experience has proven that the support of loved ones is crucial during the treatment process. Limiting a patient’s contact with their loved ones can also be detrimental to their recovery. With proper screening questions, temperature checks, and appropriate personal protective equipment usage, COVID patients can be allowed visitors at the bedside while still adhering to current CDC guidelines. As these guidelines change, so should the screening and selection of ED visitors. Though we recognize the current concerns in regard to the available PPE for ED staff, we urge that PPE contingency plans include the availability of the PPE to ED visitors as well.
AAEM requests that emergency department policies be modified to allow at least one visitor per patient during these difficult times. Each visitor should be provided with the requisite personal protective equipment appropriate for their circumstances, and in accordance with CDC guidelines. This compassionate visitor policy should be available for all patients during their ED course, and not just those at their end-of-life period. Approved: 12/11/2020
Unmute Your Probe
VIRTUAL ULTRASOUND COURSE SERIES Monthly Re-occurring Beginner and Advanced Webinars
Jointly provided by AAEM and the Emergency Ultrasound Section of AAEM (EUS-AAEM)
