I found myself suppressing a giggle as the congregation of councilors spoke up in unison for the second time in as many minutes to correct the vice speaker’s mix-up. No one could blame her; this was hour four of voting on resolutions, and I could barely keep up with everything going on in the auditorium. These were the parliamentary proceedings that occurred the weekend before the ACEP scientific assembly every year; the council that voted on ACEP policy changes and resolutions for the coming year, and it was both fascinating and entertaining.
When my attending had suggested to me a few months prior that I attend the council sessions for ACEP as a resident liaison, I’d had my reservations. After all, what did I know about policy-making, especially in healthcare? Up to this point, policies were something that were imposed upon me, not something I had any say in. Plus, the phrases “policy-making,” and “parliamentary procedure” were hardly ones that excited me. But as I thought about what my attending had proposed, I realized this was exactly why I should attend the council sessions: this was an opportunity to see the development of policies, understand why amendments to current opinions were proposed, and to witness a resolution succeed or fail on the parliament floor based on the arguments made by physicians who would be most impacted.
The first day of council involved reviewing the proposed resolutions in small committees. I chose to sit in on the committee reviewing resolutions affecting practices in emergency medicine. I must admit, I was really engaged in the process. As each resolution was introduced, polite disagreements broke out, but I was surprised to find that the majority of these were over phrasing and whether or not a small change to an already existing policy was truly necessary. For the most part, it seemed that the gathered emergency physicians agreed on the practice patterns. Most interesting to me, though, were the disagreements that clearly stemmed from an individual’s state political and social leanings. For instance, a councilor from a busy ED in New York that sees a large number of incarcerated patients felt differently about a resolution concerning police presence in the ED than the councilor from San Francisco. Hearing the perspectives presented increased my own understanding of why policies vary from system to system, and the challenges that face those tasked with developing resolutions beneficial to all.
The second day of council centered on parliamentary procedure. All of the councilors reconvened in one room and voted on the recently rephrased resolutions. The best way I can describe this process is, “incredibly organized chaos.” It reminded me of the outline method of note-taking I was encouraged to use in high school biology, or the movie Inception. A vote within a vote, a referral to another committee to be decided at a later date, then back to the initial vote on the resolution. Councilors spoke at one of four microphones set up across the large auditorium, but were often cut off by the speaker because he or she was arguing a point pertinent to the prior vote, but not the current one. Arguments were poignant, but often had to be clarified because the orator’s stance for or against a resolution was never explicitly stated. Virtual participation this year added an additional layer of complexity to the voting system, and malfunctions in the countdown timer software and complaints about the appearance of the bar graph colors added comedic relief to the scene. The speaker and vice speaker, despite a couple understandable mix-ups, did an excellent job of running the proceedings efficiently and professionally. They brought humor to the process and adapted to each technology challenge with grace. I found myself smiling and enjoying the process. This was a side of emergency medicine I had not seen before, and one I had mostly ignored until now.
As the sun set on Boston Sunday evening, I found myself reflecting on the weekend’s proceedings. Not only did I learn a great deal about parliamentary procedure and the salient issues facing emergency medicine, but I had the opportunity to network and hear what truly matters to EM physicians across our nation. These councilors enjoyed each other’s company, and especially the chance to congregate in one place for the first time since before COVID, but their overweening reason for being at this conference every year was evident: they care about their patients and the practice of emergency medicine; they love what they do.
If you’re an EM resident and you’re ever offered the chance to attend ACEP council, take it. I expect you’ll be surprised by all that you learn, but I won’t be surprised if you find yourself planning next year’s trip to council before heading home.