EDITORIALS Government/ Emergency Physician Interface n e a r future, however, we can expect state agencies a n d l a w m a k e r s to p a y much g r e a t e r attention to the medical practice. One example of i n c r e a s i n g activity is in the state boards of medical examiners, who in m a n y states control the licensure of p a r a m e d i c s as well as emergency physicians. The increasing desire of state g o v e r n m e n t s to exercise g r e a t e r a d m i n i s t r a t i v e aut h o r i t y over v a r i o u s aspects of h e a l t h care d e l i v e r y systems will u n d o u b t e d l y extend to e m e r g e n c y care. E d u c a t i o n a l l y , u n d e r g r a d u a t e medical t r a i n i n g has long recognized the tremendous impact of state g o v e r n m e n t funding in state-run institutions. For the p a s t few years, the involvement of the state governm e n t h a s e v e n e'xtended into t h e p r i v a t e m e d i c a l schools. As e m e r g e n c y medicine becomes a p a r t of more curricula, t h a t funding will affect our t r a i n i n g programs, too.

oth directly and indirectly, emergency medii n t e r a c t s w i t h all t h r e e l e v e l s of g o v e r n , m e n t to a n e x t e n t far g r e a t e r t h a n a n y o t h e r medical specialty (with the possible exception of p r e v e n t a t i v e medicine)., Legislation and r e g u l a t i o n s a d m i n i s t e r e d by federal, state and local officials affect n e a r l y every aspect of our practice.

B cine

Federal Involvement

The federal government makes its influence known in several diverse areas. First, we have not yet begun to feel the impact of the H e a l t h P l a n n i n g and Resources Development Act, but this piece of legislation will soon m a k e its bid to d i r e c t l y affect every f a c i l i t y t h a t p r o v i d e s e m e r g e n c y care. Second, the E m e r g e n c y Medical Services Systems legislation has a specific impact upon the delivery of p r e h o s p i t a l care - an i n t e g r a l portion of our practice. Third, the funds provided t h r o u g h the H e a l t h M a n p o w e r T r a i n i n g Act affect t h e t r a i n i n g of e m e r g e n c y p e r s o n n e l a t all levels: e m e r g e n c y p h y s i c i a n s , r e s i d e n t s , p h y s i c i a n s from other specialties, nurses, paramedics and e m e r g e n c y medical technicians. All of these pieces of legislation, and the p l a n n i n g t h a t creates them, i n t e r a c t in the ~area of reimbursement. While Medicare and Medicaid are the c u r r e n t concerns, the i m p e n d i n g e n a c t m e n t of n a t i o n a l h e a l t h insurance will d r a m a t i c a l l y increase the m a g n i t u d e of this aspect. F i n a l l y , the f e d e r a l g o v e r n m e n t ' s p r o v i s i o n of capitation funds and other a p p r o p r i a t i o n s as budget items in the nation's medical schools also h a s an indirect i m p a c t on e m e r g e n c y medicine. Other areas of e m e r g e n c y medical practice which are indirectly affected by specific legislation include emergency services in r u r a l h e a l t h clinics, a m b u l a n c e design and specification, and drug control. The A m e r i c a n College of E m e r g e n c y Physicians has reacted to this c o n c e n t r a t i o n of l e g i s l a t i v e and r e g u l a t o r y power w i t h direct and i n d i r e c t suggestions, complaints, testimony, etc., to the Congress, the Dep a r t m e n t of Health, E d u c a t i o n and W e l f a r e and the D e p a r t m e n t of T r a n s p o r t a t i o n . In this effort to have an impact on the decision-making process, we have b e e n a s s i s t e d b y t h e U n i v e r s i t y A s s o c i a t i o n for E m e r g e n c y Medicine in a d d i t i o n to the E m e r g e n c y D e p a r t m e n t Nurses Association, and the N a t i o n a l Association of E m e r g e n c y Medical Technicians.

Local Government

Basically, the impact of local g o v e r n m e n t on the practice of e m e r g e n c y medicine focuses on two broad areas. The first is t h a t of m a n a g e m e n t , o w n e r s h i p and/or supervision of the c o m m u n i t y hospitals t h a t provide the o v e r w h e l m i n g m a j o r i t y of the facilities where emergency medicine is practiced. The second s t e m s from t h e r e a l i t y t h a t , in an o v e r w h e l m i n g n u m b e r of c o m m u n i t i e s in the US, the p r e h o s p i t a l e m e r g e n c y medical services system is operated as an a r m of the local government. Medicine and Government

Opinions have often been expressed inside and outside of the medical profession t h a t the increasingly significant r e l a t i o n s h i p s between medicine and gove r n m e n t m a y be deplorable. Regardless of w h a t the philosophical aspects may be, it r e m a i n s a fact of life t h a t for the foreseeable future all levels of g o v e r n m e n t will r e m a i n quite active in the r e g u l a t i o n of the delivery of and r e i m b u r s e m e n t for h e a l t h care. As a m a t t e r of fact, they will most likely increase t h e i r involvement. At the same time, it is also clear t h a t unless some drastic changes occur in the m a n n e r of the delivery of e m e r g e n c y care, emergency medicine will r e m a i n ess e n t i a l l y based at hospitals, so m a n y of which are r u n by local governments. The purpose of this communication is to call readers' a t t e n t i o n to our unique a t t r i b u t e s as a medical specialty, u r g i n g t h e m to provide leadership, i n p u t and comments concerning this subject to the College, other medical organizations and, t h r o u g h the democratic process, into all levels of government.

State Government

Historically, the i n v o l v e m e n t of state g o v e r n m e n t in emergency medicine has been limited to t h e overall supervision of t r a i n i n g , communication, and transportation in prehospital e m e r g e n c y care systems. In the

8:5 (May) 1979

George Podgorny, MD President, ACEP

JACEP

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