The Pulse - Fall 2022

EDITORIAL STAFF

Timothy Cheslock, DO, FACOEP, Editor

Wayne Jones, DO, FACOEP-D, Assistant Editor

Tanner Gronowski, DO, Associate Editor

John C. Prestosh, DO, FACOEP-D Christine F. Giesa, DO, FACOEP-D Meagan Comerford, Director of Communications

EDITORIAL COMMITTEE

Timothy Cheslock, DO, FACOEP, Chair Christine Giesa, DO, FACOEP-D

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OF CONTENTS

PRESIDENT’S REPORT

G. Joseph Beirne, DO, FACOEP-D

THE ON-DECK CIRCLE

Timothy Cheslock, DO, FACOEP

EXECUTIVE DIRECTOR’S DESK

Philip Waitzman MBA, MPH, MA, LSW

WOMEN’S COMMITTEE UPDATE

Nicole Vigh, DO, MPH

PHYSICIAN WELLNESS COMMITTEE UPDATE

Matthew D. Keeler, DO

WHAT WOULD YOU DO? ETHICS IN EMERGENCY MEDICINE

Bernard Heilicser, DO, MS, FACEP, FACOEP-D

PRESIDENT’S REPORT

G. Joseph Beirne, DO, FACOEP-D

TRANSITIONS TO THE FUTURE

Hello ACOEP family! As I write my last article as president of the college, it is a beautiful Fall day here in St. Louis. Sunny, low 70s, low humidity, a day that made me reminisce about my last three years in leadership of the college. I became president-elect in 2019 at the Scientific Assembly in Austin, Texas. During my two years as presidentelect, I learned the “job” of what being the president of our college would entail. In February 2020, Bob Suter (who was president at the time), and I attended the AOA mid-year meeting in West Palm Beach, Florida. There, we met with AOA leadership and presented our case regarding the creation of a remedy to allow AOBEM-boarded diplomates, who are also EMS medical directors, to take the EMS subspecialty exam (formerly called CAQ-EMS). This was a long, uphill battle, but I am happy to report that we were successful in our appeal to AOA leadership! Just a few weeks ago, AOBEM released the eligibility criteria for the examination. During my tenure as one of the leaders of our college, this was one of my proudest moments.

March 2020 changed all of our lives. A new disease called COVID made us rethink our roles as not only emergency physicians, but as true warriors on the front line battling this terrible disease. We led the charge against COVID, we were there every day and never backed down. We

won many of those battles. We also lost colleagues, friends, patients and family members. COVID changed how our college functioned — how were we going to continue our Spring conference and scientific assembly? How would we survive?

Survive we did. Each day brought challenges and small triumphs. Each victory became a building block for the foundation of our success as a specialty and as individual physicians. We were the first EM organization to offer virtual CME conferences. After Spring 2020, Fall 2020 was just as successful. As we moved into 2021, both conferences were virtual and were just as successful. We thrived as a college and continued to provide to you, our members, our ACOEP family, with cutting edge CME that included the most up-to-date information on COVID. This past April, we had our first in-person conference and also offered the virtual option. Moving forward, both of these options will

continue to be beneficial for our members, and we plan to continue this.

When I took the presidential oath in October 2021, I thought long and hard about what I wanted to do with my year as president. As most of you know, our presidential term was two years. When I took office, our bylaws were transitioning to a one-year presidential term, and I would have been the last president with a two-year term. However, I made the decision to limit my term to one year. Our board of directors is composed of a unique blend of physicians who practice in academic centers, community hospitals and the military. These people, who I have had the honor to work with, are all future leaders of our college. If I had not limited my term to one year, this would have created a situation where many of these wonderful physicians would never have had the chance to lead the college. To deny that chance

I WANTED EACH PERSON IN THE MEMBERSHIP TO REALIZE THEY ARE A VALUABLE PART OF OUR COLLEGE, AND THEIR TALENT AND KNOWLEDGE ARE NEEDED FOR OUR SUCCESS.”

to my colleagues on the board was unacceptable to me. For that reason, I chose to only serve a one-year term. So, what did I want to do with my year as president? I wanted to increase the transparency of the college to our members, make all of the board available for questions and concerns. I wanted each person in the membership to realize they are a valuable part of our college, and their talent and knowledge are needed for our success. Many years ago, when I became a new attending member of ACOEP, I never thought I would one day lead this college. Over the years, many former board members and past presidents of our college became close friends and mentors to me. I saw their work and efforts to keep ACOEP at the forefront in emergency medicine. Their passion and spirit ignited a flame in me that continued to grow. In that same sense,

I wanted each of you, our members, to recognize and welcome that passion to be leaders of the future. My year as president has taught me many lessons — the most important of which is this: be a leader and help others realize they can be leaders as well. This creates in each of us the ability to understand that our ideas, our dreams and our passion for our specialty will make our college bigger and better. I told myself many times over the years “the answer to the question is no, if you don’t ask the question.” Never stop thinking, never stop dreaming. The next great idea often comes from those “ah ha!” moments each of us have. That is how we become leaders and mentors to our next generation of physicians.

In closing, I have had the honor to work with the very best group of physicians who serve on the board of directors! Our board is a team

that thrives on new ideas and always succeeds. All of the successes we have had as a college are because of this board that it has been my honor to lead and be a part of. As I transition to immediate past president, I will turn the reins over to Tim Cheslock, who will be our new president. Tim’s counsel and advice during my year as president has been invaluable, and I end my term knowing ACOEP will be in the very best hands! I want to thank Bob Suter, who as immediate past president, was a source of tremendous knowledge and wisdom for me when I succeeded him. Last, a very sincere thank you to our board of directors. I consider my year as ACOEP president one of the most rewarding accomplishments of my career. None of this would have been possible without all of you! •

Depending on when you are reading this, we are either headed to Las Vegas for our Scientific Assembly or already on the ground amid what is shaping up to be a great event! Either way, I hope to see many of you in person over the coming days.

It seems like just a short time ago I began my term as president elect of the college, and here I am now just days away from taking that next step to the presidency. Time really does not stand still. It has been another great year, one that we can celebrate together as a huge success. Over the past year it has been a true honor to work together with Dr Beirne and the entire board of directors to continue moving the college forward. As we transitioned out of the pandemic and back to live meetings in the spring, a sense of normalcy has been returned to our day-to-day lives. We continue to assess how the pandemic has changed us as emergency physicians, our reflections of two hard years of extraordinary challenges for each of us. We have learned together, shared our challenges, celebrated our successes, and mourned our losses. The landscape of emergency medicine will be forever changed by what we endured, but one of the constant stabilizing forces was the support we gave each other. Despite all of this our college continues to grow and I have to acknowledge and thank each and every one of our members. Without you, we would

SHARING CHALLENGES AND SUCCESSES

not have been able to rise to the challenge, but together we have done so much!

ACOEP continues to hold a prominent place within both the house of Emergency Medicine and the AOA. Over the last year we have been representing you and your interests at various meetings and workgroups across the country. Dr. Beirne and I have been present for the AOA’s house of delegates meeting and the AOA mid-year meeting.

Our immediate past president has represented us at ACEP, which just wrapped up in San Francisco. We have also had representation on the EM Workforce Group and continue to hold a seat on the EM Action Fund. Our members sit on the ACGME RRC-EM, and we are represented by our members on the International Federation of Emergency Medicine. While being a smaller group in the Emergency Medicine arena, we have harnessed on energies and found ways to amplify our voice within the community and remain relevant to the specialty in our own unique ways. It goes without saying that one of the biggest reasons we have the

influence that we do is because of the dedicated and steadfast support of each of our members. Your membership and active involvement in the college has allowed us to accomplish so much. The active participation of our members on committees and task forces within our college in representing us at the table during larger collaborative gatherings is what makes us stronger.

Over the course of the next year, I hope to continue to showcase the involvement of our membership in the many ways in which you contribute to the college and emergency medicine in your everyday practice. I also want to specifically recognize our fellows and distinguished fellows of the college. While you may not think about it daily, our fellows represent the frontline of our college in so many ways. By adding the title of FACOEP or FACOEP-D to your credentials you give an added boost to your professional designation and in turn are promoting the values and service to our organization. The pride of fellowship is something you will hear more about over the coming year, as I seek to recognize our current

THE ON-DECK CIRCLE

Tim Cheslock, DO, FACOEP

“YOUR MEMBERSHIP AND ACTIVE INVOLVEMENT IN THE COLLEGE HAS ALLOWED US TO ACCOMPLISH SO MUCH.”

fellows but also encourage more of our members to become fellows of our college. This hard-earned designation is not only a benefit to your professional development but a recognition of your support and dedication to our college. I look forward to being able to help grow

our fellowship, as it is another step in strengthening our collective influence in the EM community and the house of medicine.

I enjoy seeing so many of you at our annual gatherings! To those who I have not yet had the opportunity to meet in person, please introduce

yourself or say hello as you see me at the conference or in your travels at other functions throughout the year. I am looking forward to this year and humbled by the opportunity to represent you and the ACOEP! •

THE LANDSCAPE OF EMERGENCY MEDICINE WILL BE FOREVER CHANGED BY WHAT WE ENDURED, BUT ONE OF THE CONSTANT STABILIZING FORCES WAS THE SUPPORT WE GAVE EACH OTHER.”

EXECUTIVE DIRECTOR’S DESK Philip Waitzman MBA, MPH, MA, LSW Executive Director

MEET ACOEP’S NEW EXECUTIVE DIRECTOR

It is my honor to join ACOEP as your newest Executive Director. First, I would like to recognize the outgoing ED, Katie Geraghty. We appreciate and give thanks to Katie, who served ACOEP in 2022.

As I transition into the role, I am excited to carry forward the historical knowledge embraced by staff and leveraged to build a scalable organizational model. It is my passion to incorporate my background as a licensed mental health clinician and as an experienced association CEO to lead ACOEP’s growth into the future. As I step into the ED role, I come to ACOEP having been closely involved with the staff and Executive Committee in recent months. From being part of the strategic planning session to managing the organization’s Key Performance Indicators and goals, I am pleased to report that the organization’s membership is growing and trending favorably. I look forward to meeting our members at the upcoming Scientific Assembly. Please stop by and say hello! •

Warmest Regards, Philip Waitzman MBA, MPH, MA, LSW Executive Director, ACOEP

CME Your Way

ACOEP delivers the topics you need to succeed in today’s emergency departments.

From the ACOEP Digital Classroom to in-person events, it’s CME Your Way.

CME via In-Person Events

The ACOEP Spring Seminar and Scientific Assembly are your choices to reconnect, network and earn CME live and in person. Save the date for the 2023 Spring Seminar, April 1-5, at the Hilton Phoenix Tapatio Cliffs Resort, Phoenix, Arizona.

CME via Webinars

The ACOEP Summer Series takes place each July. Join the weekly live webinars or watch the recordings at your leisure.

CME via the ACOEP Digital Classroom

The newly updated Digital Classroom allows you to choose the topics you want at the time most convenient for you. Search by CME topic, event or certification resources.

www.aceop.org #CMEYourWay

ACOEP’s

WOMEN’S COMMITTEE UPDATE

By Nicole Vigh, DO, MPH

Ibecame a mom for the first time in February 2021, during my third year of my emergency medicine residency training. I graduated residency and became an emergency medicine attending physician in June 2022. Becoming a mom has been one of the most rewarding yet challenging experiences I have ever had. Becoming a physician has its own set of rewards and challenges. But becoming a physician mom is a whole other experience, with its own very unique set of joys and challenges. The ACOEP Women’s Committee is full of moms who have shared their experiences as a physician mom, sharing the greatest joys, challenges and even some “mom hacks” they’ve learned along the way.

Many of us can agree that becoming a mom has made us better physicians. I have found that since becoming a mom I have a better understanding of what my patients and their parents or family members are experiencing and am able to be more empathetic. The first time I frantically brought my son to urgent care with a weird rash it helped me to understand the fear that parents have when they bring their child to the emergency department, unsure what’s going on with their child, unsure

if their child’s fever is something serious or a mild cold. Having cared for my own sick child has given me a unique understanding of what other parents are experiencing. On the flip side, being a physician makes us better moms as well. As Dr. Carrick, mother of three boys says, “I am able to be the best caretaker when they are sick and injured.” As the mother of a 19-month-old son who has already had his first trip to the ER for stitches, I too can agree with that!

As a mother we need to think about providing financially not only for ourselves and significant others but our children as well. The financial reward of being a physician provides families with a comfortable lifestyle. As Dr. Dziedzic says, “I don’t have to worry about my (3) kids not getting needs met due to the cost of something.” Being a physician gives Dr. Carrick the opportunity to enjoy the luxury of traveling and making memories with her husband and three boys. The financial aspect of working in medicine takes away the financial worry of providing for a family.

As I had mentioned I had my son during my third year of my fouryear emergency medicine residency training program. Did I mention during a pandemic, with gestational diabetes?

It was really hard. But, having my son by my side during my final year of training made each and every day better and was incredibly rewarding. He watched his mama graduate from residency and of that I am extremely proud. I am proud that my son will grow up watching his mom go to work each day to help others. As Dr. Carrick says, “My boys see me working hard every day, encountering really difficult situations with students and patients, and holding important leadership positions. I tell them stories about what I do.” Dr. Selley agrees, “The biggest joy about being a physician is sharing the unique responsibility of how we care for other people that are not our family members with my (2) kids.” As physician moms we all hope to provide our children with a great role model to look up to and to learn from. I hope that my son grows up knowing that he can accomplish anything with hard work.

Being a physician mom of course comes with challenges and I think the number one challenge that all working moms can agree on is the mom guilt! I went back to work when my son was seven weeks old and I felt terrible leaving him, working long hours and missing many “firsts”. Now that I am working as an attending, I have chosen to work three night shifts per week, although it’s still hard to leave those nights, I know every week I only work three nights and the rest of the week I am completely off. Those days off I maximize the time I spend with my son and husband, planning fun activities just about every day. Dr. Dziedzic agrees working all nights has been beneficial for her and her family, “Now I only have two schedules,

work and off. This allows me to be home for most after school activities and have dinner with my family every night. I even get to see the kids before school most days.” Dr. Selley agrees as well, “One of the biggest challenges of being a physician mom is trying to balance being there for my kids and still having the drive to excel in leadership and not feel guilty.”

Dr. Carrick recently transitioned to a new role as the Associate Dean at Kansas College of Osteopathic Medicine, working only two clinical shifts per month. “Most of the time I work weekdays only so I can take my boys to their activities and be home most nights.” Finding balance between our work and home lives can be challenging but it’s important to set our priorities and make the most of our time away from work.

As physician moms we owe some of our success to the many “mom hacks” we’ve learned along the way! Juggling multiple different schedules can be really difficult. Dr. Dziedzic uses one calendar with each person having a different color for their activities to help her to manage herself, her husband and their three children’s busy schedules. Dr. Carrick, Dr. Selley and I agree our greatest mom hacks includes utilizing services and tools that make our life easier! Grocery delivery services, meal kit delivery services like Hello Fresh, a cleaning service, or a Roomba (a

great gift from my mother-in-law… possibly a hidden message…anyway it’s been a life saver!). Utilizing these services allows me to make the most of my time off and spend it with my son and husband. As Dr. Selley says, “Whatever it is that would give you the ability to breathe and not stress.” It is also important to continue doing the things you enjoy and what gives you your own identity. It’s important to be intentional with planning time for yourself. I have always enjoyed working out, but after I had my son I couldn’t get myself to spend time off exercising without feeling the mom guilt, until I found my favorite “mom hack”. Fit4mom is a mom group that does exercise classes with the kids, the instructors sing to the kids to keep them entertained, all exercises are done with your kids in the stroller and at the end of class the kids can run around and play together. It has been a great way to get in a workout without the mom guilt!

While being a physician mom comes with its own unique set of rewards and challenges, we can all agree being a physician mom combines two of the greatest jobs there are, and we wouldn’t trade it for anything! Utilizing our greatest mom hacks helps us to be successful in our work and home lives. And of course, having a great group of physician moms to talk to, share experiences and advice with helps as well!

PHYSICIAN WELLNESS COMMITTEE UPDATE

By Matthew D. Keeler, DO

Emergency physician fatigue and burnout has been well recognized for many years. The worldwide pandemic has added additional stressors, both in the work environment and in our personal lives. The nature of emergency medicine produces a raw, unfiltered view of medicine. As front-line healthcare workers there is a finite amount of energy one can provide before a recharge is required. The ACOEP recognizes the increasing demands placed upon EM physicians and the widespread stressors that lend towards clinicians moving away from bedside care years before intended. While most individuals have selfcreated mechanisms to improve their personal wellness, the ACOEP is here to help.

The causes for burnout are vast and personal. Major factors

such as increasing workload, clinical inefficiency, and diminishing autonomy rate are at the top for surveyed EM physicians. Each year is accompanied by increasing rates of physician suicide, residents experiencing major depression and medical students reporting higher rates of depression than the general population.

The focus of the AOCEP Wellness Committee is to address the high level of physician fatigue and the lack of focus on provider wellness. The Committee will provide education, resources and options for intervention to help individuals thrive throughout their career. It is crucial to optimize wellness and career longevity so EM physicians can be their best at the bedside. Self-care and healthy, personal relationships enhance one’s career and improve clinical effectiveness.

Understandably, EM physicians and other providers seek to improve both their clinical wellness and non-clinical wellness. The Wellness Committee provides resources to improve job control and autonomy, promote a healthy work environment and opportunities to explore multiple avenues of clinical interests to promote job diversification. Regarding personal wellness, expect to see resource dedication to emotional and physical wellbeing, and materials to aid in improving a work life balance.

Recognizing that you may benefit from improved wellness is the first step. Take advantage of the resources provided to you as a member of the ACOEP to aid in your own personal wellness. The first step in helping others is by helping yourself. •

SUICIDE AWARENESS AND PREVENTION

Data from Data from CDC, NIMH, WHO, NAMI and other select sources for National Suicide Awareness Month

Key Facts

• More than 700, 000 people die due to suicide every year.

• For every suicide there are many more people who attempt suicide. A prior suicide attempt is the single most important risk factor for suicide in the general population.

• Suicide is the fourth leading cause of death among 15–19-year-olds.

• 77% of global suicide occur in low-and middleincome countries.

• Ingestion of pesticides, hangings, and firearms are among the most common methods of suicide.

Individual Impact

• 79% of all people who die by suicide are male.

• Although more women than men attempt suicide, men are 4x more likely to die by suicide.

• Suicide is the 2nd leading cause of death among people aged 10–14 and the 3rd leading cause of death among people aged 15-24 in the U.S.

• Suicide is the 12th leading cause of death overall in the U.S.

• 46% of people who die by suicide had a diagnosed mental health condition - but research shows that 90% may have experienced symptoms of a mental health condition.

Community Impact

• Annual prevalence of serious thoughts of suicide, by U.S. demographic group:

• 4.9% of all adults

• 11.3% of young adults aged 18-25

• 18.8% of high school students

• 45% of LGBTQ youth

• The highest rates of suicide in the U.S. are among American Indian/Alaska Natives followed by nonHispanic whites.

• Lesbian, gay and bisexual youth are nearly 4x more likely to attempt suicide than straight youth.

• Transgender adults are nearly 9x more likely to attempt suicide than the general population.

• Suicide is the leading cause of death for people held in local jails.

Suicides are preventable. There are a number of measures that can be taken at population, sub-population and individual levels to prevent suicide and suicide attempts. LIVE LIFE, WHO’s approach to suicide prevention, recommends the following key effective evidence-based interventions:

• Limit access to the means of suicide (e.g., pesticides, firearms, certain medications);

• Foster socio-emotional life skills in adolescents;

• Early identification, assess, management and follow up of anyone who is affected by suicidal behaviors.

These need to go hand-in-hand with the following foundational pillars: situation analysis, multisectoral collaboration, awareness raising, capacity building, financing, surveillance and monitoring and evaluation.

Suicide prevention efforts require coordination and collaboration among multiple sectors of society, including the health sector and other sectors such as education, labor, agriculture, business, justice, law, defense, politics, and the media. These efforts must be comprehensive and integrated as no single approach alone can make an impact on an issue as complex as suicide.

Suicide Prevention Resources

NAMI (National Alliance on Mental Illness) Call the NAMI Helpline at 800-950-6264 or text “Helpline” to 62640

Call the National Suicide Prevention Line at 1-800-273-8255 or call 911

Call or text 988 or Chat at 988lifeline.org

Crisis Text Line – Text HOME to 741741 for free, 23/7 crisis counseling

American Foundation for Suicide Prevention: 1-888-333AFSP (2377)

Suicide Awareness Voices of Education: 952-946-7998

Wellness Resources

NAMI “It’s OK to Talk about Suicide” infographic https://nami.org/NAMI/media/NAMI-Media/Infographics/ NAMI_Suicide_2022_FINAL.pdf

NAMI “Navigating a Mental Health Crisis” infographic https://nami.org/NAMI/media/NAMI-Media/Infographics/ crisis%20guide/INFO-Warning-Signs-of-Suicide-ENG.pdf

Bernard Heilicser, DO, MS, FACEP, FACOEP-D

What Would You Do? Ethics in Emergency Medicine

In this issue of The Pulse, we present the case of a patient who may or may not be a Jehovah’s Witness and needs blood.

Our patient is a 69-year-old female being admitted for septic shock. She has a history of osteomyelitis, hypertension and dementia. Her hemoglobin had fallen from 7.0 to 6.3. She has two daughters, one being a Jehovah’s Witness, while the other is not. The patient lacks decisionmaking capacity.

As expected, one daughter (A) is a Jehovah’s Witness and would not consent for blood. However, she did not have documentation as to her mother being a Jehovah’s Witness. The other daughter (B) is not a Jehovah’s Witness and wants everything done to keep her mother alive. Daughter A claims to be the Durable Power of Attorney for Health Care, but has no documentation for this.

Who has standing in medical decisions? Is there an ethical/legal basis for your decision?

What would you do?

WHAT WOULD YOU HAVE DONE?

Please visit the ACOEP DocMatter community forum and share your thoughts on this case.

If you have any cases that you would like to present or be reviewed in The Pulse, please email them to us at mcomerford@acoep.org.