Communication
I have found that there are a small number of physicians engaged in the area of advocacy. I ask why? Is there a lack of information? Is there a lack of understanding of the impact laws may have on their practice. Are doctors just apathetic? Perhaps, it is because you do not get paid for your time? The political landscape is changing; being part of that change is of paramount importance in my opinion. For the last ten years I have worked with NJ-ACEP, I can provide testament that the same 40 physicians are working closely in our group, with a dozen of the same physicians involved year after year. While it is laudable that these individuals keep the organization viable and vibrant, it is also incumbent upon us to reach out to all members and engage and represent them. Some twelve years prior, we had a larger and broader participation from the membership as a whole. It is still unclear in retrospect why this change occurred; however, I want to move back to this model. To this end, NJ-ACEP will be reaching out to small and large groups alike who may not have been represented at the table. When one of our board members reaches out your departmental director, please listen and share the message with your staff. Ideally, I would request that your clinical site send a single representative to our quarterly meetings, on a rotating basis, to represent you and your clinical practice. We have a small state. This can be accomplished as we meet regularly and our distance is relatively small compared to other states.

Moreover, we are looking at attracting all emergency physicians in the great State of New Jersey, not only ACEP members, but also ACOEP members. Members may ask why the ACOEP? First and foremost is that they practice Emergency Medicine. That is a fundamental fact. In general, the ACOEP focuses on national issues, not local issues. Also the ACOEP does not have state chapters in its current organizational structure. Therefore, I view this as an opportunity for our chapter to collaborate and unite with our osteopathic brethren, perhaps creating a model that other states could embrace. Let me make it crystal clear, this organization is not trying to supplant the ACOEP, but create new avenues of partnership.

NJ ACEP continues to propel information to the individual with emails, our monthly newsletter – “Quick Scan” and with our regional conferences. Recently we have added Facebook as an alternative means of getting the information out. However, the most important aspect of communication is its dynamic nature; it must be two way. Without you being connected in the process, it will not work effectively. Just as you vote for your political leaders to affect change, you must inform this organization of what is important to you, your practice and your state. We may trial a virtual meeting this year due to the busy nature of the practicing physician. I understand it takes personal time and likely personal sacrifice, but the challenge of having a non-clinician change your clinical practice makes no sense to me. Be engaged to the process or the process will be taken from you!!!! The entire legislature is up for re election. Come in numbers to meet the candidates, one on one, in September. Tell them of your experiences. I know they are compelling!!!

Advocacy
Here are a few of the hot topics at hand, with several others coming soon.

End of Life / Palliative Care (A-3475 / S-2197). It provides for a standard form called the Physician Orders for Life Sustaining Treatment (POLST). This is to be used in conjunction with the advance directive. Under this bill, DHSS would be charged with increasing awareness to the health providers and the public, encourage education to health providers, and provide for additional requirements for those with mental illness or disability. This would aide in directing end of life decisions.

End of Life / Palliative Care (A-3839/S-2199). This companion bill would establish an advisory council to explore the quality, access and cost effectiveness of end of life services.

ED Triage Pilot Program (A-4229 / S-2973). This bill would establish a pilot program at six sites in the state where by the triage screening examination is completed and the patient is triaged out to a federally qualified health center (FQHC) for definitive care. Our legislature is replicating this initiative from other states as a way to “be more cost effective”. State government believes that our emergency department care is very expensive and this is the answer to save dollars.

Section 1115 Demonstration Comprehensive Waiver – Medicaid Program. The Medicaid office has submitted a waiver that would include a $25.00 co-pay for all emergency department Medicaid visits. A co-pay would be mandated for all “non emergency” visits. NJ-ACEP believes that this is direct conflict to federal EMTALA screening regulations. There are many problems with this waiver, but at the heart of the matter, it denies access to care based on a payment.

A new twist on advocacy has been a program created by Beverly Lynch our Executive Director which has grown in scope and popularity. We expanded the mini internship program for our legislators and staff. They come to our turf and shadow our ED doctors during a clinical shift. This has provided tremendous first hand insight for the legislators when working in the trenches side by side with us. If you are up for the challenge, volunteer to host a future leader and show them the way!!

Education
Our Scientific Assembly, slated for May 8, 2012, is under development. We have a commitment from Steven J. Stack, MD, Board Member of the American Medical Association, who will be the keynote speaker to discuss the current changes and trends with healthcare reform. Dr. Stack is the first emergency medicine physician elected to the board. Also, Dr. Ken Butler from the University of Maryland has committed and will discuss an update for RSI. We are working toward having category one credit for both allopathic and osteopathic accrediting societies. I anticipate Dr. Patrick Hinfey, Program Chairman, will deliver on a superb conference as always. Remember to submit your abstract for review.

ACEP
Please network with “Real” Emergency Physicians of New Jersey at our annual reception in San Francisco at the Union Square Hilton, in City Scape, on the 46th floor. This will precede the Opening Reception. Our reception is the best attended and certainly makes our mark at the Scientific Assembly. Join us.

Administrative
I have spent some time creating a Presidential Time Line, so future leaders of our State have a clear knowledge of the sequence of proceedings when navigating the spectrum of events and commitments for the chapter.

I hope to see every member at our next meeting or in San Francisco in October or the Scientific Assembly in May. Please get your message to us. I challenge you to engage the process!!!

My name is Scott Mankowitz and I am an Emergency Physician.

It is such a simple statement, and yet it fills me with such pride. I think of myself as a member of an enormous team of incredibly skilled individuals who comprise the safety net for our great land. Every second of every day, our team stands ready to protect people from their environment, their diseases, even themselves. Our team is strong and wise and powerful. We are creative and resourceful. And most important, we are there when needed. When you're in trouble, you want one of us at the bedside.

And yet, we are a community besieged. The average Emergency Physician provides approximately $138,000 in unreimbursed care each year. At the same time, legislative and regulatory requirements threaten to constrain our practice. Insurers retrospectively challenge our judgment, while lawyers seek to poison the physician-patient relationship.

We can contain these hostile forces, but only because we work together as a team. NJACEP is about advocacy. It's about having a seat at the table. It's about making our collective voice heard. I invite all Emergency Physicians to get involved. All membership is invited to every meeting. A schedule can be found here. Together, we can define our practice environment. Together, we can make a difference. 

Born and raised in Irvington, after graduating high school in 1973, I began spending my summers living in Belmar and have stayed here since. I graduated from Union College, Schenectady, NY and spent 2 years doing postgraduate work at Rutgers until being accepted at St. George’s University School of Medicine in Grenada. Not having ever been away from the east coast before, it was quite an eye opening experience. From living in a 3rd world country and being in the middle of a revolution, to spending a year in England doing clinical rotations before returning to the US to do my fourth year was not the “typical” medical school education.

My involvement in the ER began early, starting with working the summers in the ER as a tech/aide in Irvington, Point Pleasant, and Neptune. I did a 10 week elective in St. Michael’s (Newark) during my fourth year of med school, before beginning a surgical residency in UMDNJ-Newark for two years, spending some time in the ER’s there and Beth Israel (Newark), Hackensack, and St. Barnabas. In the fall of 1985, I spent 2 months in Lincoln Hosp. (Bronx) doing an observership, before becoming a full time attending in the ER in Misericordia Hosp. (Philadelphia). Since then, I have worked in several hospitals in NJ including Monmouth MC, Atlantic City MC, Brick Hospital, Helene Fuld (Trenton), CentraState MC (Freehold), Bayonne Hospital, Bayshore (Holmdel) and currently am at Meadowlands Hospital (Secaucus). I have done locums in Iowa, NY, and PA in the past as well as a Sioux Indian reservation in South Dakota and served as a cruise ship doctor.

I have been involved with the media since 1996, having hosted a TV show for 10 years and was the Chairman of ACEP’s PR Committee in the past. I also am currently the President of the National Association of Medical Communicators (NAMC), a group dedicated to help all who communicate health information to the public.

All these experiences allow me to be your voice for the issues we in EM face and that is what ACEP is about. Be it the single hospital group or multiple, urban or rural, big or small hospital, I will stand up for you, our patients, and our specialty. But you need to be involved as well, I need all the help I can get. Together, our voices are stronger. Please e-mail us, come to a meeting, and contact us with your ideas. We meet every other month and the meetings are open to all.

I have been essentially a life long New Jersey resident who began practicing Emergency Medicine in 1991. My formative years were spent growing up in Jersey City, attending Rutgers College, then New York Medical College. I started out with 2 years of surgical training then a tour with the US Navy serving as a flight surgeon for a Marine Corps F-4 fighter squadron. Definitely the coolest thing I have ever done. I then knew I needed to “grow up” and I completed my residency training at LSU/Charity Hospital of New Orleans in Emergency Medicine. After the first 3 months I knew I made the right choice and EM was the field for me. The fast pace, the excitement of not knowing what would come in next, the bizarre cases made my 3 years in NOLA fly by. I began my career at RWJ University Hospital. I worked at RWJ for 10 years, and then a 4 year directorship at Mountainside Hospital, back to being a “pit doc” and now again back in a director role at Somerset Medical Center. I had long been involved in hospital “politics” and multiple committees and became acutely aware of the importance of becoming involved in order to have Emergency Medicine issues recognized. That began my involvement in NJACEP and has lead me to this leadership position.

NJACEP is all about advocacy. We are here to promote the goals of ACEP and to make the life of the practicing Emergency Physician better and to make all our Emergency Departments better. I view my role as being your advocate for the issues. I am here to be the spokesperson for the practicing Emergency Physician. All of our initiatives will be more effective with your involvement. Please e-mail us, come to a meeting, and call us with your ideas. We meet every other month and the meetings are open to all. That’s my final message, get involved, and stay involved.

Well, let’s see, how did I become President of NJ-ACEP? First I am a NJ native, born and raised in northern New Jersey. I attended Union High School. I majored in Food Science at Cook College- Rutgers University (that was before they had a good football team), and then UMDNJ-NJ Medical School in beautiful Newark, NJ. Needing a change at this point, my wife and I ventured to UMASS for my residency in Emergency Medicine in Worcester, MA. Although, our time there was a lot of fun, family and friends in New Jersey called us home.

We are now Ocean County residents, and I currently am the Chairman of Emergency Services at Community Medical Center in Toms River, NJ. I have practiced there for the last 11 years.

Emergency Medicine has always been my passion, from the early days volunteering time in a local hospital emergency room, to becoming an EMT and serving on my local first aid squad. Emergency Medicine is my calling. It is a privilege to help those patients and their families who are faced with illness no matter how large or small it may seem. Whether you have just a cold, or are faced with a life or death situation, I will do my best to guide you through it in the short time we spend together in the Emergency Department.

Over the last few years, I have had the opportunity to work with my colleagues in NJ-ACEP and on National ACEP Committees and the Council at National ACEP. I am fascinated by the college’s ability to move forward our agenda in emergency medicine. I am also humbled by the Presidents of NJ-ACEP before me who have worked so hard for our specialty in New Jersey. Politics are such that there is always an issue confronting our specialty; overcrowding, psychiatric holds, affordable malpractice coverage to name a few. If we are not sharp and in touch with the issues, someone else will decide how things should work in our Emergency Departments without our input.

Emergency Medicine has changed in the last 15 years. The Business of emergency medicine; obtaining affordable malpractice coverage, adequate reimbursement, and managing overcrowding are becoming more and more difficult. The Practice of emergency medicine is advancing rapidly; ultrasound at the bedside, lab results at the bedside in minutes, imaging studies that reveal the subtlest abnormalities. The Philosophy of emergency medicine remains the same; competent, compassionate care to all those in need, 24/7/365.

I am certainly no Pulitzer Prize winner so I will stop writing here. I look forward to continuing to work with you toward the advancement of the specialty. If you have any questions about NJ-ACEP please do not hesitate to email me at LDesRochers@sbhcs.com.

Born and raised on Long Island, my undergraduate degree was in Biochemistry at Brown University and I went to SUNY Upstate in Syracuse for medical school. From there I did my emergency medicine residency at Allegheny General Hospital in Pittsburgh. I decided to pursue a career in medicine during college when faculty and friends encouraged me. No one in my family was a medical doctor but I worked as a lifeguard, volunteered for the Red Cross and in a hospital during high school.

In Syracuse, I originally thought I would go into Family Practice. It became clear through my rotations that I liked the excitement of the emergency department, enjoyed procedures and felt like the acute care phase of treatment often dictated the patient outcome. Emergency Medicine was a new and expanding specialty and I felt would be right for me. As time has gone on and I've accepted more administrative duties, I still look at myself first and foremost, as an emergency physician. In medical school I met my wife, Lynn, who is a practicing Pediatrician and we have 2 daughters, a college sophomore and high school senior.

My philosophy has always been that to be a good emergency physician you need to be able to multi-task, make quick decisions and work in an often chaotic environment. You must also be well trained but also compassionate, friendly and able to relate to patients and families when they are not at their best. Emergency physicians hold a unique place in the medical profession. Not always appreciated by patients or colleagues, we must set and maintain high standards and always do what is right for the patient. Even over my years I have seen a change in perception, for the better, of what we do. Our relationship with nurses and other hospital staff is critical to the care of our patients. The diversity and complexity of emergency medicine makes the "team" approach vital and I would encourage everyone practicing to embrace this concept.

A concern about emergency medicine careers has always been burnout. The high stress and fast pace can take its toll. Being part of the team, recognizing your limitations and remembering the positive impact you make on people's lives can help you avoid this. I am very glad I chose emergency medicine and am looking forward to working with you on advancing emergency medicine in New Jersey. I can be reached by e-mail at ahartmann@somerset-healthcare.com or phone at (908) 595-2349.

When I was asked to write something for the web site as the President of NJACEP, my first response was to provide a long detailed copy of my CV as my "bio." Unfortunately, that really wouldn't help you understand my persona nor be able to fully appreciate what brought me to represent this fine organization. Well, you can say I'm a Jersey dude, a pure bred, born and raised all my life here, except for medical school and student rotations. I must admit, I'm embarrassed to say I've never been to LBI! My family moved around for a few years in central Jersey until my parents settled into Bound Brook in 1968 where I went to high school and eventually met my wife, Laura.

I always had an interest in the sciences - especially in biology - and was in awe when I read my father's Red Cross first aid book (1940's edition). Medicine looked like "fun." I have learned that many forces shape one's life, and frequently, through serendipitous interactions, one's life can drastically change.

The biggest influence on my life came when my mother pointed out an article in the weekly local town paper recruiting for "kids" from the ages of 13-17, to join a newly formed "cadet corps" at the local volunteer rescue squad. Well, I was naive, but interested, went to the meeting and signed up. Perhaps, that was a turning point in my life since that experience convinced me to pursue a career in medicine. I graduated in the first EMT course run in NJ in 1972 and had a passion for emergency medical services. I attended Rutgers College, graduating in 1979, but at the time medical school was extremely competitive and I was persuaded from applying by the Dean since he said my GPA was not competitive enough.

I had few role models in medicine, except for a family practitioner in town. He was loved by all his patients and would make frequent house calls. He had a gentle demeanor and loved what he did. He also lived in the biggest house in town! So medicine was looking better and better - of course that was in the late 70's and early 80's.

I decided to work as a full time security guard at what was then Raritan Valley Hospital, working the night shifts so that I could complete my last prerequisite for medical school - biochemistry at the local community college. But again, as fate would have it, the State of NJ decided (after many public hearings) to close the hospital and convert it into a facility for the developmentally disabled. I had completed my biochemistry course but needed another full time job so, on a whim, and by luck, I found an ad in the local paper for a pathology technician - yes, the person who assisted with autopsies at a local hospital. After four interviews I was hired.

The day that Raritan Valley Hospital closed, that same family practitioner that I had worshipped when I was younger had a massive stroke. I was there that morning at 5:00 a.m. with the rescue squad to try to help him out, in that big beautiful house. I will never forget finding him on the light colored carpet in his bedroom adjacent to his bed, unconscious, seizing, posturing, and knowing that he was doomed. And what was worse was that he could not be transported to the hospital - his hospital, that he had supported financially and with his practice. So we began a long ambulance ride to what was then Middlesex General Hospital (most of you now know it as Robert Wood Johnson in New Brunswick). He never regained consciousness and died approximately a week later.

My thoughts of pursuing a career in medicine waxed and waned for the next five years, until one of the pathologists I worked with continued his monthly encouragement (it bordered on nagging) as to why I didn't want to apply to medical school. I had attempted one round already and had little ambition to spend additional time and money. He was a MD and suggested perhaps osteopathic schools. The rest is history. My wife and I packed up everything we owned, placed our furniture in storage, and moved to Maine in a one room pre-fabricated home. We essentially gave up everything and took a gamble. After all, what was in Maine - moose, cold, snow, a seven-hour ride from home, I think you get the big picture. I graduated from the University of New England College of Osteopathic Medicine and completed a rotating internship at St. Michael's Medical Center in Newark, N.J. - a grueling year of very hard work. I began a family practice residency at Somerset Medical Center. However, after one year, I decided that family practice was not for me - although I enjoyed the concept of the gate-keeper and taking care of the entire family from neonates including OB to geriatrics, I could see the early pressure of managed care. I envisioned that big insurance companies would slowly erode into the quality of care and the deleterious effects on primary care.

Thus, I entered into an emergency medicine residency at Morristown Memorial Hospital where I completed my training, including serving as chief resident, and then took a position as a member of the faculty. I have practiced there for the last eleven years. Currently, I serve as the Vice-Chairman, of the Department of Emergency Medicine and Associate Director of the ED. I also serve as the Medical Review Officer for Corporate Health Service and the medical Director for Travel MD and Work Med at the hospital.

My continued interests with emergency medicine led me to participate in NJ-ACEP many years ago, first serving on the Board of Directors and then advancing up the officer track. I welcome representing the approximately 600 physician members of our outstanding chapter for the 2005-06 year. I have always been interested in the political process (clearly influenced when I was in high school and given the honor to enroll in an experimental two-year program called Leadership Involvement Program - LIP). It was LIP that has enabled me to stay abreast in politics and learn more about the legislative process both on a local, state, and national level. Perhaps my observation of the Watergate Hearings during a trip to Washington in 1974 had something to do with my interests in the political process. I continue to serve as the STATPAC chairman and serve on the NEMPAC Board of Trustees and the Federal Governmental Affairs Committee for National ACEP for the last two years.

Despite my leadership roles both on the local and state level, I have maintained an active practice of emergency medicine, still working 50% of my shifts at night. The practice of emergency medicine is ever changing with many demands placed on our specialty - regulatory, legal, financial, moral, and ethical.

I married my high school sweetheart twenty-four years ago, and we have two children, Amanda, age 15, who is trying to find out what adolescence is all about, and Andrew, age 7, who wants to be a Marine. We have resided in Bridegwater Township for the last eleven years.

As the year progresses, I am always willing to discuss your concerns and issues on the state of affairs and the direction for our organization and its members. I can be reached either by e-mail at william.felegi@ahsys.org or office phone 973.971.7973.

Born and raised in the Philadelphia area, I attended Penn State University and Jefferson Medical College as part of the 5-year Cooperative Program between the two institutions. After graduating from Medical School, I did an Internal Medicine Residency at Mercy Catholic Medical Center outside Philadelphia. I began working for Coordinated Health Services (CHS) right out of my residency and continue to work with some of the same people 17 years later, only now EmCare owns us.

After working on the Pennsylvania side of the river for the first 8 years of my career, I saw the light and began to work full time in New Jersey in 1995, first at Our Lady of Lourdes Medical Center in Camden. In 1998, I moved up to St. Francis Medical Center in Trenton, where I currently am the Director of the Emergency Department.

In the early 1990's, I became active nationally with the organization that eventually became the Association of Emergency Physicians (AEP). I served several years on their national Board of Directors and was their Treasurer for several years. However, I realized during my tenure with AEP, that it is always better to advance your causes from within than to buck the system. Thus, I ran for and was eventually elected to the New Jersey ACEP Board in the late 1990's.

Personally, I am married to the love of my life, Sharon. We celebrate our 20th anniversary this month. She is an Advanced Practice Psychiatric Nurse who specializes in Family Therapy, and she owns a large group practice in the Abington, PA area. We have 3 sons who are currently 17, 16, and 13. Each of my sons is a wonderful, unique individual in his own right, but my middle son has brought me much knowledge, compassion, and understanding. He is disabled with a genetic disorder called Angelman Syndrome. To learn more about AS, go to www.angelman.org.

My wife and I became active in the national organization for AS in the early 1990's, and I was elected to the national Board of Directors in 1997. In 1999, I became national President and presided over the organization, Angelman Syndrome Foundation, until 2003. That has truly been a defining moment in my life. I met and continue to correspond with individuals all over the world and have had the opportunity to speak in Finland. I remain on the national Board and am currently coordinating the local site for our national fund Raiser.

Among all of this, I look forward to a continuing to serve our membership as President of NJ-ACEP for 2004-2005.

I worked in my first job for an orthopaedic surgeon in his orthopaedic research lab, and he was a D.O. and I became very interested in the Osteopathic Profession. I grew up in Pittsburgh, a huge Steelers fan!! So I applied to PCOM and did not have enough science classes, so they gave me a conditional acceptance on completion of those classes. I did complete them, and when I got to medical school, my best friend ended up being an orthpaedic technician who was very bright and had worked in the field for 10 years. He went into orthpaedic surgery and I liked everything as I went through my clinicals, so emergency medicine seemed to be a combination of all fields and the best compromise for me.

I knew I did not want to be a surgeon!!! In medical school I ran SOMA (student osteopathic medical association) nationally, and I loved the administrative aspects of medicine.

I did my internship in North Miami Beach and loved Florida but did not think it was conducive for a great work environment, so I came back to Pennsylvania to Albert Einstein Medical Center to do an EM residency and was elected EMRA president. This is where I met Scott, who is definitely my partner for life, and my real life began. Of course, now living in Philadelphia, I adopted the Eagles as well as kept the Steelers as my teams, and Sunday for both of us is the most important day of the week!!! My family in Pittsburgh then disowned me for not returning to Pittsburgh, as they assumed I would, and I became the black sheep even though I was pursuing an educational dream.

Since administration was in my blood after two other jobs, I now am at Monmouth Medical Center as their ed chairman and love being at the beach with the next two most important pieces in my life, Jacob, 4, and Benjamin, 2. I am very happy to be once again running NJ-ACEP as your current president and am humbled every day by the warmth and friendships that I have developed here.

My biggest goal for this enthusiastic NJ chapter is to get functioning committees and change our lives for the better in our every day working environment that hopefully you all love as much as I do.

Laurence DesRochers

Anthony Hartmann

William Felegi

Steve Katz

Bruce Bonanno

Jennifer Waxler

Victor Almeida

© 2003 NJACEP