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The New York American College of Emergency Physicians exists to support quality emergency medical care and to promote the interest of emergency physicians.

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Legislative Priorities

New York ACEP and Emergency Medicine
The New York American College of Emergency Physicians represents over 3,000 emergency physicians across the state that have a shared mission to provide the highest quality emergency medical care for all patients regardless of their ability to pay for care. Emergency Departments (EDs) and the people who work there play an invaluable role in every community across the State as the entry point for the health care needs of all New Yorkers.

Emergency physicians are one of the largest indigent care providers in the State, providing care 24 hours a day, 365 days a year to every patient who walks in the door, regardless of the patients’ ability to pay. Over 8.5 million people visit New York’s EDs every year. With the increased threat of terrorism in New York or a pandemic or natural disaster, it is particularly important for EDs to be prepared for the possibility of large-scale emergency crises. However, even without these threats, the State’s emergency care network is threatened by crowding of hospitals, lack of on call specialists to provide specialty care within emergency departments and inadequate Medicaid reimbursement rates.

2020

Emergency medicine (EM) residency programs not only train new doctors to become emergency specialists, but also serve as a conduit to recruit new faculty members for that department and local region upon residency graduation. Survey data from 1995 demonstrated that 43% of graduating EM residents chose to practice in the city or metropolitan area where they trained and, of those who stayed, 46% had no ties to the area prior to training.1 Hence, residency programs can be vital to attract and retain new and highly qualified physicians to practice in a particular location.1-3

Nationwide, residency-trained board-eligible emergency physicians remain in high demand. A 2005 review noted that nearly all states (49/50) lacked sufficient numbers of board-certified emergency physicians to fully staff their emergency departments.4 Retaining these well-trained doctors is, therefore, an important consideration for academic emergency departments.

The state of New York trains a large number of residents annually, with 29 EM residency programs accounting for 14% of the total EM residency spots filled by the National Resident Matching Program (NRMP) in 2019.5 Given the breadth and diversity of programs, New York should ostensibly be positioned to successfully retain graduates. A survey sent to all ACGME-accredited EM residencies in 19951 found that New York successfully retained 63% of its own graduates in-state.

New York ACEP sought to determine how often a graduate from a New York State emergency medicine residency chooses to stay in New York state for their immediate post-graduation employment. Secondary objectives were to determine if there were variations in annual retention of residents through the last seven years and variations in retention through different regions of New York State.

A literature search was conducted using MEDLINE, Embase, Scopus, Google Scholar and Web of Science with the search terms “graduating resident retention location”, “emergency medicine resident retention by state”, “emergency medicine resident retention”, and “emergency medicine first practice location” published during any date. There exists some literature discussing residents in primary care specialties but only two articles. In addition to the ones mentioned above, articles were found that discussed emergency medicine residents, one from 1983 stating “almost half” of the emergency medicine residency graduates were employed in the same state that they trained in6 and one from 2004 about retention of emergency medicine residency graduates in the Southwest inter-region of France (81% of residents would remain in the region).7 There was no information regarding retention of emergency medicine residents in any individual American state, except for the 1995 article.1

We conducted a retrospective study using data collected from a resident database updated annually by the New York American College of Emergency Physicians (New York ACEP). The database was created and updated using queries sent to affiliated residencies about graduation information for the years 2013-2019. Programs were asked a single question about each graduate: did he or she choose to work in New York State after completing residency?

Of the 2,005 graduates from that time period, data was obtained for 1,472 graduates, a 73.4% response rate. Programs that responded were split into three groups based on program location - Upstate New York, New York City and Long Island.

Of 1,472 graduates from 2013-2019, 708 (48.1%) stayed in New York State to practice emergency medicine after finishing residency. When distributed into regions, the New York City region had the highest number of graduates staying in New York with 472 (49.2%) of total graduates while the Long Island region had the lowest at 90 (45.6%). The retention rate was highest in 2013, after which there was a large decrease in the proportion of graduates remaining to practice in New York State.

  Upstate City Long Island Total
Stayed in NY (%) 146 (46.2%) 472 (49.2%) 90 (45.7%) 708 (45.7%)
Left NY (%) 170 (53.8%) 399 (50.8%) 88 (45.7%) 618 (51.9%)
Table 1: Data on graduating residents and whether they stayed or left New York State after graduation with respective percentages.
 

Figure 1: Percentage of graduates who stayed in New York State by year.

Figure 2: Percentage of graduates who stayed in New York State by year and location.

In our study, we found that New York State has seen a decrease in the retention of its own emergency medicine residents, from 63% in 1995 to 48% during the past seven years, with the highest retention rate seen in the New York City region.

There are many possible factors that can explain this lack of retention of EM residents in New York. First, New York State is one of the lowest paying regions of the United States for EM physicians. In fact, New York City is 2019’s lowest paying area in the country for emergency physicians, with an average salary of about $130/hour (compared with the national average of $221/hour).8 Unfortunately, New York also has one of the highest costs of living in the United States.9 Second, New York is a highly litigious state, burdening physicians with high malpractice payouts and premiums, increasing medical liability rates10, and lack of tort reform.11 New York’s practice environment is also subject to frequent shifts. Issues, such as emergency department boarding, departmental budget cuts and unfavorable “date of discovery” laws are among several of the recent changes in New York’s landscape of emergency medicine.10 It is potentially because of the above that emergency medicine positions in other states are viewed as more desirable than New York positions.12

New York State has seen a decrease in its retention of emergency medicine residency graduates. This highlights an important trend regarding recruitment and highlights the need for further attention to increase attraction and retention of talent in the region.

For a complete copy of the report with references visit https://www.nyacep.org/newsletter-feb-20/14-newsletter-feb-20

Governor’s Proposed Budget (S7507-A/A9507-A Article VII, Health and Mental Hygiene)

Pending Legislation
S6757 (Rivera)/A8639 (Gottfried), Patient Medical Debt Protection. Concerns
Status: Senate and Assembly Health Committees

A3741 (McDonald)/S4482 (Harkham)-report patient overdose to the PMP. Oppose
Status: Senate and Assembly Health Committees.

S6650 (Harkham)/A8541 (Braunstein)-provides discharged patient with opioid overdose education and opioid antagonists for take home use. Support
Status: Passed Senate/Assembly Alcoholism and Drug Abuse Committee

S5457 (Harkham)-expands the list of entities authorized to possess, distribute, and administer an opioid antagonist to reverse an opioid-related overdose to persons employed by restaurants, bars, and retail establishments and protects them from legal liability. Support
Status: Passed Senate. Delivered to Assembly Health Committee. 

Mandatory Continuing Medical Education. Oppose 

 
 
2019
 
 
Executive Budget Proposal to Eliminate the Exemption for Emergency Departments to Consult the Prescription Monitoring Program for Prescriptions Not Exceeding 5 Days
(Article VII, HMH S1507-A/A2007-A, Subpart C of Part BB)
Statement in Opposition
 
Budget Proposal to Fund and Extend Excess Medical Liability Program
(Article VII, HMH S1507-A/A2007-A, Part F & S1503/A2003 HMH)
Memorandum in Support
 
Executive Budget Proposal
Eliminate Medicaid Payments, Part B Co-insurance for Ambulance Services
(Article VII, HMH S1507-A/A2007-A, Part C, Section 3)
The New York American College of Emergency Physicians (New York ACEP) is strongly opposed to a proposal in the 2019-20 State Executive Budget to eliminate State Medicaid payments for Medicare Part B co-insurance for ambulance services. This proposal threatens the viability of ambulance service providers in the State and puts patient health and safety at risk.
Statement in Opposition
 
Opioid Excise Tax
SFY 2019-20 Executive Budget (S1509-A/S2009-A Part XX)
Memorandum in Opposition
 
S3271 (Lanza)
Senate Health Committee
AN ACT to amend the public health law, in relation to requiring hospital and emergency room physicians to notify a patient’s prescriber that such patient is being treated for a controlled substance.
Memorandum in Opposition

A3471 (McDonald)
Assembly Health Committee
AN ACT to amend the public health law, in relation to requiring practitioners who administer naloxone or another overdose reversal agent to a patient in the case of a suspected or confirmed overdose to report the administration of the agent to the prescription monitoring program registry.
Memorandum in Opposition
 
S1793 (Rivera)
Senate Health Committee
AN ACT to amend the public health law, in relation to hospital statements of rights and responsibilities of patients; to amend the general municipal law, in relation to insurance coverage of ambulance and emergency medical services; to amend the financial services law, in relation to dispute resolution for emergency services; and to amend the financial services law and insurance law, in relation to assignment of health insurance benefits.
Memorandum in Opposition