The Best Job inMedicine

This is the time of year when thehalls of our academic health centersare buzzing with the energy ofcareer planning. Emergency medi-cine resident physicians are startingto seriously consider the employ-ment options available to them inthe coming months, and medicalstudents are deciding if emergencymedicine is the right career forthem. A natural part of this process

is that academic emergency physicians are asked: Why didyou go into academic emergency medicine, and are youhappy that you did? This is my answer.

I never planned on going into academics. As a medicalstudent, I liked the feel of the teaching hospital, and hadgreat respect for the faculty physicians who taught me thescience and art of medicine, but I had no interest in research,and did not see myself as an academician. When I enteredemergency medicine residency at the University of Cincin-nati, I thought that I would be very happy practicing in a com-munity emergency department. I had some thoughts of goingback to my small hometown in rural upstate New York andbecoming the ED director. I would save the lives and limbs ofthe people I grew up with (even those who were mean tome), and they would be eternally grateful. But a funny thinghappened. It was never a “eureka” event, rather a steady, butpowerful influence that drew me toward academic emer-gency medicine.

At that time, the mid to late 1980’s, Richard Levy had as-sembled at the University of Cincinnati a group of emergencymedicine faculty who were brimming with intellectual energyand curiosity. Like a child learning to blow a bubble, theywere expanding the academic realm of emergency medicine,while experiencing the occasional sticky face. Their enthusi-asm and drive to know more, to try out new ideas and things,and to challenge their residents and students made for amagical learning environment. They were superb, compas-sionate clinicians and bedside teachers, but also innovativethinkers who generated a constant stream of research ques-tions and ideas. When my memory does the roll call on thatcollection of faculty — Bill Barsan, Jerris Hedges, SteveDronen, Jim Roberts, Mel Otten, Alexander Trott, JimAmsterdam, Dan Storer, to name a few – I am not surprisedthat I gravitated toward academic emergency medicine.Their pull was irresistible. Peer pressure can also be apowerful, positive force. My chief residents, senior residents,and classmates were some of the best and brightest people I

NEWSLETTERNEWSLETTER901 North

Washington Ave.

Lansing, MI

48906-5137

(517) 485-5484

saem@saem.org

www.saem.org

September-October 2000 Volume XII, Number 5Newsletter of the Society for Academic Emergency Medicine

PRESIDENT’S MESSAGE

Brian Zink, MD

(continued on page 19)

Neuroscience ResearchFellowship Available

The SAEM Board of Directors is pleased to an-nounce a new Neuroscience Research Fellowship thathas been made possible by an unrestricted educationalgrant from AstraZeneca LP to the Fund for AcademicEmergency Medicine (FAEM). AstraZeneca has agreedto fund the fellowship for three years. The FAEM Neuro-science Research Fellowship provides for one year offunding at $50,000 for a mentored research trainingexperience in cerebrovascular emergencies. Theresearch training may be in basic science research,clinical research, or a combination of both. Completionof a research project is required, but the emphasis ofthe fellowship is on acquisition of research skills.

SAEM would like to thank Dr. Dexter Morris from theUniversity of North Carolina and the Chair of the SAEMNeurologic Emergencies Interest Group. Dr. Morrisfunctioned as the primary liaison between SAEM andAstraZeneca LP in developing the neuroscience re-search fellowship. SAEM would also like to thank Dr.Steven Dronen, Chair of the Financial DevelopmentTask Force for his role in developing the funding planand the structure of the fellowship.

Cerebrovascular diseases are a major source ofmorbidity and mortality in our country. Although someprogress has been made in the past decade there is anunquestioned need for further research and new treat-ments for stroke and other acute cerebrovascularemergencies. SAEM is hopeful that the new FAEMNeuroscience Research Fellowship will help to train thenext generation of emergency physician scientists whowill make a difference in reducing morbidity and mortal-ity from cerebrovascular diseases. The call for applica-tions for the FAEM Neuroscience Research Fellowshipwill appear in a future issue of the Newsletter.

Emergency Medicine Activities atthe AAMC Annual Meeting

The AAMC Annual Meeting will be held in Chicago onOctober 27 - November 1. On October 28 the Association ofAcademic Chairs of Emergency Medicine (AACEM) will meetat 8:00 am in the Trade Room of the Inter-Continental Hotel,followed by an educational session sponsored by AACEM at1:00-2:30 pm in the Burnham Room on the topic, “The Roleof Chairs in the AAMC.” A second educational session devel-oped by the SAEM National Affairs Task Force will follow inthe Burnham Room at 2:30-3:30 pm on the topic of “Errors inEmergency Medicine.” All emergency physicians are invitedto attend the educational sessions. Contact SAEM at saem@saem.org for more information or questions.

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Medtronic Physio-Control to Support EMSResearch Fellowship

Deadline: December 15, 2000SAEM is pleased to announce that Medtronic Physio-Control Corporation will

sponsor the 12th Annual EMS Research Fellowship. Medtronic Physio-Control pro-vides $50,000 each year to fund an EMS Fellow, so the funding for the 2001-2002fellowship means that $600,000 have been dedicated to support the fellowship. Allfunds are used to directly sponsor the fellowship.

The application materials for individuals wishing to apply for the EMS Fellowshipcommencing July 1, 2001, can be found on the SAEM web site at <www.saem.org>or from the SAEM office. The application, including personal statement and lettersof reference, must be received by SAEM by December 15, 2000 .

Institutions interested in applying for consideration as a EMS Fellowship trainingsite can also find application materials at www.saem.org or from the SAEM office.Additionally, previously approved institutions whose programs have undergone sig-nificant changes must apply for renewal. All materials must be received by SAEM byDecember 15, 2000 .

Notification to both prospective fellows and institutions will be made by January,2001. The selected EMS Fellow will then have a brief period to officially designatehis/her fellowship site.

Geriatric EmergencyMedicine

Resident/FellowGrants AvailableSAEM with sponsorship from

the John A. Hartford Foundationand the American Geriatric So-ciety (AGS), is pleased to an-nounce the availability of grants tosupport resident/fellow researchrelated to the emergency care ofthe older person. Investigationsmay focus on basic science re-search, clinical research, preven-tive medicine, epidemiology, oreducational topics. Awards maybe up to $5,000 for each project.

Applications for the GeriatricEmergency Medicine Resident/Fellow Grant will be sent to eachresidency program or may beobtained from the SAEM office orthe website at <saem.org>. Thedeadline for receipt of a completeapplication at the SAEM office isMarch 5, 2001 with notification ofselections by May 7 and fundingawarded by July 1.

Constitution and Bylaws Committee SeeksMembership Input

Susan S. Fish, PharmD, MPHChair, Constitution and Bylaws Committee

The Constitution and Bylaws Committee would like membership input aboutsuggestions for changes to the current SAEM election process. As SAEMPresident Brian Zink stated in last month’s Newsletter, one of our Committee’sobjectives for this year is to “explore options for amending the SAEM processfor filling elected positions, and make recommendations to the Board ofDirectors by November 1, 2000.” While the current election process has beeneffective in choosing strong leadership for the Society, only about 10% of activemembers participate in the election.

Our goal is to increase member participation in the election process. TheCommittee has been discussing the strengths and weaknesses of our currentsystem, and trying to identify alternative methods of conducting the election. Wehave been investigating the election process of other professional organizationsto which we belong, and others that we have heard about. But I am sure this isa small sample of possible options. We are most interested in hearing aboutother systems that are successful. If you belong to an organization whoseelection process may have features that you think would be applicable toSAEM, we would love to hear about them. Please email the SAEM office atsaem@saem.org or me at sfish@bu.edu. Please tell us the name of theorganization, and describe the election process as you see its applicability toSAEM. The Constitution and Bylaws Committee will be meeting in October tofinalize its proposal to the Board, so we need your suggestions by October 18,2000. With your input, we will make recommendations to the Board of Directorsand improve the current system. Thanks.

Information on GrantsRequested

There is a common misconceptionamong some SAEM members thatemergency physicians as a group havedifficulty competing for extramuralfunding, especially from federal fundingagencies such as the National Institutesof Health or the Agency for Health CareResearch and Quality (AHRQ). Thisbelief persists, in part, because we hearabout only a small fraction of theemergency physicians who havesuccessfully competed for funding.

SAEM would l ike to publish an-nouncements about grants received byits members in the SAEM newsletter.Please send information regardinggrants received, including researchgrants, fellowship and training grants,and conference grants funded by foun-dations, state, or federal fundingagencies, to the SAEM office. Includethe title of the project, the name of thefunding agency, the name and affilia-tions of the principal investigator andcontact information. This informationwill be published in the SAEM News-letter in the section entitled “AcademicAnnouncements.”

Emergency Medicine: An Academic Career GuideNow Available

SAEM and EMRA have worked together to develop the publication, “EmergencyMedicine: An Academic Career Guide.” The Career Guide, edited by CherriHobgood, MD, and Brian Zink, MD, was originally designed as a reference forsenior residents, but with considerable expansion will be valuable to medical stu-dents, faculty, residency and research directors, and department chairs. TheCareer Guide includes 15 chapters and is available at no charge. It is downloadablefrom the SAEM web site at: www.saem.org/publicat/intro.htm and a limited numberof hard copies are available upon request to the SAEM office.

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SAEM Ethics Consultation Service Now AvailableEveryday, emergency physicians are

faced with countless ethical dilemmas.In our practice, our teaching, our re-search and our administrative duties,we make choices based not only on ourknowledge but also on our personal be-liefs and value systems. For the mostpart, these decisions are made in typi-cal emergency medicine style — wethink, we decide, we act, and we moveon. We feel confident that we haveacted appropriately, based on a rea-soned assessment of the circum-stances and the strengths of our con-victions. We act in good faith, and hopethat we have acted wisely and justly.

Occasionally, an ethical issue arisesthat is outside our world view or consid-eration, or a situation confronts us thatmakes us uncomfortable. We may lackthe knowledge that we need to make areasonable choice, we may be faced withsomething totally out of our experience,or we feel at a loss because we cannotdetermine the possible options. We maywitness an ethically questionable act,may observe unprofessional andpossibly harmful actions, may disagreeabout the correctness of another’sdecision, or may feel we ourselves arebeing subjected to exploitation, abuse, orother unethical behavior. Such situationsare frightening; it is difficult to distinguishreality from perception, to know who canbe approached for advice, or whereresources can be found to assist indeveloping an appropriate response.

Some institutions have committeesor other authoritative bodies designedto examine grievances, allegations ofscientific misconduct or specific ethicaldilemmas in clinical practice.

The advice of these groups, how-ever, may have limited applicability toemergency medicine; they may not in-

clude emergency physicians, or havethe expertise to relate to the unique as-pects of the ethics of emergency medi-cine. In addition, these groups arecharged with developing a response toa particular crisis that has arisen locally.They are goal directed and not neces-sarily able to provide a thoughtfulmethod to educate beyond the concreteresponse to the problem at hand.

For these reasons, the SAEM Boardof Directors charged the Ethics Com-mittee to develop an Ethics Consulta-tion Service. As the title implies, theEthics Consultation Service is nowavailable to assist SAEM members withtheir questions concerning ethicalissues or decisions they must makeduring the course of their clinical, aca-demic or administrative responsibilities.

Opinions from the Ethics Consulta-tion Service will be offered to SAEMmembers in a timely manner; requestsfrom nonmembers will be consideredon a case by case basis. The opinionsrendered are not meant to be part of an‘appeal process.’ This service is offeredto SAEM members who may need ad-vice or assistance when faced with adifficult ethical decision.

All communications with the EthicsConsultation Service will be anonymousand confidential. However, becausemany ethical issues confronting practic-ing emergency physicians are universalin their scope, and others may learnfrom the issue presented, we hope todevelop a series of articles for publica-tion for the Society, assuming that con-fidentiality can be maintained.

All requests, inquires, or correspon-dence should be directed to the EthicsConsultation Service at SAEM, 901North Washington Avenue, Lansing, MI48906 or saem@saem.org

Call For NominationsYoung Investigator

AwardDeadline: December 15, 2000

Again this May, SAEM will recog-nize a few young investigators whohave demonstrated promise and dis-tinction in their emergency medicineresearch careers. The purpose ofthe award is to recognize and en-courage emergency physicians/sci-entists of junior academic rank whohave a demonstrated commitment toresearch as evidenced by academicachievement and qualifications. Thecriteria for the award includes:

1. Specialty training and certificationin emergency medicine or pedi-atric emergency medicine.

2. Evidence of significant researchcollaboration with a senior clinicalinvestigator/scientist. This may bein the setting of a collaborative re-search effort or a formal mentor-trainee relationship.

3. Academic accomplishmentswhich may include:a. postgraduate training/educa-

tion: research fellowship, mas-ter’s program, doctoral pro-gram, etc.

b. publications: abstracts, papers,review articles, chapters, casereports, etc.

c. research grant awardsd. presentations at national re-

search meetingse. research awards/recognition

The deadline for the submission ofnominations is December 15, 2000 .Nominations should include the can-didate’s CV and a cover letter sum-marizing why the candidate meritsconsideration for this award. Candi-dates can nominate themselves orany SAEM member can nominate adeserving young investigator. Candi-dates may not be senior faculty (as-sociate or full professor) nor be morethan seven years beyond residencytraining at the time of application.

The core mission of SAEM is toadvance teaching and research inour specialty. This recognition mayassist the career advancement of thesuccessful nominees. We also hopethe successful candidates will serveas role models and inspirations to usall. Your efforts to identify and nom-inate deserving candidates will helpadvance the mission of our Society.

SAEM Membership Drive UnderwayAgain this year SAEM is promoting a membership drive directed towards the col-

leagues of current members. Individuals who join SAEM in the last quarter of 2000will receive membership benefits through January 15, 2002 and will therefore re-ceive up to 15 months of membership benefits with payment of one year’s dues.

SAEM members are asked to encourage their colleagues to consider joiningSAEM. A membership application is published in this issue of the SAEM Newsletter.Membership applications can also be submitted electronically from the SAEM website at www.saem.org

SAEM dues have not increased for a number of years, yet the Society’s activitieshave continued to expand. Some examples include the continued development ofAcademic Emergency Medicine (including the online version of the journal),increased funding for Society research grants (such as the Resident Research Yearand Scholarly Sabbatical), an ever-increasing Annual Meeting, continued develop-ment of the SAEM web site, and expanding programs and activities for the increas-ing number of medical student and resident members of the Society. Please en-courage your colleagues to join SAEM. A strong academic presence is necessaryfor the continued growth and development of education and research in emergencymedicine.

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SAEM Resident Research Year GrantDeadline: December 1, 2000

SAEM is pleased to announce the third annual Resident Research YearGrant. The award will provide financial support of up to $50,000 to the resi-dency program for a year of concentrated training in research methods andconcepts for emergency medicine residents. Any resident in an ACGMEapproved emergency medicine residency program who will have completed atleast one year of training is eligible.

The purpose of the award is to encourage further development andresearch involvement of residents in training to enhance the selection of anacademic and research career by recipients, and to establish a departmentalculture that will continue to support resident research training.

Applications for the Resident Research Year Grant will be sent to eachresidency program or can be obtained from the SAEM office or the web site atwww.saem.org. The deadline for the submission of applications for academicyear 2000-2001 is December 1, 2000. Notification will be made in January 2001.

CORD/AACEM Faculty DevelopmentConference: Navigating the Academic Waters

March 3-5, 2001 — Washington, DCFaculty development continues to be one of the most carefully scrutinized areasby the RRC-EM. Due to the relative growth of our specialty, coupled with rapidgrowth of residency programs over the past 10 years, many younger facultystruggle to develop needed personal, management, teaching, and research skillsrequired for successful career advancement. CORD and AACEM have conjointlydeveloped a seminar entitled: “Navigating the Academic Waters: Tools for Emer-gency Medicine.” This conference was first held in November 1996 and receivedhigh praise from attendees. The conference is designed specifically for theunique needs of junior Emergency Medicine faculty and will address essentialelements necessary for success in an academic environment including researchdevelopment, grants, presentation skills, resident evaluation, mentoring, andclinical teaching, as well as time and personal management. This course nicelyaugments the ongoing efforts made by SAEM in the area of faculty development.Young faculty or senior residents interested in an academic career should con-tact the CORD/AACEM office at 517-485-5484 or the CORD web site atwww.cordem.org. Registration is limited to 125 people, so call today!

Nominations Being Accepted forRobert Wood Johnson Health Policy

FellowshipsThe Robert Wood Johnson (RWJ) Foundation is accepting nominations

for the RWJ Health Policy Fellowships 2001, a program that seeks todevelop the capacity of mid-career health professionals in academic andcommunity-based settings to assume leadership roles in health policy andmanagement. The program is funded by the RWJ Foundation and con-ducted by the Institute of Medicine (IOM). The six chosen fellows will par-ticipate in a September-to-August program of orientation and full-time workexperience in Washington, D.C. Nominations may be made by chief execu-tive officers of academic health centers and community-based health careorganizations and agencies, and will be accepted at the IOM untilNovember 17 . For more information, go to http://www.rwjf.org, click on“Applying for a Grant,” and then on “List of Open Calls for Proposals.”

AcademicAnnouncements

Robert S. Hockberger, MD , has as-sumed the presidency of the AmericanBoard of Emergency Medicine(ABEM). Dr. Hockberger has been amember of the ABEM Board of Direc-tors since 1995 and has served aschair of the Test Administration Com-mittee and the Core Content TaskForce, and as editor of the recertifica-tion exam. Dr. Hockberger is a Profes-sor of Medicine at the UCLA School ofMedicine and Chair of the Departmentof Emergency Medicine at Harbor-UCLA Medical Center.

Jim Pribble, MD , a second year res-ident at William Beaumont Hospitalhas been selected to receive a RobertWood Johnson Clinical Scholar posi-tion. This prestigious two-year awardis given to individuals who have dem-onstrated excellence in research andscholarly activity. Dr. Pribble has co-authored several papers and pre-sented at national meetings on thetopic of the ED management of chestpain patients. Dr. Pribble will spend histenure as a RWJ Scholar at theUniversity of Michigan.

Lynne Richardson, MD , of Mt. SinaiMedical Center, has been appointedto a two-year term on the Health CareResearch Training (HCRT) StudySection of the Agency for HealthcareResearch and Quality (AHRQ),formerly AHCPR. Dr. Richardson isthe only emergency physician to serveon this standing committee that willreview grant proposals submitted toAHRQ. Specifically, Dr. Richardsonwill participate in the review of F32and F31 post-doctoral awards, RO3dissertation grants, and KO8 careerdevelopment awards.

Vincent Verdile, MD , chair of theDepartment of Emergency Medicine,has been named interim dean of theAlbany Medical College and interimexecutive vice president for healthaffairs. Dr. Verdile was unanimouslyapproved as interim dean by theMedical Center’s Board of Directors.

In addition to serving as chair of oneof the Medical Center’s largest aca-demic departments, Dr. Verdile hasalso played a leadership role in the fac-ulty practice as well as serving, since1993, as an attending physician in thedepartment of emergency medicine.

A resident of Saratoga Springs, Dr.Verdile received BS and MS degrees atUnion College and his MD degree in1984 from the Albany Medical College.He did his residency in emergencymedicine at the University of Pittsburgh.

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SAEM Response to the Prospective Payment Systemfor Hospital Outpatient Services

The Society for Academic EmergencyMedicine (SAEM) appreciates theopportunity to comment on the Prospec-tive Payment System for Hospital Out-patient Services final rule published inthe Federal Register on April 7, 2000.(HCFA-1005-FC). SAEM represents5000 academic emergency physicians, inteaching hospitals and academic medicalcenters throughout the United States.

These comments express our con-cern that the new payment system in-appropriately precludes separate pay-ment for emergency observation ser-vices and represents our formal recom-mendations to HCFA. This letter issimilar to a letter submitted on behalf ofthe American College of EmergencyPhysicians, the American College ofCardiology, the American Heart Associ-ation, the American Society of NuclearCardiology, the Society of Chest PainCenters and Providers, and the Ameri-can College of Physicians-AmericanSociety of Internal Medicine.

Our concerns are the net effect ofHCFA’s policy packaging payment forall observation services, includingemergency observation services, intoother APCs, will jeopardize patientsafety and quality of care, threaten ac-cess to medically necessary care, andincrease total Medicare costs. Further-more, this policy is inconsistent withcurrent emergency medicine practice, itis biased against emergency observa-tion services, and inappropriately at-tempts to control prior observation ser-vices coding abuses by packaging allobservation services into APCs.

We are proposing a policy that iseasy for HCFA to implement, will over-come all of the problems associatedwith HCFA’s new policy, and eliminatethe potential for abuse. Please note thatthe outpatient prospective payment sys-tem has no direct effect on physicianpayment. Our objections, and our pro-posed solution, are offered in the bestinterests of our patients and the hos-pitals who serve them.

HCFA’s policy jeopardizes patientsafety and quality of care. Refusingto provide payment for emergency ob-servation services creates a disincen-tive to their use and jeopardizes thequality care derived from these ser-vices. Improved safety by observationservices is supported by the medicalliterature. Observation of ED (emer-gency department) patients is exten-sively studied and provides improvedhealth care outcomes. For example,their use leads to a ten-fold decrease inthe rate at which heart attack patientsare inappropriately sent home. Prevent-able deaths and complications are

avoided through the use of these ser-vices. A disincentive to observation unitservice is inconsistent with the healthpolicies of the current administration,which places a high priority on patientsafety. In light of President Clinton’sand Secretary Donna Shalala’spersonal commitment to quality care, itis surprising that HCFA would imple-ment a policy jeopardizing patientsafety, especially given the successesof emergency observation services inenhancing patient safety.

HCFA’s policy threatens access tomedically necessary care. If not sep-arately covered, many present emer-gency observation units are at closurerisk. Without separate revenue, emer-gency observation units cannot oper-ate. Progress made in this area overthe last decade will suffer greatly. If thisservice is inadequately covered, HCFAwill inadvertently penalize hospitalsattempting to provide high quality, cost-effective health care. Furthermore,packaging observation services intoAPCs will discourage the addition ofthese services in hospitals not currentlyproviding them.

Many third party payers (includingHCFA carriers) use increasingly strin-gent admission criteria. They refuse in-patient admission, but allow observa-tion. If HCFA refuses observation ser-vice reimbursement, it creates a largeand growing patient population too sickto go home, but not sick enough for in-patient admission. Forcing EDs to pro-vide up to 24 hours of uncompensatedcare will greatly increase the financialburden and gridlock in EDs. This willfurther weaken the nation’s primaryhealth care safety net, the ED. Con-versely, discharge of patients not meet-ing admission criteria may lead to poorhealth outcomes. The current packag-ing of observation services creates an

untenable position where hospitals andphysicians are forced to choose be-tween two poor outcomes.

HCFA’s policy will increase Medi-care costs. Currently, many patientsreceive appropriate care by observationservices and thus avoid unnecessaryhospital admission. The managementof chest pain is a good example. Sincemost patients with acute MI do not havean initially positive test, many needeither emergency evaluation and obser-vation, or hospital admission, to identifytheir heart attack. Since physicianscannot rely solely upon a initial testing,observation identifies those presentingwith atypical signs or symptoms. Thisprocess has been shown to reducecosts significantly compared to inpatientadmission. Without observation, physi-cians will admit patients to the hospitalto rule out MI. Many more patients willbe admitted as inpatients rather thanmanaged in the observation unit. Whenthese patients are admitted to an in-patient bed, costs will increase. Manystudies have shown significant chargeand cost savings with the use of obser-vation, rather than hospital admission,to evaluate patients with chest pain.

Preventing hospitalization of non-chest pain patients by use of a period ofobservation also has great costsavings. Since 5% to 10% of ED pa-tients are appropriate for observation,the cost savings in the United States,with over 100 million annual ED visits,is billions of dollars. Clearly, a move-ment back to the inpatient setting willincrease Medicare’s total costs.

Chest pain comprises only 10% to15% of patients who benefit from EDobservation units. The range of condi-tions evaluated and treated in emer-gency observation units is broad andincludes the full range of conditionsfound in EDs.

Categories of Conditions Observed:

Evaluation of Critical Abdominal pain, chest pain, confusion, dizziness,Diagnostic Syndromes fever, gastrointestinal hemorrhage, headache,

seizure, shortness of breath, syncope, toxicology/overdose, trauma, vaginal bleeding, weakness

Treatment of Emergent Asthma, congestive heart failure, dehydration,Conditions: hyper/hypoglycemia, infections, pain management/

back pain

Meet Psychosocial Alcohol abuse, psychiatric problems, social problemsProblems and Needs

HCFA’s policy is inconsistent with current medical practice. HCFA’s discus-sion of observation services in the final rule demonstrates a fundamental misunder-standing of the current practice of emergency medicine. HCFA states:

(continued on next page)

SAEM’s full response is published below and is published on the SAEM web site.

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Prospective Payment System (Continued)

“We assume that chest pain patients,such as those described by the com-menters, are sent to the CCU or ICUfor observation. We believe that, ingeneral, if a patient needs to be moni-tored in the ICU or CCU for any lengthof time, then that patient should beadmitted as an inpatient . . .”

It is simply untrue that most chestpain patients who would require obser-vation “are sent to the CCU or ICU forobservation.” There has been a funda-mental change in health care deliveryfor chest pain patients with respect tothe use of CCUs and ICUs in the lastdecade. A move back to having thesepatients sent to the CCU will markedlyincrease health care costs, increasemissed heart attacks, and decrease pa-tient satisfaction.

HCFA’s policy fails to recognizethe increased costs of observationservices. Traditional emergency ser-vices only involve the immediate care ofacutely ill/injured patients, with admis-sion or discharge within 2 to 4 hours. Inthe past, these patients would be ad-mitted and used inpatient resources.The use of emergency observation ser-vices moves patient care from the in-patient setting to an outpatient settingwith an overall decrease visit costs.This accelerated care, over an addi-tional 6 to 24 hours, represents a signif-icant increase in service and cost takenon by the ED.

HCFA policy is biased against ob-servation services. HCFA attempts tocontrol abuse of some types of obser-vation services by packaging all obser-vation services is inappropriate. In thefinal rule, HCFA states:

“Observation service is placing a pa-tient in an inpatient area, adjacent tothe emergency department, or, accord-ing to some comments, in the intensivecare unit (ICU) or coronary care unit(CCU), in order to monitor the patientwhile determining whether he or sheneeds to be admitted, have further out-patient treatment, or be discharged.After 1983, many hospitals began torely heavily on the use of observationservices when peer review organiza-tions questioned admissions under thehospital inpatient prospective paymentsystem. However, in some cases, pa-tients were kept in “outpatient” observa-tion for days or even weeks at a time.”

We appreciate HCFA’s concern re-garding observation abuses in the post-operative and inpatient settings. How-ever, observation of ED patients over 6-24 hours is a well-established practicethat preceded the introduction of DRGs.In the ED, HCFA defined observationservices, can be provided most reliably.A number of points differentiate ED ob-

servation from prior abuses. The undif-ferentiated unscheduled nature of EDpatients best fits the original descriptionand intent of “observation services” setforth by HCFA. ED observation units donot generally “observe” post-operativepatients. Finally, unlike inpatient obser-vation, it is virtually impossible to keepa patient in an ED observation unit for“days to weeks.” Observation medicineis a diagnostic tool where focused test-ing or treatment is repeated over a spe-cific time frame to identify the need forinpatient admission. It more rigorouslystudied and better proven than manymore expensive technical innovationsfor which HCFA provides reimburse-ment. It is inappropriate to jeopardizethis valuable service in an attempt tocontrol the abuse noted by HCFA.

Proposed solution. The objective ofour proposed policy guidelines is to limitobservation services to a smallsubgroup of patients (less than 5% ofED visits) who require continued clinicalmanagement to determine the need foradmission, or those who need extendedtreatment of an acute condition.1. Clearly identify the observation ser-

vices for which separate payment isappropriate. Hospitals report and billfor observation services through theuse of revenue code 762 - Observa-tion Services. Current HCFA instruc-tions direct the reporting of the num-ber of hours of service in the unitsfield on the bill. This same revenuecode is used to report postoperativeor post-procedure observation ser-vices, ED observation services, “23hour admission” services in an in-patient bed, and holding unit ser-vices. Of these services, only ED ob-servation services should be eligiblefor separate payment.

2. Restrict observation services to onlyED patients.

3. Require extensive and well-docu-mented physician involvement in theobservation services.

4. Assign the new HCPCS to a newAPC. Payment for extended emer-gency evaluation and managementservices should be made in additionto the payment for the ED APC inrecognition of the added costs for theservices.

5. Do not limit payment to a list of cer-tain clinical conditions. Restrictingemergency services to specific con-ditions conflicts with the “prudent lay-person” standard of defining anemergency based on presentingsymptoms, not f inal diagnoses.Symptoms should be used. Further-more, while emergency observationservices are shown to be effectivefor many common conditions, thereare many other less common prob-

lems that do very well in this settingand should not be excluded. A “list ofconditions” would either be so re-strictive that it would not reflect rea-sonable practice, or would be solarge as to be difficult. Progress inthis area has rapidly shifted carefrom the inpatient setting to the ob-servation unit. Maintaining a restric-tive list will be slow and unlikely tomatch medical progress, and it islikely these transitions would bestalled by a restrictive list.

6. Changes to the system must be madepromptly. We ask that HCFA recon-sider waiting for further claims databefore changing the current policy.HCFA must recognize that if observa-tion services are inadequately cov-ered, asking hospitals to provide un-funded care while studying the losses,will result in a dramatically biasedpractice behavior toward admission.This will skew the proposed cost dataanalysis. Additionally, because of thehistorically slow rule making process,a large portion of U.S. observationunits will close before all data is col-lected and analyzed.By statute, payment rates are based

on the median costs of the services inthe APC. HCFA should select from the1996 claims file those bills that includecharges for both ED services and ob-servation services to compare them tobills for ED services alone. This shouldallow the determination of the marginalcosts of observation services withoutwaiting for future claims data. 7. Proposed payment rate. We recog-

nize problems in 1996 data may pre-clude the determination of an appro-priate payment rate for extendedemergency evaluation and manage-ment services. If that occurs, we rec-ommend the assignment of a pay-ment of $375 based on our estimatesof the cost. Our cost estimates arebased upon the ACEP observationsection’s national survey, VHA obser-vation unit benchmarking study, andACEP observation section leader’sexperience. Generally, payment forextended emergency evaluation andmanagement services should notexceed payment for an inpatient day,which we estimate to be $600. Thekey determinants of costs are staff,space, support services and time.

Cost elements: Nurse staff — Observation unitstypically staff with a nurse/patient ratiobetween a regular med-surg floor and astep-down unit; usually 1 nurse to each4 - 8 patients. The average is 1:5.Support staff — On average, 1 clerkand 1 tech are needed for 15 to 20 pa-

(continued on next page)

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tients. This is comparable to an in-patient med-surg unit.Space — Observation rooms are usu-ally about 10 X 10 feet in sizeServices — Observation services needsupport (e.g. food, linens, etc.) similarto med-surg units. Time — On average, patients in an ob-servation unit require services for 15hours, not 24 hours.

A reimbursement estimate can bemade by comparing these services toinpatient services. Modifications may bemade over time as accurately codeddata is collected in the future. If weassume that 24 hours of inpatient carecosts $600, then 15 hours of obser-vation would cost $375. This is a con-servative cost estimate since observa-tion units actually staff at a higher levelthan traditional med-surg floors.

Conclusion: HCFA’s decision topackage payment for all observationservices into other APCs jeopardizespatient safety, quality care, and in-creases total Medicare costs. The pol-icy fails to recognize the increasedcosts of emergency observation ser-vices and, unless appropriate changes

are made, access to medically neces-sary emergency observation care byMedicare beneficiaries will be seriouslycompromised. Forcing EDs to provideup to 24 hours of uncompensated careincreases the financial burden and grid-lock in the ED. HCFA’s policy will onlyfurther weaken the nation’s primaryhealth care safety net, the ED. The cur-rent packaging of observation servicescreates an untenable position for hospi-tals and physicians. On the one hand,sending patients home too early willlead to poor health outcomes, on theother, admitting them for inpatient carewill drive up costs and decrease patientsatisfaction.

We have proposed a policy thatHCFA could readily implement, willovercome all of the problems associatedwith the recently announced policy, andeliminate the potential for abuse. Weappreciate the opportunity to offer thesecomments look forward to continuing towork cooperatively with HCFA toaddress this important issue. We askthat necessary and appropriate changesbe made as soon as possible in order toensure that patients are not put at risk.

Prospective Payment System (Continued)

Call for PhotographsDeadline: February 15, 2001

Original photographs of the practice of emergency medi-cine are invited for presentation at the 2001 SAEM AnnualMeeting. The theme for the photographs is “Clinical Pearlsand Visual Diagnosis.” Original photographs of patients,pathology specimens, gram stains, EKG’s, and radiographicstudies or other visual data may be submitted. The deadlinefor receipt is February 15, 2001.

Submissions should depict findings that are pathognomo-nic for a particular diagnosis relevant to the practice of emer-gency medicine or findings of unusual interest that have edu-cational value. Accepted submissions will be used for the“Clinical Pearls” photography session, and may also be usedin the Medical Student-Resident Visual Diagnosis contest.

No more than three different photos should be submittedfor any one case. Submit one glossy photo (5”x 7,” 8”x 10”,11”x 14” or 16”x 20”) and a digital copy in either JPEG orTIFF format on a disk or by email attachment (resolution atleast 640 x 480). Radiographs should be submitted asglossy photos, not as x-rays. For EKG’s, the original andone photocopy (or digital image) is preferred. The back ofeach photo should contain the contributor’s name, address,hospital or program, and an arrow indicating the top. Sub-missions should be shipped in an envelope with cardboardbut should not be mounted.

All photo submissions must be accompanied by a casehistory written as an “unknown” in the following format: 1. Chief complaint2. History of present illness3. Pertinent physical exam

4. Pertinent laboratory data 5. One or two questions asking the viewer to identify the

diagnosis or pertinent finding6. Answer(s) and brief discussion of the case, including an

explanation of the findings in the photo7. One to three bulleted take home points or “pearls”

The case history must be 250 words or less and fit on asingle page in 14 point font with at least one blank line be-tween sections. The case history should be submitted as ahard copy and as a file on a disk or as an email attachment.

Submissions will be judged by the Program Committeeand accepted based on their educational merit, relevance toemergency medicine, quality of the photograph and the casedescription. Submissions will also be reviewed to assure ap-propriateness for public display at a national meeting. SAEMwill mount accepted photos and display them at the 2001Annual Meeting in Atlanta. Contributors will be acknowl-edged and photos will be returned after the meeting.

Photographs must not appear in a refereed journal priorto the Annual Meeting. Appropriate masking of recognizablepatients or written consent is the responsibility of the con-tributor. Documentation of written consent must accompanysubmissions and include a release of responsibility. Allsubmissions will be considered for publication in AcademicEmergency Medicine. SAEM will retain the rights to usesubmitted photographs for use in future educational projects,with full credit given for the contribution.

Send submissions to SAEM at 901 North WashingtonAvenue, Lansing, MI 48906 or saem@saem.org

More MedicalStudent Excellence

Award WinnersThe July/August issue includedthe listing of the 2000 SAEM Med-ical Student Excellence Awardrecipients. However, since thattime, a few more award recipientshave been received, or need to becorrected:

Albany Medical CollegeChris M. Davison

George Washington UniversityCurtis C. Sandy

Texas Tech UniversitySteve Arze

Also, the name of the recipient ofthe award from the University ofCalifornia, San Francisco was in-correct. The recipient of the Medi-cal Student Excellence Award isSusan M. Fitzgerald.

8

Nominations Requested for Resident Member ofthe SAEM Board of Directors

Nominations are sought from the membership for the resident member of theSAEM Board of Directors. This is a rare opportunity for a resident to serve as a full,voting member of the SAEM Board. The resident Board member is elected to a one-year term and is a full voting member of the Board. The deadline for nominations isJanuary 1, 2001 .

Candidates must be a resident during the entire one year term on the Board (May2001-May 2002). Candidates should demonstrate evidence of strong interest andcommitment to academic emergency medicine. Nominations should include a letterof support from the candidate’s residency director, as well as the candidate’s CVand a cover letter. Interested candidates are encouraged to review the Board of Dir-ectors orientation guidelines which are available on the SAEM web site at www.saem.org or from the SAEM office.

The election will be held during the Annual Business Meeting of the SAEM AnnualMeeting which this year will be held in San Francisco on May 8. Only activemembers of the Society are eligible to vote.

The resident member of the Board will attend three SAEM Board meetings; in thefall, in the winter, and in the spring (at the 2002 SAEM Annual Meeting). Inaddition, the resident member will participate in monthly Board conference calls.

Call for Nominations for SAEM Board ofDirectors Position

Marcus Martin, MDSAEM President-ElectChair, SAEM Nominating CommitteeUniversity of Virginia

Have you considered becoming a member of the Board of Directors ofSAEM? SAEM will have two positions on the Board of Directors to fill by elec-tion for the term beginning May 2001. The Board of Directors position is for 3years. Typically members elected to the Board have shown dedication toSAEM through committee, task force and/or interest group involvement andparticipation in other ways such as the Annual Meeting. However the only ab-solute requirement is to be a member in good stead. The Nominating Commit-tee will look closely at service and dedication to SAEM. As a Board of Directorsmember for SAEM I have been honored to serve in that capacity. The experi-ence has been rewarding and beneficial to me in many ways. The SAEM staffmembers are very knowledgeable and supportive and my peers on the Boardare great leaders in academic emergency medicine. Most importantly, Boardmembers are charged with carrying out the business of the Society, includingmaking sure that we are on target with our mission. There are generally 2-3Board meetings per year with one being held at the SAEM Annual Meeting andthe others being held at other locations such as a winter regional SAEMmeeting, the AAMC Annual Meeting or the ACEP Scientific Assembly. Thereare monthly teleconferences held by the Board. Each Board member is as-signed liaison responsibilities too committees, task forces and interest groups.

I hope you will consider becoming a candidate for the SAEM Board ofDirectors, but if not, the Nominating Committee would like to know the namesof SAEM members that you may recommend as a potential candidates for theBoard of Directors positions. On behalf of SAEM, I thank for your consideration.

Call for NominationsDeadline: January 1, 2001

Nominations are sought for the HalJayne Academic Excellence Awardand the Leadership Award. Theseawards will be presented during theSAEM Annual Business Meeting onMay 8 in Atlanta. Nominations forhonorary membership for those whohave made exceptional contributionsto emergency medicine are alsosought.

The Nominating Committee wishes toconsider as many exceptional candi-dates as possible. Nominations maybe submitted by the candidate or anySAEM member. Nominations shouldinclude a copy of the candidate’s CVand a cover letter describing his/herqualifications. The awards and criteriaare described below:

Academic Excellence AwardThe Hal Jayne Academic ExcellenceAward is presented to a member ofSAEM who has made outstandingcontributions to emergency medi-cine through research, education,and scholarly accomplishments.Candidates will be evaluated on theiraccomplishments in emergencymedicine, including:1. Teaching

A. Didactic/BedsideB. Development of new tech-

niques of instruction or instruc-tional materials

C. Scholarly worksD. PresentationsE. Recognition or awards by stu-

dents, residents, or peers2. Research and Scholarly Accom-

plishmentsA. Original research in peer-re-

viewed journalsB. Other research publications

(e.g., review articles, bookchapters, editorials)

C. Research support generatedthrough grants and contracts

D. Peer-reviewed research pre-sentations

E. Honors and awards

Leadership AwardThe Leadership Award is presentedto a member of SAEM who has dem-onstrated exceptional leadership inacademic emergency medicine.Candidates will be evaluated on theirleadership contributions including:1. Emergency medicine organiza-

tions and publications.2. Emergency medicine academic

productivity.3. Growth of academic emergency

medicine.

Fellowship and Clerkship and Residency CatalogUpdates Requested

The Emergency Medicine Fellowship and Undergraduate Rotation Lists on theSAEM web site are very popular, receiving many "hits" each week. These lists areupdated continuously, but it is difficult to ascertain if any institutions or residencyprograms are being missed. If your institution has an Emergency Medicine fellow-ship or offers a clerkship, please take a few moments to review these sites on theSAEM web site and contact SAEM at saem@saem.org to help make the lists areaccurate as possible.

The SAEM Residency Catalog is also undergoing its annual update. Residency direc-tors are encouraged to update their institution's listing for the upcoming interview season.

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Call for NominationsDeadline: January 1, 2001

Nominations are sought for the SAEM elections which will be held during the Annual Business Meeting on May 8 inAtlanta. The Nominating Committee will select a slate of nominees based on the following criteria: previous service to SAEM,leadership potential, interpersonal skills, and the ability to advance the broad interests of the membership and academicemergency medicine.

Interested members are encouraged to review the appropriate SAEM orientation guidelines (Board of Directors,Committee/Task Force or President-elect) in considering the responsibilities and expectations of an elected position in theSociety. Orientation guidelines are available on the SAEM web site at www.saem.org or from the SAEM office.

The Nominating Committee wishes to consider as many candidates as possible and whenever possible will select more thanone nominee for each position. Nominations may be submitted by the candidate or any SAEM member. Nominations should in-clude a copy of the candidate’s curriculum vita and a cover letter describing the candidate’s qualifications and previous SAEM ac-tivities. Nominations may also be made from the floor in San Francisco. Nominations are sought for the following positions:President-elect — The President-elect serves one year as President-elect followed by one year as President and one yearas Past President. Candidates are usually current members of the Board of Directors. Board of Directors — Two members will be elected to three year terms on the Board of Directors. Candidates should havea track record of excellent service and leadership on SAEM committees and task forces and are often currently serving ascommittee or task force chairs.Resident Board Member — The resident member is elected to a one year term and is a full voting member of the Board of Dir-ectors. Candidates must be a resident during the entire term on the Board (May 2001-May 2002). Candidates should demon-strate evidence of strong interest and commitment to academic emergency medicine. Nominations should include a letter of sup-port from the candidate’s residency director.Nominating Committee — Two members will be elected to two year terms on the Nominating Committee. The NominatingCommittee is charged with selecting the recipients of the Young Investigator Award, the Academic Excellence Award, and theLeadership Award, as well as developing the slate of nominees for the elected positions within the Society. Candidatesshould have considerable experience and leadership on SAEM committees and task forces.Constitution and Bylaws Committee — One member will be elected to a three year position on the Constitution and BylawsCommittee. The final year will be served as the chair of the Committee. The Committee is charged with reviewing the Con-stitution and Bylaws and making recommendations to the Board for any proposed amendments to be considered by themembership. Candidates should have considerable experience and leadership on SAEM committees and task forces.

2000 Annual Meeting ReportSusan Stern, MDChair, 2000 SAEM Annual MeetingProgram CommitteeUniversity of Michigan

It is my pleasure to report on theevents of the SAEM 2000 Annual Meet-ing held in San Francisco this past May.Once again, the SAEM Annual Meetingcan be considered a roaring successwith all of the indications that emer-gency medicine is progressing and thriv-ing in the academic arena. There wereapproximately 500 scientific presen-tations ranging in topics from educa-tional methodology, to domestic vio-lence, to ischemia/reperfusion. The ex-change of information that occurred atthe poster and scientific platform pre-sentations was informative, at times pro-vocative, of very high caliber, and indi-cative that as a specialty we are makinggreat strides in the area of research thatshould benefit our future patients.

In addition to the numerous out-standing scientific presentations, therewere over 40 hours of didactic sessionofferings. These too covered a widevariety of research and educationtopics, and involved well over 100speakers and panelists most of which

Stroke.” The Annual Meetingevaluations indicate that attendees arevery enthusiastic about theseinnovations, and the Program Com-mittee will consider this feedback duringthe planning of next year’s meeting.

The topic discussion poster sessionsfirst introduced last year were continuedand again the feedback was very posi-tive regarding this presentation format.The Program Committee acknowledgesthat there has been difficulties withnoise and acoustics during these ses-sions and is working hard to come upwith solutions for this problem. We alsoimplemented a new awards process, inwhich award candidates were requiredto submit an expanded abstract or draftmanuscript prior to the meeting. Thisnew process provides several advan-tages. This better enables the awardssubcommittee to judge the science ofthe presentations, it encourages investi-gators to develop manuscripts for sub-mission for publication, and it allows thesub-committee to select the award win-ners at the meeting itself. There wascertainly stiff competition and the Pro-gram Committee spent many hours

were from our own specialty. In addi-tion, there were several outstanding ex-ternally recruited national and interna-tional speakers. Among these were Dr.Drummond Rennie, Deputy Editor ofJAMA, and Dr. Kenneth Shine, Presi-dent of the Institute of Medicine, whoprovided the the Kennedy Lecture andthe Keynote Address. Dr. Rennie pro-vided a provocative presentation on re-search and publication ethics, while Dr.Shine addressed “Sustaining Excel-lence in Academic Medicine in the NewMillennium.”

There were several new programsand innovations at the Annual Meeting.Among these was the institution of oralpaper presentations with extended timefor audience and panel interaction. Inaddition, a session entitled “HighlightsFrom Other Meetings” was introduced.During this hour, data from high profileabstracts presented at other meetingswith the potential for immediate impacton patient care were presented. Thisyear the presentations included “Resultsof a Controlled Trial of Benzodiazepinesfor the Treatment of Status Epilepticus,”“The Util ity of B-Type NatriureticPepetide in the Diagnosis of CHF,” and“Abciximab for the Treatment of Actue (continued on next page)

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reviewing a large number of excellentdraft manuscripts. All of the award can-didates should be congratulated ontheir outstanding submissions. The Pro-gram Committee will continue to evalu-ate the newly implemented awardsprocess next year and look for ways ofenhancing it.

The meeting was not all business;attendees were able to partake inseveral social activities as well. Theseincluded the opening reception at whichfor the first time there was live music,an opportunity to see the San FranciscoGiants take on the Montreal Expos inthe new Pacific Bell Park, and a pro-duction by the Beach Blanket Babylonplayers. The closing banquet was heldat the California Academy of Scienceswhere attendees were allowed to walkthrough the Aquarium and the Earth-quake Exhibit. Banquet attendees weretreated to some very special and out-standing entertainment provided byDrs. Paul Pepe, Chuck Cairns, TerryVanden Hoek, Jeff Coben and theCyanosis Blue Band with MileaMenckhoff. In addition, we introducedthe first “SAEM, Who Wants to be aBillionaire” contest. A team comprisedof Henry Ford Hospital and WayneState University participants provedtheir genius and medical prowessduring these very competitive games.Incidentally, despite extensive researchand remarkable intellect, the committeewhich provided the questions andanswers for this contest has been un-able to definitively determine the originand meaning for the SAEM logo. Ifthere is any member who has re-searched this very vital topic and knowsthe answer to the question, “what doesthe SAEM logo stand for?” the SAEMPresident, Brian Zink, would appreciateit if you would step forward and provideus with that information. Dr. Zink recog-nizes the seriousness of this knowledgedeficit and hence one of his primarygoals as president is to correct this ig-norance. You will receive an appro-pri-ate reward, of course. On a serious,note I would like to offer my gratitudeand a million thanks to Drs. Pepe,Cairns and Vanden Hoek for providingsuch excellent entertainment and mak-ing the banquet a great success. Theyworked tirelessly to put this togetherand much of the planning prohibitedthem from enjoying and partaking inseveral of the Annual Meeting offerings.

On a more administrative note, I’dlike to discuss the issue of obtaininghotel reservations at the host hotel.SAEM booked 3,260 room nights forthe 2000 Annual Meeting. Four weeksbefore the Annual Meeting the hotelhad reservations for 3,656 rooms. Thiscaused some registrants to get a roomat the host hotel only by paying a higher

Annual Meeting Report (Continued)rate, or going to another hotel. How-ever, because of cancellations in thelast month before the conference,SAEM actually utilized only 2,729 of therooms in the block.

The Program Committee under-stands the frustration of its memberswhen they call the hotel a month or twobefore the conference and they cannotget a room reservation in the block.However, SAEM can only “block” asmany rooms as the hotel believesSAEM will use. Because the block was3,260 and only 2,729 were used, it willbe very difficult for SAEM to increasethe block for future years. The problemcontinues to be that members makeroom reservations well in advance ofthe conference, not yet knowingwhether they will be able to attend,when their paper will be presented, orbefore the Annual Meeting schedule ispublished. They are worried that if theydon’t make a reservation early, theymay not get one. However, our datashows that in the last month before theAnnual Meeting, the hotel receivednearly 1,000 room night cancellations.

The Program Committee would liketo urge the membership to do twothings: 1) try not to make a reservationfor the whole week of the Annual Meet-ing before knowing whether you will beable to attend, or which days you willattend. If you must make a reservation,please be sure to release dates that you

will not use or cancel well in advance ofthe Annual Meeting. 2) If you call for areservation and find that the block is full,be patient. As this year’s data shows,about 1,000 room nights will be can-celled within the last month. In short, bekind to your colleagues. In the comingmonths the SAEM web site will includeinformation on the host hotel at the 2001Annual Meeting in Atlanta. There shouldbe plenty of rooms for all SAEM mem-bers who wish to attend.

In closing, I would like to take this op-portunity to thank the SAEM 1999-2000Program Committee. It was truly anhonor and a privilege to work with themduring this past year. This Committeeworked continuously from from May oflast year up through the end of this year’sAnnual Meeting to provide the mem-bership with an outstanding experience.Special thanks go to the SubcommitteeChairs: Steven C. Dronen (RegionalMeeting Subcommittee), Sue Fish (Di-dactic Subcommittee), Judd Hollander(Scientific Subcommittee), and JohnHowell (Medical Student and ResidentPrograms Subcommittee). In addition, Iwould like to thank the general mem-bership of SAEM for all of their abstractand didactic submissions. It is your inputand participation which makes the An-nual Meeting so successful and the pre-miere academic meeting for EmergencyMedicine. I thank you for the privilege ofbeing able to serve in this capacity.

Newsletter AdvertisingThe SAEM Newsletter is mailed every other month to the 5,000 membersof SAEM. Advertising is limited to fellowship and academic facultypositions. All ads will be posted on the SAEM web site at no additionalcharge.

Deadline for receipt: January 15 (Jan./Feb. issue), March 15 (March/Aprilissue), May 15 (May/June issue), July 15 (July/August issue), September15 (Sept./Oct. issue), and November 15 (Nov./Dec. issue). Ads receivedafter the deadline can often be inserted on a space available basis.

Advertising Rates:Classified Ad (100 words or less)

Contact in ad SAEM member ...............................$100Contact in ad non-SAEM member ........................$125

1/4-Page Ad (camera ready)3-1/2” wide x 4-3/4” high .......................................$300

To place an advertisement , e-mail, fax or mail the ad, along with contactperson for future correspondence, telephone and fax numbers, billingaddress, ad size and Newsletter issues in which the ad is to appear to:Jennifer Mastrovito at <Jmastrovito@saem.org>, via fax at 517-485-0801or mail to 901 N. Washington Avenue, Lansing, MI 48906. For moreinformation or qustions, call 517-485-5484 or <Jmastrovito@saem.org>.

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SAEM Response to HCFA June 2000 DGs

The Society for Academic Emer-gency Medicine (SAEM), as a memberorganization of the Association ofAmerican Colleges (AAMC) Council ofAcademic Societies, serves as thevoice of over 5000 academic emer-gency physicians at more than 130teaching hospitals. SAEM is respondingto the June 2000 DocumentationGuidelines (DG2000), specifically to thefollowing section relating to documen-tation of history:

“The physician should document ef-forts made to obtain a history from thepatient, accompanying family members,friends or attendants or emergency per-sonnel (e.g., paramedics) or availablemedical records (e.g., previous hospitalrecords, nursing facility records, ambu-lance records). It is rare that no historywill be available. Any history obtainedwill be evaluated according to theguidelines.” (page 5)

SAEM is extremely concerned aboutits potential effects on patient care,appropriate reimbursement for servicesby faculty physicians, and on Emer-gency Medicine residency trainingprograms.

DiscussionEvaluation and Management codes

99281 through 99285 are used to billfor E/M services provided in the ED.Code 99285 requires a comprehensivePatient History, which includes anextended History of Present Illness(HPI), a complete Review of Systems(ROS) and a complete Past, Familyand/or Social History (PFSH). CurrentE/M codes for the ED do contain anexception, however, known as the“History Caveat”, which states that thehistory should be taken “within theconstraints imposed by the urgency ofthe patient’s clinical condition andmental status.”

HCFA apparently proposes to removethis “History Caveat” from the docu-mentation guidelines on the grounds that”it is rare that no history will be avail-able.” Complete inability to obtain a his-tory is indeed relatively infrequent, al-though every emergency physician canprovide examples of such situations.However, elderly and/or acutely ill or in-jured patients in the ED are frequentlyunable to provide a comprehensive his-tory sufficient to meet 99285 require-ments. Even if old records, friends orfamily can offer additional information,this will often not substantiate the level ofservice actually needed by and providedto these patients.

The three emergency departmentcases below describe some of thesesituations:

Vignette #1 : An elderly man is foundby passers-by sitting on the sidewalk,confused, unable to give his name andtrying unsuccessfully to stand up. He istransported by EMTs to the nearestemergency department (ED). He hasno identification papers and is unable togive ED staff his address or telephonenumber. After extensive evaluation inthe ED, he is admitted to the hospitalunder the name “John Doe.”

Vignette #2 : A 72 year old womandevelops chest pain while in a shoppingcenter, and EMS is called. By the timethe ambulance reaches the ED she ispale, diaphoretic, almost unable to talk,and clinging to the hand of one of theparamedics, repeating “Help me.” In herpocket-book ED staff find a prescriptionbottle of nitroglycerin tablets, as well asa card giving the name and telephonenumber of a son living in a distant state.It is Friday evening. The physician’s of-fice is closed, and the answering servicepages the physician on-call who is un-fortunately not acquainted with thispatient. The son is called, and a mes-sage is left on his answering machine.

Vignette #3 : An elderly man is foundin a wooded area with a gunshot woundto his face and jaw. A handgun is onthe ground nearby. During transport tohospital, the man repeats “Let me die.”On arrival he is unable or unwilling toanswer any questions. The ED staffsearch his pockets for identificationpapers, but find only a hand-writtensuicide note, which does include thename and telephone number of hishealth-care proxy. The telephone atthat number is disconnected.

Emergency physicians cannot wait foradditional historical information beforetreating their patients. Surely HCFAdoes not believe that the missing his-torical information should be obtainedand entered into the medical record at alater date? Information obtained after thepatient has left the ED may be helpful toother physicians, but gathering this datais not part of the responsibilities of anemergency physician.

The alternative, systematic down-coding of E/M services in all patients inwhom a comprehensive history cannotbe obtained would be inappropriate,legally dubious and financially catastro-phic to emergency physicians andemergency departments.

SAEM strongly recommends that theHistory Caveat be maintained, and thatit should be made applicable to emer-gency department visits, new patientsin an outpatient setting, and initialhospital care codes. SAEM endorseslanguage such as the following:

“If the physician is unable to obtain a

sufficient history from the patient orother source within a cl inicallyappropriate time frame, the recordshould describe the patient’s medicalcondition or other circumstance thatprecludes obtaining a sufficient history.These may include patients who areunable to communicate, and where oneor more of the following apply: lack ofinterpreter, lack of medical record, ab-sence of family or significant other orlegal guardian unavailable by telephoneor in person. These may also includecritically ill patients where immediatetreatment is necessary, and no or mini-mal historical information is available.

Documentation of the circumstancesrelated to the inability to obtain a suffi-cient history will be deemed equivalentto a comprehensive history for codeselection purposes.”

ConclusionSAEM agrees with HCFA that “any

counting in the DGs should be minim-ized and, if needed, should be re-stricted to areas where it reflects clinic-ally relevant care.” (6/22/00 Town HallStatus Report) Therefore, SAEM isstrongly opposed to the elimination ofthe “History Caveat”.

SAEM believes that this would placeundue emphasis on details of history atthe expense of care and managementof patients in critical need. It would in-terfere with the dual efforts of patientcare and education of our residents inteaching hospital EDs. Finally, it wouldjeopardize the care of the most vulner-able members of our society, who oftenseek care from the ultimate safety netof our health care system, the emer-gency department.

SAEM’s full response is published below and is published on the SAEM web site.

Future SAEM AnnualMeetings

May 6-9, 2001Atlanta Hilton and Towers

Atlanta, GA

May 19-22, 2002Adam’s Mark Hotel

St. Louis, MO

May 29-June 1, 2003Marriott Copley Place

Boston, MA

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Resident DebtJudith Brillman, MDSAEM GME CommitteeUniversity of New Mexico

Resident debt has become an important priority for SAEM.A Resident Debt Task Force was established in 1999 andwas rolled into the SAEM Graduate Medical EducationCommittee this year. The purpose of the task force was toidentify the extent of resident indebtedness and identifymechanisms to alleviate the impact of indebtedness on EMresidents. The next few issues of the SAEM newsletter willtackle the important issues of managing debt and avoidingexcessive debt during residency. Indebtedness of EM appli-cants has been reported by the AAMC as one of the twohighest of all specialty choices. Not adjusting for inflation,the average debt of EM applicants has tripled in the pastone and half decades (Table I). The median debt of EM res-idents was 100,000 in the year 2000 as compared to theaverage medical student debt of $90, 000 reported by theAAMC for the year 1999.

There are factors that affect resident debt over which theindividual has little control: cost of living increases, the rapidrise in medical school tuition, and a shrinking pool ofavailable sources to fund one’s medical education. Startingdebt is compounded by the fact that the deferment of resi-dent loan repayment does not extend for the full duration ofresidency. The 2-year grace period for repayment of federalloans expired with loans originating in 1993. Residents cantry to delay federal loan repayment by applying under aneconomic hardship provision or by placing loans in forbear-ance which exponentially builds overall debt. While loansmay weigh heavily on a resident’s shoulders, they are oftennot the most pressing financial concern. Rather, the con-cern lies in day-to-day financial survival. A typical resident’ssalary is modest at best, especially when attempting tosupport a family. The time period during which long hoursare spent in residency happens to correspond with thesame time that many people are getting married, havingchildren and beginning to expand their families. For those inthis situation, there may be a resultant loss or decrease in aspouse’s income in order to care for a child or to accommo-date a move for residency. There are new costs (e.g. child-care, life and disability insurance, home-owners insurance,higher rent, mortgages) notably absent when life was moresimple. There are other factors that affect debt accumula-tion over which the individual does have some control.Spending habits and the avoidance of credit card debtduring residency is vitally important in maintaining financialhealth. This involves prioritizing spending and delayinggratification despite being tired of second-hand furniture,unreliable cars, and living in questionable apartments sincebeginning college. There are several on-line resourcesavailable to help residents understand and organize studentloan debt and repayment plans.

The first place for the indebted resident to look for help isthe AAMC web site located at www.aamc.org. Once at theirsite, follow the prompts through to Medical Education andResidency Issues then to Educational Debt ManagementServices for Residents. The Layman’s Guide to EducationalDebt Management for Residents and Graduate MedicalEducation Staff is a step-by-step strategy to organize yourloan portfolio and understand it. It consists of eight stra-tegies that identify and explain the major points needed tounderstand the debt you have accumulated and how tomanage it. The first section prompts you to identify and un-derstand what loans you have taken. It offers descriptionsof the major loans available and touches on key aspectssuch as interest and capitalization. The second and thirddescribes in detail the concepts of grace, interest accrualand capitalization, as well as the entirety of options avail-able after graduation to postpone payment of your loans.Developing a calendar or a timeline is the focus of thefourth section followed by strategies regarding choosing arepayment plan when the time comes. The sixth sectiongives advice on how to keep efficient records and describesmany of the financial terms used in your statements suchas secondary market and servicers. The final two sectionsconcentrate on where to look for help if you need outsideassistance from a financial planner and other support sys-tems available to the student/resident. A video presentationavailable through Real Player is offered on each separatestrategy to help explain important aspects. The presenta-tions require a password, appropriately named “debthelp”.This is probably the most comprehensive and easiest touse resource available to the medical student or resident.Moneymatters Listserv is an email server designed to allowyou to ask specific questions about your loans and can besubscribed to through the AAMC web site. (MD)2: MedicalDecisions for Medical Doctors and the corresponding website at www.aamc.org/md2. May also be helpful to theresident interested in finances and debt management. It isan electronic resource manual for financial planning formedical students and residents published by the AAMC.

The National Association of Residents and Interns is an or-ganization whose membership entitles the medical student,resident, fellow or practicing physician special discounts onmedical equipment such as lab coats, stethoscopes andeyewear. Furthermore, they offer their members specialloans, mortgages and specialized services such as dentalcare and life insurance if they qualify. Their web address isat www.nari-assn.com. Access Group is a non-profit organi-zation whose goal is to provide information and help for stu-dents wishing further education. Their website at www.accessgroup.org offers valuable information on the loanprocess, as well as managing debt. They additionally offer

ACADEMIC RESIDENTNews and Information for Residents Interested in Academic Emergency Medicine

Edited by the SAEM GME Committee

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federal Stafford loans, as well as some private loansthrough their organization to eligible individuals. Additionalresources to begin looking at managing your debt includethe Graduate Medical Education office of your residencyprogram or financial aid office of your medical school. Someindividual state chapters of national organizations such asACEP or the AMA may offer additional information in theforms of management tutorials or scholarships available tostudents and in the rare case, residents.

The following is a list of printed material published in thelast two years which address the issue of resident debtmanagement.

• Dealing with Your Debts, ACP Observer, December 1999• Say goodbye to medical school debt, Medical Econ-

omics, December 6, 1999• Med Students Seek Cure for Debt — For Doctors in Trai-

ning, Profession’s Outlook is Hardly Lucrative, Los An-geles Times, November 27, 1999

• Financial Planning Takes Sting Out of Educational Debts,Academic Physician and Scientist, May/June 1999

• Understanding and Managing Your Student Loans, Inspir-ations — The Anesthesia Residents’ Quarterly, Fall 1998

• Managing Medical Student Educational Loan Indebted-ness, Contemporary Issues in Medical Education(CIME), December 1999

Table I

EM Resident Average Indebtedness

1986: $33,500 AAMC survey1989: $48,700 AAMC records1996: $72,300 393 EM applicants in 54 programs (1996)1999: $85,224 29 EM applicants interviewing at UC Irvine2000: $95,689 48 EM applicants interviewing at UC Irvine

EMF Call for Grant ProposalsThe Emergency Medicine Foundation is currently accepting applications for its annual grants. Funding is for research donewithin the academic year of July 1, 2001 through June 30, 2002 unless otherwise specified. To request an application, contactEMF, P.O. Box 619911, Dallas, Texas 75261-9977 or call (972) 550-0911 ext. 3340. The following is a description of the awardsand application deadlines:

EMF Career Development GrantA maximum of $50,000 to emergency medicine faculty at theinstructor or assistant professor level who needs seed moneyor release time to begin a promising research project.Deadline: November 6, 2000

EMF Creativity and Innovation in Emergency MedicineGrantA maximum of $5,000 to support small pilot projects that arenew and innovative. It is intended to provide release time orprovide equipment and supplies for new investigators or forexperienced investigators who have a novel idea.Deadline: November 13, 2000

EMF Research Fellowship GrantA maximum of $35,000 to emergency medicine residencygraduates who will spend another year acquiring specificbasic or clinical research skills and further didactic training inresearch methodology.Deadline: November 20, 2000

EMF Resident Research GrantA maximum of $5,000 to a junior or senior resident to stimul-ate research at the graduate level.Deadline: December 4, 2000

Riggs Family/EMF Health Policy Research GrantBetween $25,000 and $50,000 for research projects in healthpolicy or health services research topics. Applicants mayapply for up to $50,000 of the funds, for a one- or two-yearperiod. The grants are awarded to researchers in the healthpolicy or health services area, who have the experience toconduct research on crit ical health policy issues inemergency medicine.Deadline: January 8, 2001

EMF/FERNE Neurological Emergencies GrantA maximum of $50,000. This grant is sponsored by EMF andthe Foundation for Education and Research in NeurologicalEmergencies (FERNE). The goal is to fund research basedtowards acute disorders of the neurological system, such asthe identification and treament of diseases and injury to thebrain, spinal cord and nerves.Deadline: January 15, 2001

EMF/SAEM Medical Student Research GrantA maximum of $2,400 over 3 months for a medical student orresident to encourage research in emergency medicine.Deadline: January 29, 2001

EMF/SAEM Innovations in Medical Education GrantA maximum of $5,000 to support projects related to educa-tional techniques pertinent to emergency medicine training.Deadline: February 12, 2001

EMF/ENAF Team GrantA maximum of $10,000 to be used for physician and nurseresearchers to combine their expertise in order to develop,plan and implement clinical research in the specialty of emer-gency care.Deadline: March 5, 2001

EMF Established Investigator AwardA maximum of $50,000 to established researchers. An es-tablished investigator is one who has obtained significant ex-tramural funding and made significant contributions to emer-gency medicine research. Priority will be given to those whohave been principal investigators on federal and/orfoundation grants.Deadline: March 19, 2001

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2000-2001 Interest Group Objectives and ReportInterest groups were developed to allow members to participate with other SAEM members in areas of mutual interest.

Currently there are approximately 25 interest groups. All interest groups are asked to meet at the SAEM Annual Meeting and thechairs were asked to develop objectives for the 2000-2001 academic years, as well as provide a narrative report on theirmeetings in San Francisco. Because the Newsletter has limited space, some of the reports have been extensively edited. Thefull text of the reports can be found on the SAEM web site at: www. saem.org/inform/intgrps.htm

All SAEM members are invited to participate in the interest groups. Contact the SAEM office at saem@saem.org or 517-485-5484 to become a member of an interest group. Dues are $25 per year per interest group. For information on specific interestgroups, please feel free to contact the interest group chairs listed below. For general information on interest groups or how todevelop an interest group, please review the Interest Group Orientation Guidelines on the SAEM web site at: www.saem.org/inform/igorient.htm. The SAEM Board recently approved the development of list-servs for interest groups that request a list-serv and have at least 20 members. Many Interest Groups now have active list-servs.

AirwayCarlos Camargo, MD, DrPH, Chair: ccamargo@partners.org

Objectives1. To support collaborative research on asthma, COPD, and

other airway disorders. 2. To provide national leadership on asthma education of ED

patients and staff. 3. To prepare an airway-related didactic session, workshop,

or satellite symposium for the SAEM Annual Meeting. 4. To provide SAEM representation to the National Asthma

Education and Prevention Program (NAEPP).Approximately 30 people attended the meeting which beganwith a general update, including the latest membership count(60), completion of the new AIG website (http://healthcare.partners.org/saem-airway), and some NAEPP initiatives (eg,a proposed resolution to support increased multicenter re-search on ED-based asthma care). Each the committee chair(Drs Brian Rowe, Steve Emond, and Charles Pollack) re-viewed their 1999-2000 agenda, discussed what their com-mittee had accomplished during the past year, and solicitedcomments and ideas from the general membership. Dr.Emond announced that Barry Brenner will chair the Educa-tion Committee for the duration of the two-year term. Minutesfrom each committee chair will be posted on the AIG website,and include the current committee objectives and timeline. Atthe next SAEM Annual Meeting elections will be held for the2001-2003 AIG chair, who may choose three new committeechairs shortly thereafter. The AIG chair also may nominate tothe SAEM Board a new AIG member to represent SAEM onthe NAEPP Coordinating Committee. Contact Drs. Camargo(ccamargo@partners.org), Rowe (brian.rowe@ualberta.ca),Brenner (doctor2315@aol.com), or Pollack (pollack@pri-menet.com) if you have any questions or concerns.

Clinical DirectorsLeon L. Haley Jr., MD, MHSA, Chair: lhaley@emory.edu

Objectives1. Promotion of the role of the ED Clinical Director within

Academic Emergency Medicine.2. Improving ED operations through administrative research,

benchmarking and education3. Development of a didactic program for the entire SAEM

body at the May 2001 annual meeting4. Growth and development of the interest group itself.

The meeting focused on four major topics:• Promotion of the role of the ED Clinical Director in aca-

demic emergency medicine• Improvement in ED operations through administrative re-

search, benchmarking and education.• Development of a didactic program for next year’s annual

meeting.• Growth and development of the interest group.The role of the ED Clinical Director is interesting since somemembers of the group have had the role thrust upon themwithout adequate preparation. The group debated several

questions: what are the necessary skills to run an academicemergency department, what is the role of formal training(either a fellowship or degree program), what administrativesupport is necessary to succeed in the job and how does onebalance the role with other personal academic growth issueslike research and education?

The second major topic focused on the clinical operationsof our departments and how it fits into the mission and visionof the larger SAEM body. The members were particularlyconcerned about the continued development of the educa-tional and research missions when departmental operationsare undergoing the pressures of healthcare and have theability to negatively affect those areas. There was discussionabout current and future benchmarking initiatives so thatmembers would have the opportunity to share information. Itwas hoped that this type of information would have a placeon the Annual Meeting agenda. Approximately 10 membersattended the meeting. Elections will be held at the 2001SAEM Annual Meeting.

Clinical SkillsWilliam Rennie, MD, Chair: rennie@lij.eduThe Clinical Skills Interest Group did not meet in San Fran-cisco and has not yet submitted objectives for 2000-2001.

CPR/Ischemia/ReperfusionJames Manning, MD, Chair: jmanning@med.unc.eduThe CPR/Ischemia/Reperfusion Interest Group did not meetin San Francisco and has not yet submitted objectives for2000-2001.

Disaster MedicineLester Kallus, MD, Chair: lkallus@earthlink.net

Objectives1. A listserver of all members will be created. 2. Review a bibliography of Disaster-related articles and to

maintain this bibliography annually. The bibliography is tobe published on the internet.

3. A didactic course on Disaster Medicine authored in the1980s and last offered in the early 90s will be updated.An international disaster medicine course currently in usein Europe will be reviewed.

4. CME credit for a disaster medicine course and funding forcreation of such a course will be investigated.

Sixteen people attended the interest group meeting and Dr.Kallus was elected to continue serving as chair of the Disas-ter Medicine Interest Group. It was suggested that a meetingof the Disaster Medicine Interest Group be held one day priorto the ACEP Scientific Assembly to compile various lectures.

DiversityThea James, MD, Chair: theaj@bu.edu

Objectives1. Addressing mission of recently approved Diversity Interest

Group (DIG) position statement.(continued on next page)

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2. Determine our diversity baseline in SAEM: Completion of2 studies on our research agenda.

3. Solicit feedback from CORD on DIG position statementand its relationship to residency training programs.

4. Create and establish a comfortable space for opendialogue about diversity.

The interest group will develop a focused mission and re-search agenda; the major objective for 2000-2001. The in-terest group plans to query all SAEM faculty and residents todetermine our diversity baseline in SAEM, to inquire aboutthoughts on necessity for, want of, or understanding of diver-sity initiatives in emergency medicine, and to provide the op-portunity for open expression from both residents and faculty.Hopefully this query will reveal data to stimulate open andcomfortable discourse about diversity in medicine and partic-ularly, EM. A previous survey was done by the Women andMinorities Task Force. The ethnicity demographic data fromthis study has not been published, however it will be interest-ing to compare those data to some of the data that will becollected in the DIG study, given the time difference. Thequery will be administered in a participant-friendly, con-venient manner.We also have a qualitative survey planned.In addition, we would like to solicit feedback from CORDabout the DIG position statement as is relates to EM trainingprograms.

A dozen people attended the Diversity Interest Groupmeeting (DIG) and Kevin Ferguson, MD, was elected incom-ing chair with his term to begin May, 2001.

Domestic ViolenceCarolyn J. Sachs MD, MPH, Chair: csachs@ucla.edu

Objectives1. Sponsor an educational session for the 2001 conference

“Challenges and Solutions to Longitudinal Outcomes Re-search of ED Based Interventions.”

2. Sponsor an educational session for the 2001 conference“Development of a national web based emergency medi-cine education tool.”

3. Complete the project started in year 1999-2000 which ex-amines reporting requirements for patients with violentlyinflicted injuries in all 50 states.

4. Improve communications with the SAEM Board to assurethat our educational sessions are implemented in year 2001.

The meeting was attended by 35 individuals and BarbaraHerbert MD, was elected incoming chair with term to beginMay, 2001.

The interest group developed a collection of referenceprotocols for our website. As the SAEM DV Education Sitewill have these protocols, we decided to add our efforts totheirs by giving them our representative protocols and leaveour web site as an interest group member reference site tobe maintained by Dr. Ron Moscati.

The SAEM Domestic Violence Education Site was demon-strated by Dr. Heidi Queen. Dr. Queen continues to solicit as-sistance from SAEM members for the web site for the follow-ing ongoing projects: case reports with photos, updatedlegislative and bibliographical information, research projectdescriptions, referral forma, and web site management.Contact her at hfqueen@hotmail.com for any contributions.

A national update on state legislation regarding violent in-jury reporting, was accomplished under the leadership of Dr.Debra Houry. Members shared various research projectswith one another and expressed frustration on the questionof how to improve DV screening in the ED. Drs. KarinRhodes and Bruce Becker shared their projects aimed at in-creasing screening and Drs. Ron Moscoti and Greg Larkin in-formed us about their ongoing research to show improvedoutcomes with ED based intervention.

EMSTed Delbridge, MD: delbridget@pitt.edu

A group of 15 EMS physicians and professionals attended aplanning meeting to lay the groundwork for the new EMS In-terest Group. The primary focus of the meeting was planningfor the transition from the present EMS Task to an interestgroup. This transition will allow for much broader participationby SAEM members and may allow for discussion of a widervariety of topics and the completion of a larger number ofprojects.

Potential activities for the interest group might include ex-ploring the role of EMS in public health, updating the EMScurriculum for EM residents, developing an EMS curriculumfor medical students, and the facilitating of EMS mentoringrelationships, particularly for young EMS researchers. Theseand other possible projects should blend EMS with SAEM’sacademic focus on research and education.

Possible early action items for the group include the devel-opment of an inventory of funded EMS research projects, aposition paper regarding EMS in academic EM centers, anda list of EMS research priorities. The group will also begin ex-amining possible didactic session proposals for future SAEMAnnual Meetings.

Those who attended the meeting will continue to work withthe EMS Research Task Force and the SAEM leadershiptoward the implementation of the interest group. InterestedSAEM members may contact Dr. Delbridge (delbridg+@pitt.edu), Dr. Michael Sayre (Michael.Sayre@uc.edu), or Dr.David Cone (david.cone@yale.edu) for further information.

EthicsJohn Krimm, MD: jkrimmaemc.pol.net

Objectives1. To support collaborative research into ethical issues as

they relate to emergency medicine;2. To identify the uniqueness of ethical issues as they relate

to emergency medicine;3. To provide emergency medicine related didactic sessions

and/or workshops at the Annual and/or regional SAEMMeetings;

4. To establish and review annually a bibliography of emer-gency medicine related articles and publications; and,

5. To increase the awareness of ethical problem areas foremergency medicine educators and researchers.

In response to numerous inquiries from SAEM members, theformation of a new interest group, focused on ethical mattershas been proposed. This notice serves to inform the generalmembership of the Ethics Interest Group, which has as itsgoal to bring together like-minded SAEM members for dis-cussions of ethical issues in emergency medicine. Proposedactivities include:

• To meet for collegial discussions at the Society’s AnnualMeeting and the ACEP Scientific Assembly;

• To increase the awareness of ethical issues as they impacton emergency medicine, by creating a forum for discussion;

• To help identify the uniqueness of ethical decision makingin emergency medicine;

• To assist members in the publication of articles germane toemergency medicine ethics;

• To create resources for SAEM members; And,• To communicate with other emergency medicine organiza-

tions to open discussions on common ethical issues.

Evidence Based MedicinePeter Wyer, MD, Chair: pwyer@worldnet.att.net

Interest Group Objectives and Report (Continued)

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Objectives1. To draft an outline of needs and guidelines for faculty

development required for emergency medicine programsto incorporate the teaching of evidence-based medicineskills and principles into their curricula.

2. Initiate the development of a proposed curriculum plan forEBM within EM programs.

3. Undertake a systematic exploration of possible modalitiesfor training of EM faculty in EBM.

4. Develop specific educational resource initiatives relevantto EBM faculty development and curricular designs.

Approximately 25 individuals attended the meeting and PeterWyer was re-elected chairman for the coming year. The pre-liminary results of the survey of EM program directors weredistributed and reviewed. The lack of faculty interest and train-ing and of monetary and time resources were identified as lim-iting to incorporation of EBM in the curricula. Projects identifiedfor the coming year include development of a proposal forEBM didactic presentations at the 2001 SAEM Annual Meetingand a project to abstract the tables of sensitivities, specificitiesand likelihood ratios for elements of history and physical fromthe JAMA Rational Clinical Exam series into an online andprinted resource for use by EM programs. Committees wereestablished for each of these projects.

Steve Hayden (SH) agreed to chair a sub committeecharged with formulating the didactic proposal(s) on behalf ofthe IG.

There was discussion on modalities appropriate to realiza-tion of a faculty development and broader educational EBMagenda, once formulated. Modalities proposed included:Workshops, Teleconferencing, Web-based learning instru-ments, and On-Site workshops by mobile EBM teaching/tutorial teams

There was discussion on the appropriateness of a kind of‘certification’ for faculty EBM training. Some participantsopposed this from the standpoint that EBM learning anddevelopment of skills constitute a process that cannot beadequately ‘certified’ as the result of a discrete courseexperience. Bill Cordell proposed “point-of-care” as thestrategic guide to a curriculum design. Closing the ‘evidencetransfer gap’ at the point where decisions happen-thebedside. It was proposed that Dr. Cordell formulate hisproposal as a strategy statement that can be used to guidethe development of a curriculum plan. Differentiation oflearner-specific goals and identification of existing EBM train-ing options were also mentioned as important considerations.

Dr. Kuhn described a project to compile and disseminatetables of likelihood ratios, sensitivities and specificities forelements of clinical examination as part of an educationalvehicle for teaching EBM at the EM bedside. A formattedand categorized bibliography of the RCE series has alreadybeen done by Dr. Kuhn and can be obtained on theEBEM.org website. Dr. Kuhn proposed a project to abstractthe relevant tables from the RCE series, compile them andmake them available on-line and possibly as a printedcompilation through SAEM. A committee was formed for thepurpose of pursuing this project.

GeriatricLowell Gerson, PhD: lgerson@neoucom.eduObjectives1. Develop a didactic session about innovations in geriatric

education for residents, fellows and practicing physiciansfor the 2001 Annual Meeting.

2. Develop a research network to facilitate studies aboutelder ED patients.

3. Update the Elder Abuse Teaching Module.C. Seth Landefeld MD, Chief Division of Geriatrics spoke

with us about educational opportunities. After the talk we

had an informal discussion with Dr. Landefeld. This led to adecision to focus our didactic session proposal on educa-tional innovations.

The instructional materials and text have been scannedthanks to Wayne Satz and are ready to be put on the SAEMweb site. It was decided that we should consider updatingthese materials next year. The elder abuse case-basedteaching module has been receiving a lot of hits and down-loads. Bert Woolard, the original author, agreed to update it.

We agreed that a network of collaborating departmentswould facilitate research. Steve Meldon agreed to head upan effort to develop a research network. Some projects thatwere considered are short-term outcomes and prediction ofpatients who are likely to return to the ED.

We agreed that a speaker was a beneficial part of theinterest group meeting. Next year the group would like tohave a speaker talk about issues in geriatric injury preventionor management. Lowell Gerson will arrange for a speaker,probably from the CDC. Steve Meldon told us about theavailability of Geriatric Emergency Medicine Reports, apublication by American Health Consultants.

Health Services and Outcomes ResearchRobert J. Rydman, PhD and Lawrence Melnicker, MD, Co-Chairs: rjrydman@uic.edu and lam9004@nyp.org

Objectives1. Submit proposals for 2 didactic sessions for 2001 Confer-

ence in Atlanta: Introductory session “Measuring healthservices performance indicators: access, cost, quality-out-comes, and organization of care” and Advanced session“Econometrics in HSR: Microeconomic analyses of diag-nostic and treatment interventions in EM.” Possible others.

2. Work with SAEM program to plan for HSORIG spon-sorship of Spivey Lecture: Guest National HSR expert.

3. Submit EMRA newsletter article: “The Role of HealthServices and Outcomes Research in EM.”

The Health Services Research IG, chaired by Dr. RobertRydman, approved a merger with the Outcomes Research IG,chaired by Dr. Larry Melnicker. Both chairs will continue asco-chairs for one year. A reciprocal decision was made at theOutcomes Research IG meeting. A discussion of the HSR IGdidactic presentation at the 2000 conference in San Franciscoby Drs. Heidenreich, Zalenski, Lowe, and Rydman wasconducted. The state of membership, objectives, and plansfor more didactics at next year’s conference were discussed.Approximately 10 members attended the meeting.

Injury PreventionLinda Degutis, MD, Chair: linda.degutis@yale.edu

Objectives1. To develop and present a didactic session at the 2001

SAEM annual meeting;2. To develop and implement mechanisms for networking

with other professional organizations and agencies thathave an interest in the field of injury prevention. These in-clude but are not limited to: ACEP, APHA (American Pub-lic Health Association), ACS (American College of Sur-geons), ATS (American Trauma Society), NCIPC (CDC),STIPDA (State and Territorial Injury Prevention DirectorsAssociation), American Academy of Pediatrics (AAP), etc.

The meeting was attended by 14 members of the interestgroup. Discussion of the Didactic Session proposal for the2001 SAEM meeting centered around the benefit of havingthe Director of the National Center for Injury Prevention andControl of the Centers for Disease Control and Preventionparticipate in a session. The potential topics for the session

Interest Group Objectives and Report (Continued)

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included: injury prevention research priorities and opportuni-ties; innovative methods in injury prevention research; andinjury prevention program evaluation strategies. Linda C.Degutis, DrPH, Yale University, was elected to chair theinterest group.

InternationalJeff Smith, MD, Chair: emdjps@gwumc.edu

There were approximately 80 persons in attendance. TheInternational Interest Group completed the long-term projectof generating a series of published manuscripts which defineand provide the academic framework for internationalemergency medicine development. The latest three of thesepublications are the “Observational” International EmergencyMedicine Fellowship Curriculum manuscript which waspublished in the April issue of Academic EmergencyMedicine. The article on International Emergency MedicineJournals and Web Sites was published in the Annals ofEmergency Medicine in December 1999 and the manuscripton Planning Recommendations for International EmergencyMedicine System Development was published in AcademicEmergency Medicine in August.

Dr. Douglas Rund made a presentation on an emergencymedicine development project he is working on in Brazil. Dr.Gary Green provided an update on the activities of the or-ganization, Emergency International. A report on the activi-ties of the ACEP International Section was made. The ACEPPresident has appointed a Special Task Force in Interna-tional Emergency Medicine to plan and coordinate ACEP’sefforts in this field. Dr. Phil Anderson has been working oncoordinating international emergency medicine information tobe placed on the SAEM web site.

Dr. Kris Arnold has completed a major project involvingplacing on the web the information previously accumulatedby the International Interest Group on emergency medicinerotations available in other countries for residents and stu-dents. Dr. Arnold encouraged attendees who might know ofadditional rotations to access the web site and send himinformation electronically on these new rotations. The website address is www.ed.bmc.org/iem/search.cfm.

It was reported that the American Academy of EmergencyMedicine is planning a conjoint conference with the Euro-pean Society of Emergency Medicine in the year 2001. Dr.Antoine Kazzi of the University of California, Irvine is coordin-ating this project.

Elections for new officers of the Interest Group were heldand Dr. Jeff Smith was elected Chair, Dr. Mark Davis waselected Vice-Chair, Dr. Kris Arnold was elected Secretaryand Dr. Joseph Epstein and Dr. Kumar Alagappan wereelected Members at Large. Dr. Mike Drescher was electedInternational Advisor to the Interest Group.

Dr. Jon Mark Hirshon will chair a committee which willdevelop a list of clinical opportunities in emergency medicinein which physicians from the U.S. can participate in othercountries.

Dr. Joe Epstein, Dr. Kumar Alagappan and Dr. GaryGreen will chair the development of a grid for recordingprovisions and features of the emergency medicine and EMSsystems in different countries. This would utilized as a surveyto start to be able to provide outcomes analysis of emer-gency medicine system effectiveness in different countries.

The SAEM office will be contacted to determine if rejectedabstracts from international sources might be able to beaccepted for presentation during one of the SAEM InterestGroup business meetings to allow physicians from othercountries to attend the meeting. A letter will be sent to theSAEM Board requesting consideration of reduced dues andmeeting fees for international attendees. The goal of thiswould be to increase the interest in academic emergency

medicine in other countries. Dr. Holliman then presented his lecture on academic and

development aspects of international emergency medicine.

Medical Student EducatorsJamie Collings, MD, Chair: jcolli@luc.edu

Objectives1. Start a web site for medical student educators that would

be a resource for lecture/teaching information2. Contact all medical school student rotation directors to

determine what computer based teaching/skills materialsthey are using

3. Submit a didactic proposal to invite a speaker to helpteach people how to make web based teaching materialsand interactive computer teaching lectures for medicalstudent rotations

Approximately 25 members attended the Medical StudentEducators Interest Group meeting.

Jamie Collings, MD, was elected chair and Dave Manthey,MD, was elected vice-chair. The interest group discussedwhat the SAEM Undergraduate Committee is working on.We discussed the need to obtain accurate information aboutclerkship requirements at all medical schools and thedifficulties getting the survey to those people who can andwill accurately provide information for their medical school.We also discussed starting a central database with links toindividual websites. This database would be available to allmedical student educators and would contain lectures,interactive computer modules, or whatever teachingmaterials people chose to provide. Our goal would be toallow medical student educators access to what other peopleare teaching and enhance their curriculum without having toproduce it all themselves. We then discussed developing aproject proposal that would involve computer informatics andinnovative teaching approaches.

Neurological EmergenciesDexter Morris, MD, Chair: dmorris@med.unc.edu

Objectives and a narrative report have not yet been submitted.

Pain ManagementJames B. Jones, MD, PharmD, Chair: jbjones@clarian.com

Objectives1. Link all members of the interest group on listserv2. Develop a “state of the art” session for 2001 Annual

Meeting.3. Develop an educational session on how to teach resident.

Approximately 10 members attended the Interest Groupmeeting and it was agreed that elections would be held at the2001 SAEM Annual Meeting.

PediatricJill Baren, MD, Chair: jbaren@mail.med.upenn.eduObjectives and a narrative report have not yet been submitted.

Research DirectorsMichelle Blanda, MD, Chair: blandam@summa-health.org

Objectives1. New Research Directors Manual project.2. Didactic proposals for 2001: If accepted, develop faculty

and agenda.Didactic proposals for 2002: Ideas for new proposals.

3. Development of an ED database. The Public Health TaskForce has started to develop a new public health processwhere they collect data on screening for domestic vio-

Interest Group Objectives and Report (Continued)

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lence, how many people are doing it, making it relevant toemergency medicine. Bob Rydman had talked about thisand we may have him talk about it again here.

Approximately 20 members attended the meeting. MichelleBlanda was elected chair. The first item of discussion wasthe database of EM researchers. This has been assigned tothe research committee to form a database of researchersthat are used for industry. Many people have managed itbefore including Geoff Rutledge. SAEM has developed atask force that will look at this (Brian Zink, Larry Melniker).There were concerns about the qualifiers, how it would beused and the information that was put in regarding funding.This is an informational item only and no action was taken.

It was agreed there should be a research directors orien-tation, similar to what is given to new residency directors. Wedecided that we may do a type of workshop that is approxim-ately 1/2 to 1 day long. Focus would be on precepting resi-dents, teaching research curriculum, evaluations, time man-agement and resources.

Substance AbuseRobert Woolard, MD, Chair: robert_woolard@brown.edu

Objectives1. Propose and conduct a training session at 2001 Annual

Meeting on changing behaviors: Present innovative train-ing strategies for physicians on advising or counselingpatients.

2. Participate in the planning of and conduct an EM alcoholresearch conference (in conjunction with CDC).

3. Create an EM bibliography of substance abuse articlesand make it available on the web site.

4. Seek approval for an abstract submission category inSubstance Abuse.

There were approximately 10 participants. SubstanceAbuse Interest Goals were reviewed and new draft of goalsfollows:

1. Develop and promote a more comprehensive approach toAddiction Medicine within Emergency Medicine, includingprevention strategies, an educational curriculum, and a re-search agenda.

2. Promote EM research in substance abuse, including de-fining appropriate topics and identifying funding sources.

3. Promote liaison with other organizations in the field of sub-stance abuse research and treatment.

An update of current projects was presented. Dr. Woolardagreed to continue to press for the creation of a substanceabuse abstract submission category at SAEM. Dr. GailD’Onofrio reported that the educational materials for EM resi-dents are available through the SAEM web site. Dr. DanPollock reported on planning a CDC sponsored conferencewhich should set the research agenda for EM alcohol inter-ventions. The 2-1/2 day meeting will be held in the Washing-ton, DC area in April, 2001. Dr. Runge agreed to create a bib-liography of Substance Abuse articles in the Emergency Med-icine literature for distribution to the Substance Abuse InterestGroup. Ultimately this bibliography can be appended to theresident alcohol educational materials on the SAEM web site.

There was discussion of the need for EmergencyMedicine experts to bring the alcohol educational materials toresidency programs and give grand rounds. It was generallyaccepted that no or little education is given to EM residentsconcerning addiction medicine. However, it was noted by Dr.D’Onofrio that the SAEM alcohol web site has been quiteactive. Dr. Woolard will seek requests from CORD throughthe CORD list. Requests for grand round speakers will beforwarded to Substance Abuse Interest Group members viae-mail.

It was agreed that substance abuse is an area ofconsiderable public debate with well funded, active researchunderway and a promise to improve EM training and the carewe provide. Nationally, university based centers for alcoholand addiction studies, the NIAAA, NIDA, CDC, NHTSA andHCPQR have “discovered” the teachable moment in theemergency department. Opportunity abounds the academicemergency physicians who get involved now.

ToxicologyLeslie Wolf, MD, Chair: leslie.wolf@wright.edu

Approximately 10 individuals attended the SAEM ToxicologyInterest Group meeting (STING). The chair is Leslie Wolf, andthe secretary is Stewart Wright. The group will continue torevise the guidelines for Toxicology training for EM residentswith a goal to submit a manuscript to AEM. We discusseddeveloping an award and the fund for Toxicology trainingbeing developed through FAEM. The group agreed to developguidelines for the fellowship. We discussed the didacticsubmission guidelines and possible topics for submission forthe 2001 Annual Meeting. The group was also informed andgiven details about the Toxicology CPC and didactic sessionat the annual Toxicology meeting in Tucson this fall. Thegoals of the SAEM leadership (faculty development, nationalaffairs, and research) were relayed to the group. The nextmeeting will be held in Tucson in September.

TraumaMichael Gibbs, MD, Chair: mgibbs@carolinas.org

Two didactic submissions were suggested for 2001. Dr.Bilkovski expressed an interest in developing a proposal re-garding non-invasive hemodynamic monitoring of trauma pa-tients. This proposal generated significant enthusiasm in thegroup since non-invasive hemodynamic monitoring is notcommonly used currently. Dr. Bilkovski will speak withtrauma researchers including Drs. Manny Rivers and RichardSummers who have experience in the use of these devices.He will develop a protocol for a didactic session on the po-tential for future use of these devices and suggest severalspeakers. A didactic session on the use of cyto-protectiveagents in preventing secondary injury in trauma was alsoconsidered.

Donnie Baron gave a brief update on the status of thepenetrating neck trauma study. Subjects are no longer beingenrolled. 150 patients have been enrolled to date in theShoulder Dislocation study. Boston Medical Center andParkland in Texas are currently the two participating centers.Patient enrollment will continue. Dr. Michael Gibbs waselected the new chair of the interest group.

Ultrasound Interest GroupMichael Blaivas, MD, Chair: blaivas@pyro.net

Objectives 1. Promotion of outcome research of emergency ultrasonog-

raphy.2. Establishment of an image bank on SAEM web site for

ultrasound educators.3. Joint ACEP-SAEM position statement on emergency

ultrasound education.4. Establishing training and credentialling criteria for the field.

Approximately 70 members attended. Elections for chairwere held. Dr. Blaivas was elected.

Vivek Tayal discussed efforts to draw up credentiallingguidelines for the field, as well as standardizing the education

Interest Group Objectives and Report (Continued)

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that sonographers should receive. ACEP and SAEM will beputting forth a joint position document with the objective, “toprepare a joint document that will provide a comprehensiveoverview of the role of ultrasound in the practice of emer-gency medicine.” The outline is being submitted to the boardsof SAEM and ACEP for approval. Larry Melniker discussedhis work to the SOAP trial(s). A number of these studies willsoon be under way. The prospective version of the first SOAPstudy has also begun. Approximately five other SOAP trialsare in the works with a number of primary investigatorsinvolved. Anthony Dean discussed his work with a rigorousand standardized test of ultrasound skills, which is nowcomprised of almost 80 questions. Dr. Dean was elected tothe chair-elect. Testing on the examination is now underwayand consists of image recognition and interseparation as wellas other knowledge questions. Work on the proposed imagebank was discussed with a proposal to be submitted to theSAEM Board. The bank will initially consist of still images butmay eventually include MPEG video clips. Mike Petersondiscussed his survey of ultrasound program costs. Thepreliminary results show surprising breadth of answers onsome issues with conformity on others. The “white paper,” adocument requested by ABEM, was discussed by MikeHeller and the group working on it. This document willdiscuss the need for ultrasound training in emergencymedicine. It will likely cover the extent of its applications and

Interest Group Objectives and Report (Continued)

may mandate or suggest uniform training in all residencyprograms.

Web-educatorsJ. Stephen Huff, MD, Chair, jshuff@virginia.edu

Objective1. To serve as a resource and development tool for web-

based educational projects for interest group members.

The organizational meeting was attended by 17 indi-viduals and was convened for the purpose of forming aninterest group to promote internet use as an educational toolfor emergency physicians. The Web-educators’ interestgroup (WIG) was organized after 20 members expressed thedesire to form an interest group. A listserve will be organized.The objective of the group is to serve as a resource and de-velopment tool for interest group members. Possibleactivities discussed included forming a project gallery formembers, linking to projects presented at SAEM meetings,and providing a forum for technical advice on web activities.It was proposed that a web site be created for the group withlinks for educational related emergency medicine sites.

Youth Violence PreventionKaryn Cole, MD, Chair: kcole@fac.howard.eduObjectives and a narrative report have not yet been submitted.

have ever encountered – people likeMichelle Biros, Scott Syverud, BrianGibler, Dan Savitt, Susan Gin-Shaw,Mike Spadafora, and Jim Hoekstra. So,when I had an inkling to try out aresearch idea on alcohol and shock inthe laboratory setting, I was pulled in bythe faculty and residents and steered inthe right direction. When I needed helpwith statistics, it was there. When mypapers or book chapters needed acritical yet gentle review there wereunconditional offers to help.

I went to my first national emergencymedicine meeting as a second yearresident, and had the chance to presentmy study as a fledgling investigator. Atthat point I became hopelessly hooked.I had come to realize that while aca-demic emergency medicine is a job,and a career, it is also a cause, basedon a need. Emergency patients needbetter care, and the way to achieve thatis through research and education. Asa latecomer to the world of academicmedicine, emergency medicine has agreat deal of catching up to do. WhenI took my first job out of residency in1988, I was compelled by the idea thatthe need for academic physicians whowere true to the cause was greater inemergency medicine than in any otherdiscipline. I think that is still the case.So, the short answer to the first part ofthe question — why did you go intoacademic emergency medicine? Be-cause I had exceptional role models,and I was needed.

I have no problem answering the

President’s Message (Continued)

second part of the question in the affir-mative — I think that academic emer-gency medicine is the best job in medi-cine. Am I happy? Well, not alwaysdeliriously so, but I am able to leave themedical center most days with a senseof contentment and satisfaction with thework I have done. Academic emergencymedicine can be an immensely satis-fying career for a number of reasons:

Clinical CareAcademic emergency department

patients are the most challenging co-hort in medicine. The challenge comesfrom two ends of the spectrum. On theone hand, academic health centers, astertiary medical facilities, care for theunfortunate patients who have complex,rare, or especially difficult diseases tomanage. These patients — the livertransplant patient with fever, the lupuspatient with altered mental status —present with complicated medicalemergencies, where prompt diagnosisand treatment is crucial to a good out-come. On the other hand, manyacademic ED’s serve an urban, indigentpopulation where common diseases areseen with their worst manifestationsdue to inadequate health care, neglect,or psychosocial factors. The academicemergency physician must have theexpertise to handle, and to teach othershow to handle, the complicated and thecommon. The progression toward thislevel of expertise has many humblingmoments, but I believe the mastery ofclinical care in an academic ED is one

of the highest achievements that can bemade in American medicine.

Teaching I put teaching before research on this

list, even though I am a huge advocateof the development of research in emer-gency medicine. The greatest academicemergency physicians are first and fore-most great teachers. Is it paradoxicalthat the loudest, most hectic place in thehospital is the best teaching environ-ment? Not when we think of the key ele-ments of teaching — interesting subjectmatter, and the student’s role as anactive learner. A medical student mayhear an in depth discussion of diabeticketoacidosis during ward rounds on aninternal medicine rotation, but that samestudent will learn DKA better when sheis drawing a blood gas on a DKA patientin the ED, feeling Kussmaul’s respira-tions blow across her forehead, andmaybe catching a whiff of ketones. Thismedical student sometimes ends up asan emergency medicine resident, andthe satisfaction that comes from helpinga fresh, eager, scared intern developinto a confident, caring, competentsenior emergency medicine resident isimmense. The intense, direct contactthat emergency medicine faculty havewith their residents makes for a uniqueteaching relationship. Teaching anemergency medicine resident changesa three a.m. rendezvous with acombative, intoxicated trauma patientfrom a routine, and somewhat tiresome

(continued on next page)

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President’s Message (Continued)

case, into an opportunity to shareexperience and knowledge.

A lot of little guppies have the chanceto swim in the big fishbowl that is theacademic ED, and as a result, academicemergency physicians play a huge rolein the education of American physicians.This is reinforced when I travel aroundthe country, and encounter physicianswho remember me from their days as amedical student, when I taught them tosuture, or when they were an internalmedicine resident and we treated apatient with ethylene glycol poisoning.Academic emergency physicians alsoserve as teachers of paramedics,EMT’s, nurses, and other health careprofessionals. The opportunity to havean impact on the education of so manypeople is probably the most rewardingpart of academic emergency medicine.The need for excellent teachers will notdiminish in the future. Despite this greatneed and the prominent role thatteaching plays in our lives, most currentacademic physicians have no formaltraining in education. I am hopeful that atleast some of the current generation ofmedical students and emergencymedicine residents who aspire to beacademic emergency physicians canimprove the quality of our teaching byobtaining formal training in education.

ResearchProviding clinical care and teaching

in the ED are academically enrichingactivities that have strong elements ofservice to others. Research is a moreselfish pursuit. While the ultimate goalis to improve patient care, for most aca-demicians doing research is l ikescratching an itch. The itches are theresearch questions that keep oneawake at night, and the scratching isthe experiments or studies that will pla-cate the itch. I have previously high-lighted the great opportunities that existfor emergency medicine researchers,including the new emphasis on clinicalresearch funding at a national level.Residents who are entering academicemergency medicine have unprece-dented options for funded researchtraining fellowships, career develop-ment grants, and seed money for start-up research projects. They also have abigger core of qualified emergencymedicine investigators to serve as men-tors and role models. Ten years ago,emergency medicine research was onthe fringes, but this is no longer thecase. We now enjoy representation viafunded research or administrative andadvisory roles in every major researchniche in both national research institu-tions and the biomedical industry. Thefuture is bright for research, but, again,the issue of need arises. We needbright and motivated emergency physi-

experiment in the lab, attending noonemergency medicine resident confer-ences, giving a medical student lecture,counseling some students on careerchoices, and then working an afternoonshift in the ED. It is not clear if the tri-quetrous career of clinical care, educa-tion and research will hold up in theworld of academic medicine, but evenas a two pronged attack, the job hasamazing variety. Not everyone wantsthis amount of stimulation, but I wouldchallenge anyone to find an academicemergency physician who is bored withhis or her job. Because of this variety,something positive is almost alwayshappening – my experiment may havefailed that day, but I helped a medicalstudent make a career decision, and aresident learned how to manage acutepulmonary edema.

Yes, I’m glad that I went into aca-demic emergency medicine. Nowhereis the need greater. No other job inmedicine has more variety or chal-lenges than clinical care in the ED. Inno other job is there the opportunity toteach so many people. In no other jobis quality research needed more. Andno other patients need our nationalinvolvement and advocacy more thanemergency patients. To the residentsand medical students who arecontemplating their career choice, Iinvite you experience the challenge ofthe best job in medicine.

Brian Zink, MDSAEM PresidentUniversity of Michigan

cians to go out and seek research train-ing, so they can take advantage of theplentiful resources that are currentlyavailable. And our patients need us asresearcher leaders — no one else bet-ter understands how research cantranslate into improved care for emer-gency patients than academic emer-gency physicians.

Professional InteractionsJust as the ED provides broad expo-

sure to all types of trainees, it also pro-vides opportunities for interactions withfaculty in the other disciplines of medi-cine. The turf wars and adversarial rela-tionships that were part of the assimila-tion of emergency medicine into theacademic world are largely over. One ofthe best aspects of being an academicfaculty member is the chance to collab-orate with non-emergency medicinefaculty who may have valuable exper-tise, insights, and resources. The ED,with its high patient volumes, and largenumber of trainees, may be the idealsite for joint research studies or educa-tional projects. As front line providers,academic emergency physicians cancontribute to collaborative efforts inareas such as public health, drug devel-opment, testing of medical devices, andpatient safety. Especially in big aca-demic centers, many investigators haveno exposure to acute care, and greatlyappreciate the broad-based, real worldperspective of the academic emergencyphysician. This same perspective canbe valuable in administrative roles.Professional interactions are the part ofsustenance of academic life, and thestrength of these interactions promisesto increase as academic emergencymedicine matures and improves itseducational and research efforts.

National Involvement andAdvocacy

While it is possible to become in-volved in the big picture of health careas a community emergency physician,an academic career provides more op-portunities to serve at a national level.Whether it is in the realm of research,education, public health, or governmen-tal affairs, the chance to work on a na-tional level for an important cause canbe instructive and satisfying. Academicemergency physicians who work inbusy teaching hospital ED’s have anunquestioned credibility when speakingon issues that concern emergencycare. We can use this credibility to ad-vocate for improved patient care, re-search and education in the field.

If variety is the spice of life, then aca-demic emergency medicine is like aThai curry. When people ask me how Ispend my time, I have to laugh as I takethem through a day of doing a morning

Call for Proposals inMedical Education

ResearchThe National Board of Medical Ex-aminers has announced a call for pro-posals (CFP) for the 2000-2001 EdwardJ. Stemmler, MD, Medical Education Re-search Fund. Grants of up to $70,000will be awarded for research or develop-ment of innovative evaluation methodol-ogy in medical education. Pilot and morecomprehensive projects will both be con-sidered. Eligible applicants include allmedical schools accredited by the Liai-son Committee on Medical Education orthe American Osteopathic Association.The full CFP guidelines and applicationforms can be downloaded at http://www.nbme.org/new.version/CFPentry.htm.The proposal deadline is November 12 .For more information, contact DeborahKuhar, National Board of Medical Ex-aminers, (215) 590-9657 or dkuhar@mail.nbme.org.

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FELLOWSHIP POSITIONSROCKY MOUNTAIN POISON AND DRUG CENTER: MEDICAL TOXI-COLOGY fellowship program is recruiting applicants for two positions be-ginning July 1, 2001. Our two-year ACGME-accredited program providesextensive clinical (>150,000 poison center calls/year from four state region& in-patient service), research, publishing, and teaching experience underthe supervision of ACMT and ABEM certified faculty. Affiliations includeDenver Health Medical Center (level 1 trauma center) and University ofColorado Health Sciences Center. RMPDC is an Equal Opportunityemployer. For more information contact Richard Dart, MD, PhD, Director,Rocky Mountain Poison and Drug Center, 1010 Yosemite Circle, DenverCO 80230 (phone: 303-739-1100; email: rdart@rmpdc.org).

FACULTY POSITIONSGEORGIA: The Department of Emergency Medicine at the Medical Col-lege of Georgia has an opening for a full-time emergency attending.Candidates must be board certified or prepared in emergency medicine.Established emergency medicine residency program with eight residentsper year. Spacious ED facilities. Children’s hospital and beautiful pedi-atric ED. Over 50,000 visits per year. Level I trauma center for pediatricand adult patients. Energetic young faculty with diverse academic back-grounds. Augusta is an excellent family environment and offers a varietyof social, cultural, and recreational activities. Compensation and benefitsare excellent and highly competitive. Please contact: Larry Mellick, MD,Chair and Professor, Department of Emergency Medicine, 1120 15th St.AF 2036, Augusta, GA 30912; 706-721-7144; e-mail: Lmellick@mail.mcg.edu EOE/AA

NEW YORK CITY, Director of Clinical Operations: Exciting position forexperienced board certified emergency physician to join the faculty, De-partment of Emergency Medicine, Mount Sinai School of Medicine;manage operations, informatics and fiscal issues during a time of signifi-cant departmental growth. Combined annual ED census over 80,000,EM residency program, 1100-bed tertiary center. Academic rank com-mensurate with qualifications. Please submit confidential letter and CVto Scot Hill, MD, Chair of Search Committee, Department of EmergencyMedicine, Mount Sinai School of Medicine, One Gustave L. Levy Place,New York, NY 10029. Fax: 212-426-1946.

Albany Medical CollegeFaculty Position

Department of Emergency Medicine

Open rank: The Albany Medical Col-lege Department of Emergency Medi-cine is seeking Board Eligible or BoardCertified emergency physicians for anacademic position with research,teaching and patient care responsibili-ties. Salary, rank and track commen-surate with accomplishments and ex-perience. The Emergency Departmentcares for 65,000 patients per year andserves as the primary teaching site fora fully-accredited emergency medicineresidency program. Albany MedicalCenter is a level 1 trauma center withactive air and ground transport pro-grams. The Albany Medical College isan equal opportunity/affirmative ac-tion employer. Send CV to VinceVerdile, MD, Chairman, Department ofEmergency Medicine, Albany MedicalCollege, MC-139, 47 New ScotlandAvenue, Albany, NY 12208, 518-262-3773; Fax 518-262-3236.

Mayo ClinicRochester, Minnesota

EMERGENCY PHYSICIANThe Department of Emergency Medicine is seeking a full-timeacademic emergency physician. Opportunities include:m Clinical practice in a Level 1 Trauma Center with 77,000

visits/year.m Involvement in a recently accredited Emergency Medicine

Residency Program.m Supervising and teaching Emergency Medicine residents, off-

service residents and medical students.m Research and administrative support and intramural funding

available.m Prehospital/aeromedical care in base station hospital for para-

medics, 2 helicopters/1 jet.m Academic appointment in Emergency Medicine at Mayo

Medical School.

Candidates must be: residency trained emergency medicine spe-cialists; ABEM board certified or eligible; individuals with estab-lished track records in academic emergency medicine as provenby performance in residency training, fellowship training, orfaculty positions; Minnesota medical license or eligible. Competi-tive salary with excellent benefit package. For further informa-tion, contact:

Thomas Meloy, MDChair, Department of Emergency Medicine

Saint Marys Hospital — Mayo Clinic1216 Second Street, SWRochester, MN 55905Phone: (517) 255-4399

Mayo Foundation is an affirmative action and equal opportunity employer and educator.

22

Emergency Medicine at NorthwesternUniversity School of Medicine

Applications are invited for full-time faculty in the Division of EmergencyMedicine (open rank). The Attending Physician, Emergency Medicine is re-sponsible for clinical practice in the Emergency Department of North-western Memorial Hospital, for the teaching of residents and medical stu-dents, and for demonstration of academic productivity. The newly build(1999) Emergency Department serves over 60,000 patients/year andserves as a Level 1 Trauma Center for the city of Chicago. The residencyprogram has enrolled its 27th class, currently accepting 7 EM residents/year. The hospital is committed to service excellence and innovation. Appli-cants for this faculty position must have completed residency training inemergency medicine. Preference will be given to applicants with demon-strated research interest and to those who will serve as exceptional rolemodels for residents and medical students. Women and minorities areencouraged to apply. Salary is commensurate with experience. Proposedstart date is September 1, 2000. To ensure full consideration, please send acurriculum vitae, along with a brief description of career interests, prior toSeptember 1, 2000, at:

JAMES ADAMS, MDNORTHWESTERN UNIVERSITY SCHOOL OF MEDICINE

DIVISION OF EMERGENCY MEDICINE216 E. SUPERIOR STREET, SUITE 100

CHICAGO, IL 60611

Northwestern University is an Affirmative Action/Equal Opportunity Employer. Hiring iscontingent upon eligibility to work in the United States.

UNIVERSITY OF CALIFORNIA, DAVIS isrecruiting for a full-time faculty in Academic Emer-gency Medicine at the Assistant, Associate or FullProfessor level. Eligible candidates must be boardcertified in Emergency Medicine, or anticipate grad-uation from an RRC-approved training program inEmergency Medicine. Individual must be eligible forlicensure in the state training program in EmergencyMedicine. Individual must be eligible for licensure inthe State of California. Candidate must have a mini-mum of one recent publication in an EmergencyMedicine journal and presented an abstract at anational scientific meeting. The UC Davis EmergencyDepartment is located in Sacramento, California. Itsees 65,000 patient visits per year, has 29 EmergencyMedicine residents, an aeromedical program, and acritical trauma volume placing it in the top fivebusiest programs nationally. Responsibilities of theposition include: Clinical care, teaching of medicalstudents and residents, and a commitment to clin-ical research in the area of Emergency Medicine.For consideration, send a letter outlining your re-search, teaching background and interests, admin-istrative experience, curriculum vitae, and a list offive references to: Donna Kinser, MD,; Chair, Emer-gency Medicine Search Committee, University ofCalifornia, Davis, Health System; 2315 Stockton Blvd.,PSSG 2100; Sacramento, CA 95817. Position is openuntil filled, but not later than January 31, 2001. TheUniversity is an Affirmative Action/Equal Opportunityemployer.

OREGON HEALTH SCIENCES UNIVERSITY Department of EmergencyMedicine is conducting an ongoing recruitment campaign for talentedfaculty members: 1) Entry-level clinical faculty members at the Instructorand Assistant Professor level. Preference given to those with Fellowshiptraining (especially in Pediatric Emergency Medicine) or equivalent experi-ence. 2) PhD or MD/MPH research faculty member experienced in col-laborative clinical research, microcomputer database use, epidemiology,and statistics. Excellent research and writing skills are mandatory. Evidenceof extramural funding potential is required. Knowledge of emergencymedicine as a clinical discipline is expected. Please submit a letter of inter-est, CV and the names and phone numbers of 3 references to: Jerris Hedges,MD, MS, Professor & Chair, OHSU Department of Emergency Medicine,3181 SW Sam Jackson Park Road UHN-52, Portland OR 97201-3098.

UNIVERSITY OF CALIFORNIA, San Diego: Department of EmergencyMedicine is recruiting for full-time Research Director. The UCAD DEMincludes a Comprehensive ED with a census of 38,000; a basic ED witha census of 18,000; clinical programs in Hyperbaric Medicine and Medi-cal Toxicology; a node of the California Poison System; a busy Para-medic Base Hospital; an air medical service; a regional DMAT; a PGY 2-4 emergency medicine residency; and fellowship training programs inHyperbarics and Toxicology. There are presently 15 full-time faculty inthe department with plans to expand to 17 July 1, 2001. Will considercandidates with PhD or MD degree. Physician applicants must be EMboard certified with California medical license or eligible to apply. For-mal training and prior research experience required. Established extra-mural funding desirable. Appointment level and salary commensuratewith qualifications and experience; salary per established UCAD salaryscale. Reply to David A. Guss, MD, Director, Department of EmergencyMedicine, UCSD Medical Center, 200 West Arbor Drive, San Diego, CA92103-8676; 619-543-6217; email: dguss@ucsd.edu. AA/OE

UNIVERSITY OF CALIFORNIA, San Diego: Department of EmergencyMedicine is recruiting for full-time faculty positions starting July 1, 2001.The UCSD DEM includes a Comprehensive ED with a census of 38,000;a basic ED with a census of 18,000; clinical programs in HyperbaricMedicine and Medical Toxicology; a node of the California Poison Sys-tem; a busy Paramedic Base Hospital; and air medical service; a regionalDMAT; a PGY 2-4 emergency medicine residency; and fellowshiptraining programs in Hyperbarics and Toxicology. EM board certification

or eligibility and California medical license or eligibility to apply re-quired. Appointment level in the clinical series commensurate with ex-perience/qualifications; salary per established UCAD salary scale. Replyto David A. Guss, MD, Director, Department of Emergency Medicine,UCSD Medical Center, 200 West Arbor Drive, San Diego, CA 92103-8676; 619-543-6217; email: dguss@ucsd.edu. AA/OE

UNIVERSITY OF MISSOURI-KANSAS CITY/TRUMAN MEDICAL CEN-TER, Department of Emergency Medicine seeks academic faculty for afull-time appointment at the assistant or associate professor level.Candidate must be board-certified or board-eligible in EM and havedemonstrated research interests. TMC is the primary teaching hospital forthe UMKC School of Medicine; fully accredited EM residency since1973. Current research in infectious disease surveillance, trauma, EDultrasonography, asthma, EMS, public health, and clinical process im-provement. Contact Robert A. Schwab, MD, Truman Medical Center,2301 Holmes S., Kansas City, MO 64108. (816) 556-3250. Schwabra@trumed1.trumanmed.org. An equal opportunity employer.

UNIVERSITY OF NEW MEXICO, Albuquerque: Department of Emer-gency Medicine: Faculty positions, Clinician Educator or Tenure track,are available for board certified/board eligible Emergency Physicians,with strong clinical skills and demonstrated interest and experience inteaching and in research. Qualified applicants are invited to send a letterof interest, CV, & two letters of recommendation to David Sklar, MD,Chair, UNM Health Sciences Center, Department of Emergency Medi-cine, ACC 4-West, Albuquerque, NM 87131. Positions open until filled.For best consideration, submit application materials before November30, 2000. EEO/AA

UNIVERSITY OF TEXAS MEDICAL BRANCH IN GALVESTON, TEXAS isseeking candidates for full-time faculty positions in emergency medicine.Candidaes must be BE/BC in emergency medicine or in a primary carespecialty with emergency medicine experience. Opportunities forclinical care, teaching of housestaff and students, and research. TheEmergency Department has a diverse, high acuity patient populationwith an annual census of 72,000. UTMB is an equal opportunity/affirma-tive action employer m/f/d/v. UTMB hires only individuals authorized towork in the US. Send inquiries to Paul W. English, MD, Co-Director,Emergency Medicine, UTMB-Galveston, 301 University Blvd., Galves-ton, TX 77555-1173; Phone: 409-772-1425; Fax: 409-772-9068.

23

EMERGENCY MEDICINE RESEARCH ASSOCIATE

The Department of Emergency Medicine atMaimonides Medical Center in Brooklyn,New York is seeking a Research Associate.

The emergency department is advancing anacademic and research theme based on operationsresearch of clinical service delivery andevidence-based emergency medicine. We areexploring establishment of an emergencymedicine residency program. Credentialsappropriate to support academic appointment atour university affiliation are required.

The department serves over 75,000 patientsannually from diverse cultural backgrounds in aunique community setting. PhD applicants withclinical research experience are preferred. Thesalary and benefits are competitive.

Mail CV to Daniel G. Murphy, MD, ViceChairman and Medical Director, Department ofEmergency Medicine, Maimonides MedicalCenter, 4802 Tenth Avenue, Brooklyn, NewYork, 11219, or e-mail to dmurphy@maimonidesmed.org.

Open Rank: The University of Cincinnati Departmentof Emergency Medicine has a full-time academicposition available with research, teaching, and patientcare responsibilities. Candidate must be residencytrained in Emergency Medicine with boardcertification/preparation. Salary, rank, and trackcommensurate with accomplishments andexperience. The University of Cincinnati Departmentof Emergency Medicine established the first residencytraining program in Emergency Medicine in 1970.The Center for Emergency Care evaluates and treats76,000 patients per year and has 40 residents involvedin a four-year curriculum. Our department has a longhistory of academic productivity, with outstandinginstitutional support.Please send Curriculum Vitae to:

W. Brian Gibler, MDChairman, Department of Emergency MedicineUniversity of Cincinnati Medical Center231 Bethesda AvenueCincinnati, OH 45267-0769.

FACULTY POSITIONSDept. of EM • Tufts University School of MedicineBaystate Medical Center • Springfield, MA 01199

www.baystatehealth.com

Senior Emergency Medicine Researcher: Seeking an emergency medicine researcher withexperience in clinical research and grant writing. The position includes significant protected time;minimal clinical and administrative responsibilities; competitive salary (AAMC Standards) notbased on grant support; departmental research staff including a clinical nurse researcher, a team ofEM research faculty; office space and secretarial support; an academic appointment with TuftsUniversity School of Medicine consistent with experience and publications.Pediatrics Emergency Medicine: Seeking BC/BE physician board certified or board eligiblein Pediatric Emergency Medicine to join a regional trauma center with a fully-accreditedEmergency Medicine Residency Training Program and a Children’s Hospital. Opportunitiesinclude a full unencumbered medical school academic appointment and an active clinical researchprogram. You will serve as an attending physician in the Pediatric Emergency Department anddevelop and direct a Pediatric Emergency Medicine Fellowship Program.Emergency Medicine Physicians: Seeking BC/BE emergency medicine physicians, residencytrained in Emergency Medicine, for full-time positions (open rank) available with patient care,teaching, and clinical research responsibilities. Salary and academic rank commensurate withaccomplishments and experience.Baystate Medical Center is a Level 1 Trauma Center, 600-bed hospital with an annual ED censusof 85,000 in Western Massachusetts, Baystate Medical Center has a PGY1-3 emergency medicineresidency with 8 residents per year and was recently named one of the top 15 major teachinghospitals in the United States for clinical excellence and efficient delivery of care (HCIA and TheHealth Network).Springfield is located in the beautiful Connecticut River Valley at the foothills of the Berkshireswith convenient access to coastal New England, Vermont and metropolitan Boston and New York.The area also supports a rich network of academic institutions including the University ofMassachusetts and Amherst, Smith, Hampshire and Mount Holyoke Colleges.Please send your letter of interest with curriculum vitae to:

Philip Henneman, MD, Professor and ChairDept .of Emergency Medicine, Tufts University School of Medicine

c/o Don Rainwater • Baystate Health System759 Chestnut Street, Suite S1578 • Springfield, MA 01199

Telephone: (800) 767-6612 • Fax: (413) 794-5059 • Email: Don.Rainwater@bhs.orgBaystate Health System is an Equal Opportunity Employer

UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER ATDALLAS: Unique academic opportunity in EM. EM faculty will have anopportunity to be involved in the establishment of a first-rate EM divisioncommitted to excellence in patient care, education and clinical research.Full-time and part-time openings BC/BP faculty for the University of TexasAffiliated Emergency Medicine Training program, comprised of ParklandHospital and Children’s Medical Center. An equal opportunity employer.Respond in full confidence to Paul E. Pepe, MD, Chairman, Division ofEmergency Medicine, UT Southwestern Medical Center at Dallas, 5323Harry Hines Blvd., Dallas, TX 75390-8579, (214) 646-3916.

UNIVERSITY OF WISCONSIN HOSPITAL AND CLINICS. BC/BE EDPhysician for Level I Trauma Center with 33,000 visits/year. Clinicalteaching responsibilities for Medicine, Pediatric, Family Medicine andSurgery housestaff. Clinical research opportunities. Flight physician op-portunities on helicopter critical care transport service (>1,200 flights/year). Premiere health care facility and tertiary referral center providingcare to patients with the widest array of diagnoses providing a stimulat-ing and challenging clinical environment. Superb living standard in avery desirable community with a highly respected University. Competi-tive salary, benefits and clinical workload. Phone: 608-263-1325; Fax608-262-2641; jrc@medicine.wisc.edu

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WEST VIRGINIA UNIVERSITYEMERGENCY MEDICINE CHAIR

The West Virginia University (WVU) School of Medicine is seeking aChair of the Department of Emergency Medicine at the Robert C. ByrdHealth Sciences Center. The Department of Emergency Medicine is anestablished academic department with strong teaching programs andleadership in research in rural emergency medicine. The WVU HospitalSystem includes a Level 1 Trauma Center and an active aero-medicalprogram serving a large geographical area. The position requires an in-dividual with strong leadership skills, experience in academic medicineand administration, and a commitment to service, teaching, and re-search. He/She must have a vision for the future of medical education inthe context of a changing health care delivery system. Applicants shouldsend a curriculum vitae and the names and addresses of three references.These materials should provide evidence of qualifications as noted above.Review of applications will begin after October 16, 2000. The position willremain open until filled. Applications should be directed to:

C.H. Mitch Jacques, M.D., Ph.D.Chair, Department of Family Medicine

Chair, Emergency Medicine Chair Search CommitteeRobert C. Byrd Health Sciences Center

West Virginia University School of MedicineP.O. Box 9152

Morgantown, West Virginia 26506-9152304-598-6920

jacquesm@rcbhsc.wvu.eduWVU is an Equal Opportunity/Affirmative Action Employer.

Women and minorities are encouraged to apply.

NORTH CAROLINA:Instructor/Assistant Professor in EmergencyMedicine. The Department of Emergency Medicineof the Wake Forest University School of Medicineis seeking a Research Director. This is a well-established training program with full RRCapproval. The hospital itself is a Level I TraumaCenter seeing in excess of 57,000 patients per yearand a full compliment of residency trainingprograms in addition to Emergency Medicine. Theresidency training program itself is configured as aPGY-I through PGY-III program with ten residentsper year. All academic positions are tenure tractwith Wake Forest University School of Medicine.Salary and benefits are extremely competitive.Candidates must be residency trained and eitherBoard Certified or eligible to sit for the boards inEmergency Medicine. Interested applicants shouldcontact: Earl Schwartz, M.D., Chairman,Department of Emergency Medicine, MedicalCenter Boulevard, Winston-Salem, NC 27157-1089., Phone (336) 716-4626, FAX: (336) 716-5438 or E-mail eschwart@wfubmc.edu. EqualOpportunity Affirmative Action Employer.

North Carolina: Opening for Director ofEducation/Assistant Residency Director at Wake-Med, a private level II trauma center in Raleigh.Join an independent democratic group of board cer-tified emergency physicians staffing 2 hospitals in-cluding a large trauma center and a community hos-pital. WakeMed emergency department sees over90,000 visits annually, includes a separate Chil-dren’s Emergency Department, and is a major teach-ing site for emergency medicine residents. Affiliatedwith the University of North Carolina at ChapelHill emergency medicine residency. Academic ap-pointment based on credentials. Excellent mix ofclinical, research, educational, and administrativeduties. Excellent compensation and benefit packagewith ample protected academic time. Interestedapplicants should send CV to Lance Brown, MD,MPH, Interim Director of Education, Departmentof Emergency Medicine, WakeMed, PO Box 14465,Raleigh, NC 27520-4465. (919) 350-8823, fax(919) 350-8874; e-mail: LBROWNMD@AOL.com.

ACADEMIC EMERGENCYPHYSICIAN

SOUTH CENTRAL PENNSYLVANIA

www.wellspan.org

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DDISTRICTISTRICT OFOF CCOLUMBIAOLUMBIA

The Department of Emergency Medicine at The GeorgeWashington University Medical Center is seeking

applications for full-time faculty physicians. EmergencyMedicine is a full academic Department in theUniversity. The Department provides physician staffingfor the Emergency Unit (annual patient volume 45,000)and Hyperbaric Medicine Service at The GeorgeWashington University Hospital. The Department alsosponsors an Emergency Medicine Residency and multiplestudent programs.

Under the auspices of its Ronald Reagan Institute ofEmergency Medicine, the Department manages educa-tional, research, and consulting programs in the areas of In-ternational Emergency Medicine, Injury Epidemiology/Vio-lence Prevention, Health Policy and Disaster Medicine.

We are currently seeking physicians who will activelyparticipate in our clinical and educational programs andcontributed to an area of the Department’s research/con-sulting agenda. We are particularly seeking candidateswith backgrounds in medical informatics or bedsidediagnostic imaging.

Physicians should be residency trained or boardcertified in Emergency Medicine. Please submit yourcurriculum vitae to Robert Shesser, MD, MPH, Chair, De-partment of Emergency Medicine, The George WashingtonUniversity Medical Center, 22140 Pennsylvania Ave., NW,Washington, DC 20037. E-mail: emdrfs@gwumc.edu.

FULL-TIME FACULTYASSISTANT OR ASSOCIATEPROFESSOR LEVEL

The Section of Emergency Medicine at Yale University School ofMedicine is recruiting full-time faculty members at the Assistant orAssociate Professor level. Our environment offers:• Academic growth with generous protected time to pursue

research and scholarly activities.• All clinical practice at Yale-New Haven Hospital, a Level 1

Trauma Center with over 80,000 ED visits per year• An accredited Emergency Medicine Residency program with 40

residents (PGY-1-4)• An EMS fellowship• Opportunities for collaboration with other faculty in the School

of Medicine, School of Public Health and other professionalschools in the University

Applicants should be residency trained and board certified/qualified in Emergency Medicine. Salary and academic rank iscommensurate with experience and accomplishments.Send letter of interest and curriculum vitae to:

John A. Schriver, MDChief, Section of Emergency Medicine

Department of SurgerySection of Emergency Medicine

464 Congress Avenue, Suite #260New Haven, CT 06519-1315

Yale University and Yale-New Haven Hospital are affirmative action, equal opportunityemployers and women and members of minority groups are encouraged to apply.

26

2000-2001 SAEM Committee/Task Force Interest FormDeadline: January 15, 2001

Members interested in serving on a committee or task force in 2001-2002 should complete this form or send a letter responding tothe questions on this form. Completed forms submitted as an e-mail attachment are preferred, however mail and fax copies arealso acceptable. Members are encouraged to review the following materials on the home page at www.saem.org or upon requestfrom the SAEM office:1. Committee/task force orientation guidelines that detail the role and structure of SAEM committees/task forces. 2. Current 2000-2001 committee/task force objectives.3. SAEM mission, vision statement, and five year goals and objectives.

The following guidelines will be used:1. Completed interest forms must be received by January 15, 2001.2. Members, whether currently serving, or wishing to serve, on a committee/task force must complete the form.3. Due to the relatively small number of committees/task forces, preference will be given to those who offer thoughtful

responses and suggestions on the interest form.4. Typically, members will serve on one committee or task force at a time.5. Committee/task force appointments and reappointments will be made by the President-elect by April 2001. The term of ap-

pointment is May 2001 to May 2002.6. Committee/task force members are expected to attend the meetings and participate in the committee/task force activities. All

committees/task forces meet at the SAEM Annual Meeting and many meet at the ACEP Scientific Assembly. 7. Individuals must be SAEM members to serve on a committee/task force. 8. Whenever possible, at least one resident will be appointed to each committee/task force.

1. Which description best characterizes you?

M EM resident, will finish in _____ (year)

M Faculty member without previous SAEM committee or task force participation

M Faculty member with previous SAEM committee or task force participation

M Other: ____________________________________________________________________________________________

2. Is there a particular committee or task force in which you are interested? M Yes M No

Explain: _____________________________________________________________________________________________

____________________________________________________________________________________________________

3. Is there a particular objective in which you are interested? M Yes M No

Explain: _____________________________________________________________________________________________

____________________________________________________________________________________________________

4. Do you belong to an SAEM interest group? M Yes M No

If yes, which one(s):____________________________________________________________________________________

5. What specific objectives or tasks do you think SAEM should pursue in the coming year?

____________________________________________________________________________________________________

____________________________________________________________________________________________________

6. Have you previously served on an SAEM committee or task force? M Yes M NoIf yes, list name of committee/task force and time period served:_________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

Name:_______________________________________________________________________________________

Institution:____________________________________________________________________________________

E-mail address:________________________________________________________________________________

Return to SAEM at 901 N. Washington Ave., Lansing, MI 48906, fax (517-485-0801), or e-mail at saem@saem.org

27

SAEM Membership Application

Please complete and send to SAEM with appropriate dues, $25 initiation fee, and supporting materials.SAEM • 901 N. Washington Ave. • Lansing, MI 48906 • 517-485-5484 • 517-485-0801 Fax • saem@saem.org

Name_________________________________________________________________ Title: MD DO PhD Other____________

Home Address_________________________________________________________ Birthdate____________________ Sex: M F

___________________________________________________________________________________________________________

Business Address ____________________________________________________________________________________________

___________________________________________________________________________________________________________

Preferred Mailing Address (please circle): Home Business

Telephone: Home (_______)________________________________ Business (_______)________________________________

FAX: (_______)____________________________________________ E-mail:__________________________________________

Faculty Appointment and Institution _______________________________________________________________________________

Membership benefits include:• subscription to SAEM’s monthly, peer-reviewed journal, Academic Emergency Medicine• subscription to the bimonthly SAEM Newsletter• reduced registration fee to attend the SAEM Annual Meeting

Check membership category: □ Active □ Associate □ Resident □ Fellow □ Medical Student

Active: open to individuals (a) with an advanced degree who hold a medical school or university faculty appointment and activelyparticipate in acute, emergency, or critical care in an administrative, teaching or research capacity; (b) with similar degrees in activemilitary service or (c) who otherwise meet qualifications but who do not hold a faculty appointment and who petition the MembershipCommittee. Annual dues are $295 plus a $25 initiation fee payable when the application is submitted. The application must beaccompanied by a CV and a letter verifying the faculty appointment.

Associate: open to health professionals, educators, government officials, members of lay or civic groups, or members of the public whohave an interest in Emergency Medicine. Annual dues are $275 plus a $25 initiation fee payable when the application is submitted.The application must be accompanied by a CV.

Resident/Fellow: open to residents and fellows interested in Emergency Medicine. Annual dues are $90 plus a $25 initiation fee payablewhen the application is submitted. The application must be accompanied by a letter from the director verifying that the applicant is aresident or fellow and the anticipated graduation date. (A group discount resident member rate is available. Contact SAEM for details.)

Medical Student: open to medical students interested in Emergency Medicine. Annual dues are $75 (includes journal subscription )or $50 (excludes journal subscription), plus a $25 initiation fee payable when the application is submitted. The application mustbe accompanied by a letter verifying that the applicant is a medical student and the anticipated graduation date.

Interest Groups: SAEM members are invited to join interest groups. Include $25 annual dues for each interest group:

M airwayM CPR/ischemia/reperfusionM clinical directorsM clinical skillsM diversityM disaster medicine

M research directorsM shock/traumaM substance abuseM toxicologyM ultrasoundM youth violence prevention

M domestic violence researchM emsM ethicsM evidence-based medicineM geriatricsM health services & outcomes research

M injury preventionM internationalM medical student educatorsM neurologic emergenciesM pain managementM pediatric emergency medicine

My signature certifies that the information contained in this application is correct and is an indication of my desire to become an SAEM member.

Signature of applicant___________________________________________________________________ Date__________________

NEWSLETTERNEWSLETTERNewsletter of The Society For Academic Emergency Medicine

Board of DirectorsBrian Zink, MDPresidentMarcus Martin, MDPresident-ElectRoger Lewis, MD, PhDSecretary-TreasurerSandra Schneider, MDPast PresidentJames Adams, MDMichelle Biros, MS, MDCarey Chisholm, MDJudd Hollander, MDPatricia Short, MDSusan Stern, MDDonald Yealy, MD

EditorDavid Cone, MDDavid.Cone@yale.edu

Executive Director/Managing EditorMary Ann Schroppmschropp@saem.org

Advertising CoordinatorJennifer MastrovitoJennifer@saem.org

Society for AcademicEmergency Medicine901 N. Washington AvenueLansing, MI 48906-5137

The SAEM newsletter is published bimonthly by the Society for Academic EmergencyMedicine. The opinions expressed in this publication are those of the authors and donot necessarily reflect those of SAEM.

Bulk Rate

U.S. Postage

P A I D

Lansing, MI

Permit No. 485

CALL FOR ABSTRACTS2001 Annual Meeting

May 6-9 — Atlanta

The Program Committee is accepting abstracts for review for oral and poster presentation at the 2001 SAEMAnnual Meeting. Authors are invited to submit original research in all aspects of Emergency Medicine includ-ing, but not limited to: abdominal/gastrointestinal/genitourinary pathology, administrative/health care policy, air-way/anesthesia/analgesia, CPR, cardiovascular (non-CPR), clinical decision guidelines, computer technolo-gies, diagnostic technologies/radiology, disease/injury prevention, education/professional development, EMS/out-of-hospital, ethics, geriatrics, infectious disease, IEME exhibit, ischemia/reperfusion, neurology, obste-trics/gynecology, pediatrics, psychiatry/social issues, research design/methodology/statistics, respiratory/ENTdisorders, shock/critical care, toxicology/environmental injury, trauma, and wounds/burns/orthopedics.The deadline for submission of abstracts is January 9, 2001 at 3:00 pm Eastern Time and will be strictlyenforced. Only electronic submissions via the SAEM online abstract submission form will be accepted.The abstract submission form and instructions will be available on the SAEM web site at www.saem.org byNovember 1, 2000. For further information or questions, contact SAEM at saem@saem.org or 517-485-5484or via fax at 517-485-0801.Only reports of original research may be submitted. The data must not have been published in manuscript orabstract form or presented at a national medical scientific meeting prior to the 2001 SAEM Annual Meeting.Original abstracts presented at other national meetings within 30 days prior to the 2001 Annual Meeting will beconsidered.Abstracts accepted for presentation will be published in the May issue of Academic Emergency Medicine, theofficial journal of the Society for Academic Emergency Medicine. SAEM strongly encourages authors to submittheir manuscripts to AEM. AEM will notify authors of a decision regarding publication within 60 days of receiptof a manuscript.

Society for Academic Emergency Medicine • 901 North Washington Avenue • Lansing, MI 48906