President's Message

Get to Know Your EMRA President: Omar Z. Maniya, MD, MBA

Omar Maniya, a second-year resident at The Mount Sinai Hospital in New York City, began his tenure as EMRA President in October. With an MBA from Harvard University, experience as the youngest Trustee of the American Medical Association, and a willingness to extend opportunities wherever possible, Dr. Maniya’s leadership promises to be eventful.

Why did you run for EMRA President?
I couldn't be more excited to lead EMRA in this historic year, our 45th anniversary! As a medical student, I was involved in the AMA and served on their Board. But then I came to a few EMRA meetings and found the energy and passion and the commonalities all of us EM residents have with each other electrifying.

While EMRA has a storied history as the world's largest independent resident- run organization, I'm not here for the four letters on the wall. Rather, I'm passionate about helping us residents shape the future of emergency medicine, and I believe that EMRA is by far the most impactful organization that can do that. This year we're turning our amazing clinical resources into apps, continuing our ground-breaking advocacy with the ACGME's Program Requirements, growing our leadership pipeline with 111 funded national leadership positions and a brand-new Leadership Academy for residents, and innovating our clinical resources with new books and apps. It's an exciting year, and we need all hands on deck!

As the voice of emergency physicians in training, EMRA is diligent about advocating for residents and students. What are the most important issues facing us in the coming year?
We're at a really interesting inflection point in the growth of our specialty right now, and that paths we collective choose to move forward will have unbelievably significant ramifications. Here's my take on some of the issues to watch:

  • Clinical: Our specialty's scope of practice is growing, and we have to navigate those growing pains. Whether it's affirming our ability to administer propofol and ketamine in the ED in the face of Anesthesiology opposition through the ACEP Procedural Sedation Guidelines, removing burdensome medical merit badge requirements for skill sets we use daily like ACLS through the Council to Oppose Medical Merit Badges (COMMB), or supporting innovative clinical research through the Emergency Medicine Foundation, EMRA is standing up for your right to practice and save lives.
  • Policy: Prudent Layperson is under attack from insurance companies. As you know, that's the concept that patients can't distinguish GERD from ACS by themselves, so regardless of what the final diagnosis ends up being their ED visit should be covered. Additionally, if ACA repeal comes back to life, the requirement that all insurers cover ED visits as an essential health benefit may also be at risk. Finally, we must keep an eye on evolving alternative payment models (APMs) and how they affect our reimbursement so that we can continueto provide the best care for our patients.
  • Workforce: Historically the need for Board- Certified Emergency Physicians far outstripped the number of them. But with the dramatic growth in the number of EM residencies that we've seen over the last decade and the proliferation of Advanced Practice Providers (APPs) in EDs, that might start to change. That'swhy EMRA's actively engaged in voicing the resident perspective on ACEP's APP and Workforce task forces.
  • Business: The volume of ED visits has been slowly increasing for decades. It weathered the financial crisis, the development of urgent care and telemedicine. But that's starting to change. Isolated reports of falling volumes are coming out, and the competition for lower-acuity patients is intensifying. That means that we can't just assume more patients will keep showing up at our front door. We have to actually provide more patient-centric experiences (for better or worse) to stay in business and keep buying more scanners and ultrasound machines.
  • Wellness: We've got to figure this one out, or the unfortunate suicides, burnout, and depression will ruin our specialty. EMRA sends residents to the EM Wellness Summit and has an active Wellness Committee. For the first time next year, the SAEM Consensus Conference, where leading researchers in our specialty gather to discuss a research agenda, will focus on Wellness. EMRA plans to ensure that resident wellness is highlighted, and that we move beyond prevalence studies to actually finding positive interventions we can implement across the country.

How do you build unity and strength in this specialty?
By focusing on our mission: serving as the voice of EM residents. It's unbelievably liberating. And EMRA has been doing it for decades. For example, recent ACGME proposals threatened to rescind the requirement that residency programs protect core EM faculty time. We studied the issue, and quickly realized that unprotected faculty would have less time to teach us, mentor us, and incorporate us into their unique projects, so we were against it. Luckily ACEP, CORD, SAEM, and AAEM came to similar conclusions, so we joined forces and made sure the ACGME heard our voice. It was one of the most exciting and collaborative projects, with all the major organizations in EM coming together to move our specialty forward. And it had nothing to do with whose acronyms stood for what, all of us were in it for our members. That's what EMRA's all about, and why I believe that when we focus on our mission, the rest will fall into place.

In 25 words or less, please share your leadership philosophy.
Find rockstars (such as our committee leaders), Get out of their way (my job is to motivate), And say yes!

Tell us your own "why EM" moment — that one patient encounter or situation that made you realize emergency medicine is your calling.
In high school my aunt had a sudden- onset, worst headache of her life. In retrospect, the diagnosis was obvious. But at the time it wasn't, and a few days of trying Tylenol and Motrin later, when she presented to the ED she was in critical shape. Everyone was crying and freaking out, but a bald and soft-spoken emergency physician appeared. With a calm, cool, and collected demeanor, he told us he'd do everything to save her, and we believed him. She lived, and I couldn't wait to become that person, who could handle anything and save lives, for someone else.

What's at the top of your professional bucket list?
I fantasize about leading a rational health care system. By rational, I mean that we do things that make sense for our patients and for our physicians and staff. For example, the ubiquitous "but the policy is..." or "the administration wants..." is usually an attempt to standardize or micromanage health care delivery, which is a fool's errand because there is so much information asymmetry between management and the frontline providers. We experience this every time the inpatient team calls and asks why we admitted someone who can't ambulate and the person on the other end of the phone can't see how unsafe this discharge would be. Or the crazy variation in "policies" that prevent us from doing the best things for our patients. Many departments can't get a stress test during the typical timeframe of an ED stay or a high sensitivity troponin, but why? One of the Ten Commandments wasn't "thou shall not have stress tests in the ED," and high-sensitivity troponin testing has been shown to double the chest pain discharge rate, freeing up beds for other patients and reducing boarding.Sure, there are logistical and financial hurdles to overcome, but we sent a man to the moon 50 years ago and those hurdles were much bigger!

I believe it's our job as the future of Emergency Medicine to think differently and push our departments and hospitals to become more innovative, patient- centric, and rational.

What's the most-used app on your phone?
Seamless, NYC's food delivery app. One of the hospitals we rotate at is in America's most diverse zip code, so I get to try fantastic authentic cuisine from around the world at work.
Incidentally, I've also found myself using the translator app with patients who speak languages I never knew existed.

Hollander J. High-Sensitivity Troponin: Time to Implement. Ann Emerg Med. 2018;72(6):665-667.

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