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A Seat at the Table


Physicians as policymakers

magine a world where patients

in need of emergent treatment
were turned away because of their
race, religious beliefs, or ability to pay.
Believe it or not, patient dumping
used to be a common practice,
whereby poor, often critically ill
patients were shifted from private
to public hospitals, many times
to the patients detriment. Thanks
to the Emergency Medical Treatment
and Active Labor Act (EMTALA),
this is no longer a widespread reality.
EMTALA requires all hospitals that
accept Medicare to provide screening
and treatment for emergency medical
conditions, regardless of insurance
status. And emergency medicine
physicians are happy to do this. As the
safety net of our health care system, we

provide more uncompensated care than

any other medical specialty.
EMTALA does not apply only to
emergency physicians, however; it
pertains to on-call physicians of every
specialty. If a hospital provides a
service to the public, that service is also
expected to be provided through on-call
coverage of the emergency department.
Unfortunately, in many communities
there are some specialists unwilling to
take call, which necessitates patients
being transferred to distant hospitals.
This practice not only delays the onset
of treatment, it can create a distressing
inconvenience for families unable to travel
with their loved ones.
It is not that specialists in these
communities lack the compassion or

Zach Jarou, MSIV


Michigan State University
College of Human Medicine
Lansing, MI

competency to treat these patients;

it is that often they fear being liable
for the outcomes of this already
high-risk patient population. This
self-protectiveness may make them
hesitant to provide care. Even when
standards of care are followed,
these patients are prone to bad
outcomes completely unrelated to
the skillfulness of the physician.
Its also important to keep in mind that,
unlike patients seen in the clinic, many
patients referred from the emergency
department come with no past medical
history, further complicating informed
medical decision-making.
Ive always believed that physicians
have a duty to be involved in the
policymaking process. If we dont
have a seat at the table, others
will make decisions for us and
not always for the betterment of
our patients. I am proud to have
stood shoulder-to-shoulder with nearly
100 student, resident, and attendingphysician members of the Michigan
College of Emergency Physicians at the
Michigan State Capitol in September
to advocate for the adoption of a grossnegligence standard for all EMTALArelated care.

Nearly 100 student, resident, and attending-physician members of the Michigan College of
Emergency Physicians convened at the Michigan State Capitol in September to advocate for the
adoption of a gross-negligence standard for all EMTALA-related care.

Reducing the disincentive for specialists

to take call will increase patient access
to quality emergency care. Additionally,
by creating a more favorable practice
environment, specialists will have more
motivation to provide local services
where they are needed most.
October/November 2013 | EM Resident 13