A Note From the Section Newsletter Editor - Undersea and Hyperbaric Medicine Section Newsletter, June 2011
Jawad N. Kassem, MD
2010 was an exciting year for the undersea and hyperbaric medicine subspecialty; filled with ups and downs. As you know, Undersea and Hyperbaric Medicine (UHM) is recognized as a unique medical subspecialty by the American Board of Medical Specialties. Since 2002, The Accreditation Council on Graduate Medical Education (ACGME) sponsors fellowships in UHM. In 2008 the ACGME Monitoring Committee warned that UHM fellowships were in jeopardy of discontinuation. The UHM community requested and was granted a two year stay in the committee’s formal recommendations for closure of fellowships. During those two years, the main objective was to grow the number of fellowships. We did not sufficiently meet the challenge. To that end, in the fall 2010, ACGME revisited whether or not they would sponsor UHM fellowships. Again, our ability to grow subspecialty training was questioned – thereby questioning the need for subspecialty training in the field altogether.
As all medical specialties, UHM is based in science. There are inherent risks and benefits associated with it. Operational and safety considerations abound. In order for patients to be treated safely and effectively we need to expand its clinical and scientific reach through evidence-based research and a larger number of fellowships. Through an unprecedented collaborative effort between the fellowships and clinicians around the country, spearheaded by our Chair, Tracy LeGros, Heather Murphy-Lavoie, Laurie B. Gesell, Kevin Hardy, Enoch Huang and Robert Sanders put together an approximately 100 page dossier to encourage ACGME to reevaluate their decision and continue their sponsorship of UHM fellowships. Included in the dossier were letters of support from the Surgeon Generals of the U.S. Navy and the U.S. Air Force. They outlined the need for training, a summary of publications in the field, our growth and how we met ACGME requirements. Thanks to their efforts, the ACGME agreed to continue accreditation.
We must heed this wakeup call. For too long our community has been satisfied with accepted indications without furthering clinical or basic science understanding. We need to expose our residents early in their careers to hyperbaric medicine and encourage them to participate in fellowship training. We need to organize, collaborate and participate in clinical and basic science research in hyperbaric medicine to elucidate the clinical benefits as well as the basic science principles that drive them. Without the latter, we will perish as a legitimate field of medicine. As Dr. Kevin Hardy often says, “You cannot believe in hyperbaric medicine. It’s not a belief. You can accept the science or reject it, but it is not religion.” Let us work together to prove it!
The ACEP Undersea and Hyperbaric Medicine Section challenges all those who accept the science of hyperbaric medicine and practice it, to contribute to the field. How can you contribute, you ask? Those of us in academic centers with emergency medicine residencies and a clinical or research hyperbaric facility with 2 board certified UHM physicians are eligible to start a fellowship. The SUNY system is celebrating their inaugural year participating in fellowship training in UHM. (See Spotlight on Fellowships below) The former Chairman of Emergency Medicine, now SUNY Upstate CEO, Dr. John McCabe, board certified UHM physician, championed the effort, collaborated with the Fellowship program at Louisiana State University and after a year of hard work, the SUNY Upstate Department of Emergency Medicine added a fellowship. The ACGME weighs the number of active fellowships heavily for continued accreditation. If you lack a residency program, but you practice clinical medicine, reach out to your colleagues and/or academic institutions nearby and collaborate.
With continued effort, we hope to continue to solidify our place as the legitimate medical subspecialty we know and understand hyperbaric medicine to be.
Emergency Medicine Action Fund Announced - Undersea and Hyperbaric Medicine Section Newsletter, June 2011
ACEP's New grassroots effort aims to influence health care reform’s regulatory implementation.
With changes in the health care system already underway, a new initiative is looking to positively impact the regulations that will be written and implemented under this sweeping reform.
The Emergency Medicine Action Fund, launched by ACEP in February, will pool contributions from individual emergency physicians and groups, ACEP Sections of Membership, and anyone else interested in advancing emergency care to provide financial support for advocacy activities in the regulatory arena.
“This is probably the most important, defining moment for emergency medicine in our lifetime,” said ACEP President Dr. Sandra Schneider. “The decisions that are made now will set the course for us for years to come and we must positively influence the regulatory agenda. This Action Fund will help us do that and create a practice environment we can thrive in.”
The Emergency Medicine Action Fund will pursue a regulatory agenda that supports emergency physicians and quality emergency care. For example, evolving practice models and demonstration projects, such as accountable care organizations and bundled payments, are two areas of the Patient Protection and Affordable Care Act where the Action Fund might be able to wield some influence.
“We need to be out there with the rule writers, working to ensure that emergency medicine’s perspective is valued,” said Dr. Angela Gardner, ACEP Past President who first proposed a national grassroots initiative focused on federal regulatory affairs. “It is critical that we be involved in these decisions regarding the formation of the future of health care delivery. This is our opportunity to be part of it.”
The following organizations have been invited to designate representatives to the initial Board of Governors – American Academy of Emergency Medicine (AAEM), Association of Academic Chairs of Emergency Medicine (AACEM), American College of Osteopathic Emergency Physicians (ACOEP), Emergency Department Practice Management Association (EDPMA), Emergency Medicine Residents’ Association (EMRA), and Society for Academic Emergency Medicine (SAEM).
One of the unique features of the Emergency Medicine Action Fund is that multiple Sections can band together to form coalitions that would be eligible to have a seat on the Board of Governors. Or Sections can organize their individual members for collective representation. The first 10 groups of contributors at $100,000 will be granted seats on the Action Fund’s Board of Governors.
“We are encouraging Sections, chapters and small to mid-sized groups to combine their resources,” Dr. Schneider said. “This is intended to be an inclusive effort, and everyone’s contributions are needed.”
The Emergency Medicine Action Fund is modeled on a successful initiative sponsored by CAL/ACEP, CAL/AAEM, EDPMA, and rural emergency physicians in California that has raised several million dollars for state advocacy since 2004.
Wes Fields, chair of the California Emergency Medicine Advocacy Fund, said their program doubled the size of the CAL/ACEP advocacy staff, increased the number of lobbyists and consultants, and engaged in legal activities related to physician payment practices. He has been appointed by Dr. Schneider as the founding chair of the new national Action Fund.
“I view this as the best form of free speech on behalf of emergency physicians and our patients,” Dr. Fields said. “It is not partisan. It is not political.
“The rule writers and the policy makers will hear emergency medicine speaking with one voice, with one set of goals, one approach,” he added. “We need wide and deep support, even from those who are not members of the College.”
CEP America, the nation’s largest emergency medical partnership, will be the inaugural donor to the Emergency Medicine Action Fund, pledging $100,000.
Activities planned by the Emergency Medicine Action Fund are intended to enable participants to make contributions that would be tax-deductible business expenses (tax deductibility can be determined only by participants’ tax advisors).
NEMPAC, the National Emergency Medicine Political Action Committee of the ACEP, gives contributions to candidates who have listened to the needs of emergency medicine and made a positive change. However, NEMPAC may be used only to support candidates.
The Action Fund can enhance regulatory advocacy with policy makers to ensure emergency physicians receive fair payment for their services. It can also fund numerous meetings with regulators to help guarantee that patients receive the best care, and provide funding for studies to demonstrate the value of emergency medicine.
“With the new Congressional session upon us, it is as important as ever to be active on both the legislative and regulatory fronts,” Dr. Schneider said. “We will depend on all of these funds to make our case. This will be the year we ask everyone to dig a little deeper. In these challenging times, we need contributions to both the Action Fund and NEMPAC.”
Find out more about the Emergency Medicine Action Fund at www.acep.org/EMActionFund.
How is the Emergency Medicine Action Fund Different from NEMPAC?
Both are valuable tools that need our continued support, but the Emergency Medicine Action Fund serves a different purpose than NEMPAC.
EM Action Fund
Gives campaign contributions to Congressional candidates
Funds meetings with regulators and policy makers
Enhances emergency medicine advocacy efforts
Spotlight on New Fellowships - Undersea and Hyperbaric Medicine Section Newsletter, June 2011
Applications are currently being accepted at all of the ABEM sponsored fellowship programs. It is not too late! Apply now to ….
- The University of Pennsylvania
- University of California, San Diego
- Louisiana State University, New Orleans
- University of Texas, Dallas (military fellowship)
- Active ACGME Accredited Fellowships in Hyperbaric Medicine https://www.acep.org/content.aspx?id=46012
And of course…
We are pleased and excited to announce the inception of the newest fellowship program in undersea and hyperbaric medicine, SUNY Upstate Medical University’s Department of Emergency Medicine. Congratulations, to the SUNY system and all those who worked tirelessly to bring this program to life.
Included for your review is a summary of the position.
Fellowship in Undersea and Hyperbaric Medicine
SUNY Upstate Medical University
The Undersea and Hyperbaric Medicine Fellowship at SUNY Upstate Medical University is located in the only 24/7 hyperbaric medicine unit in central New York. The fellow will be exposed to a variety of indications for hyperbaric oxygen therapy. This includes experience in the management of critical care patients in a monoplace chamber and consults in a variety of conditions at University Hospital. In addition, the fellow will oversee multiplace hyperbaric treatments at Phelps Memorial Hospital in Sleepy Hollow, NY. The fellow will gain additional experience in the management of problem wounds in the University Hospital Wound Care Center. This is all supplemented by weekly patient rounds, didactic lectures, monthly journal club, and research experience. The fellow will collaborate with the Fellowship in Toxicology and poison control center including semi-annual ‘CO Rounds’. The fellow will attend national conferences that include the NOAA Diving Program Physician’s Training Course, Medical Assessment of Fitness for Diving, and the UHMS Scientific Assembly. The fellow is overseen by six physicians who are board certified in Undersea and Hyperbaric Medicine.
For more information, please visit http://upstate.edu/emergency/residency/fellowship/hyperbaric.php or contact Mary Lewis, Program Coordinator, at (315) 464-6222 or email@example.com.
The Undersea of Undersea and Hyperbaric Medicine - Undersea and Hyperbaric Medicine Section Newsletter, June 2011
Jawad N. Kassem, MD
At one point or another in your training and or your practice, you undoubtedly read statistics or research compiled by the Diver’s Alert Network (DAN). Their mission is, “To help divers in need with medical emergency assistance and to promote diving safety through research, education, products and services.” In doing so, over the past 31 years DAN compiled invaluable statistics and conducted extensive research on dive medicine. Recently, DAN began collaborating with the undersea and hyperbaric medicine fellowships at the University of Pennsylvania and the University of California at San Diego. This collaboration offers DAN members an additional layer of diving expertise on a day to day basis and when they need it most – dive emergency situations. DAN members, wherever they are in the world can call the DAN emergency line and consult the stellar DAN dive medical technicians. When medical decision-making requires further consideration by an undersea and hyperbaric medicine trained physician; the technicians contact the on-call dive physicians at one of these institutions. It’s a win, win, win. The members get the medical expertise of board certified physicians trained in dive medicine, DAN gets the medical staff to support their ever important operations and the fellows at Penn and UCSD get to tap into the vast DAN membership’s diving medical experiences.