American Academy of Emergency Medicine

My experience with EmCare

Date: July 21, 2004
Subject: My experience with EmCare

I am one of those docs that have held dual membership in AAEM and ACEP for several years. I "kind of" listened to what AAEM was trying to tell us, but thought them a bit "over-zealous". One year ago, I signed with EmCare as an associate director of a site in New Haven, CT, lured with big money and a promise of career advancement.

Allow me to describe what occurred;

Told repetitively by corporate "regional managers" to force docs to maximize documentation even if exams/histories in all areas weren't performed. (Ex: ankle sprain should include a head to toe exam, ROS, etc. to maximize billing/coding.

Told all docs that attendings had to sign every single midlevel chart and write a note on it stating we had seen the patient when indeed we hadn't or risk losing salary/job.

When I, as an Associate Chair, stepped in to re mediate a surgical resident who had physically struck one of the ED nurses, I was asked by corporate to "not get involved", that it was a hospital issue "not ours".

EmCare's only concern was to please the face of their contract who happened to be an internist VP of Medical Affairs who had never worked in emergency medicine and simultaneously oversaw EM, Anesthesia, and outpatients clinics. His "solution" to ED overcrowding was to "just not see so many patients" wanting us to turn patients away when we reached our "quota". When I pointed out that he clearly did not understand emergency medicine, the EMTALA laws, etc., he complained to corporate that I was an obstacle to him and was summarily dismissed as Associate Chair, with loss of benefits, and about 40,000$ in income. Keep in mind that I had No recourse to this decision. No Peer review, No protection from medical staff bylaws (emcare docs are "temporary med staff not active")...I continued to work non-administratively for 4 additional months when at the end of a very long 4 day weekend stretch of night shifts, at 7am, I was told not to return to work that night. No reason why. Just terminated.

A colleague suffered the same fate because we didn't "fit" EmCare's vision of the department and weren't "Team players" (unfortunately, my colleague had taken this job as his first after residency and is now soured on the specialty overall).

Tom, I write to you not to bore you, but as a vehicle through which I can vent. I want you to know how much I appreciate AAEM and all that we stand for. NOW, I get it. NOW, I see the huge dichotomy between the individual ED doc and the corporate practice of medicine. NOW, I see the difference between ACEP and AAEM. I have resigned my membership in ACEP. The colleague I mentioned who also was fired for no apparent reason (He refused to "butter up" his charts, refused to say he did things he didn't do on charts) are interested in forming a state chapter here in Connecticut. Any advice regarding the formation of a Connecticut or New England Chapter would be greatly appreciated.

Thank you for your time,

Jim Bovienzo, DO, FAAEM