Resolution 26 underwent significant amendments during the Reference Committee hearing, with much of the debate around whether to include special emphasis on EMTALA. When it came time for Resolution 26 to be debated on the Council floor, testimony was mostly supportive.

Dr. Saxena said she was braced for strong opposition from some councillors, but the live testimony—even from those who disagreed with the resolution—was constructive and collegial. “That was wonderful to see that people were coming together to advocate for patients,” said Dr. Saxena.

As a newcomer to the ACEP Council process—it was Dr. Saxena’s first time writing a resolution and attending the meeting—she described her experience as eye-opening, educational, and encouraging. “This was just a group of four or five physicians who came together and said, ‘We want to do something, and we pooled our resources and we wrote a resolution, and we got it passed. That’s democracy at its best.”

Scope of Practice

Another hot topic at the 2022 ACEP Council meeting was scope of practice. Four resolutions were debated that covered competencies, offsite supervision, safe staffing and educational standards. Many of the scope of practice discussions had a common theme: How can we ensure ACEP is emphasizing the importance of emergency physician-led care teams without opening the door to unintended consequences?

“Resolution 44: Competencies of Independent Emergency Medicine Nurse Practitioners and Physician Assistants” called for ACEP to adopt policy positions stating that nurse practitioners and physician assistants should never practice emergency medicine without in-person physician supervision. Prior to the meeting, asynchronous testimony overwhelmingly agreed that nurse practitioners (NPs) and physicians assistants (PAs) should not practice without onsite supervision available for support, but comments questioned the practicality of requiring every patient to be seen by an emergency physician in all settings. Heavy debate ensued: How would this policy play out in rural EDs? Could this resolution incidentally create a path for physicians who do not meet ACEP’s definition of an emergency physician? In the end, this resolution was not adopted by the Council.

The Council did reach consensus on the gold standard for supervision when it approved “Resolution 45: Onsite Supervision of Nurse Practitioners and Physician Assistants,” which calls for ACEP to revise its existing policy statement so that onsite emergency medicine physician supervision is stated as the gold standard.

The next scope of practice debate centered on staffing ratios: Should ACEP take the lead, or is this complex, circumstantial issue best left to local medical directors? After lively debate on both sides of the issue, the Council adopted an amended version of “Resolution 46: Safe Staffing for Nurse Practitioner and Physician Assistant Supervision” that called for ACEP to investigate and make recommendations regarding appropriate and safe staffing models of emergency physician-led teams.