American Academy of Emergency Medicine

Thank You to AAEM

Having recently retired, it is time to reluctantly relinquish my membership in AAEM. In response to the annual plea for membership renewal, I am sending this long overdue letter to AAEM thanking you for your support many years ago, when my position as an ER doc in Camarillo, California, at a Catholic Healthcare West (now Dignity Health) hospital was threatened. Those of you who are of my vintage will remember that CHW attempted to turn all its emergency department contracts over to Meriten, its in-house subsidiary contract management group, taking them away from the then current contract holders, EPMG and others.

I was happy in Camarillo. We had a good hospital and a good community in which to practice. Our contract had been held by a single individual, who ran our group democratically, for over 20 years prior to this move by CHW. We had good community support but wondered how much help this would be in the face of a large, regional change by CHW. Anxiety and sleepless nights followed, as we encountered the usual worries of relocating — finding new jobs, dealing with mortgages, school issues, spouse’s jobs, and family ties. Fortunately, the directors of EPMG acted promptly and decisively to resist this change.

California has strong prohibitions on the corporate practice of medicine, and the California Medical Association responded promptly to our request for help. But, despite the fact that most of us were members of ACEP, I was shocked and puzzled to find that ACEP met our pleas for help with total silence. I could not believe that our specialty’s largest professional society felt this issue was none of its concern.

Fortunately for my colleages and me, AAEM stepped in and became our steadfast advocate. Much effort was expended by Bob McNamara and the other leaders of AAEM on our behalf, and CHW’s attempts were finally rebuffed. As a result I joined AAEM and left ACEP, and I have never regretted that decision.

In preparing this letter, I see that history is now repeating itself: a very similar situation is happening with Tenet and its attempt to replace emergency medicine, anesthesiology, and hospitalist groups in its California hospitals with a single large staffing corporation — using profit from the emergency medicine groups to subsidize money-losing hospitalist and anesthesia programs in the process. I’m happy to see resistance to this move, including a website (http://coalitionforqualitycare.com/). 

This is an old story. I want to stress, particularly to those of you early in your career or in residency, that there will always be substantial pressure from others to take over the management of physicians, in an effort to siphon off the income for which you’ve put in countless hours of training and endured stress and fatigue in a work environment that is unimaginable to most people. This will not stop. It is suicidal for you to remain passive, sleepwalking through the financial environment of 21st century health care. Vigilance and resistance are required.

You are fortunate to have a responsive partner in AAEM, which will support you as it did me. You need to make strong efforts to convince your colleagues who are not currently members of the Academy to join, supporting each other and our specialty.

I’m sure you have the support of your medical staff, and I’m confident that the community you have worked in for years will support you, prompted by the gratitude of the families you have been treating with professionalism 24/7/365. We know the devastation that will occur in our communities and hospitals if Tenet’s naïve and self-serving efforts are successful. Appealing strategically and courteously to influential people in your communities should help.

Best of luck. Stick together. Actively resist. AAEM worked for us, and it will work for you if you support it.

— Ted Angus, MD
Ojai, CA

Thank you very much for your letter. Residents and young emergency medicine attendings weren’t around for the Catholic Healthcare West (CHW) battle. Many older emergency physicians may not have been aware of it, and even those of us who do know about it need to be reminded of AAEM’s important victories from time to time.

All emergency physicians should be aware of the significant differences between ACEP (the College) and AAEM (the Academy), and the CHW incident is a good example. The College stayed out of the battle, calling it a “private business matter” and (in my opinion) leaving its members to the tender mercies of predatory corporations motivated only by profit. I should point out that I have nothing against profit. It is being motivated only by profit that I object to, and those of us who practice the ancient profession of medicine have sworn to put other values first. Those values require that physicians control the practice of medicine so that patients are the highest priority, rather than allowing corporations to make shareholder profits and obscenely bloated CEO compensation the highest priorities.

For a fuller exploration of the differences between the College and the Academy, read three articles from the Jan/Feb 2014 issue of Common Sense: 1) Why AAEM?, 2) Legitimate, and 3) Highlights of AAEM’s Legal Advocacy for Emergency Physicians (http://www.aaem.org/UserFiles/ January-February14CommonSense.pdf). As you read the third article, ask yourself why the College would sit out each of the battles in which the Academy came to the rescue of local, independent EM groups. In my opinion the explanation is that, while the College no longer elects the owners and CEOs of contract management groups (CMGs) to its presidency, its leadership is still too riddled with the owners, CEOs, regional directors, and other management-level employees of CMGs - including its leadership at the state chapter level. This is a flagrant and unresolvable conflict of interest. As St. Matthew wrote, “No man can serve two masters.” Many current issues in emergency medicine boil down to this: individual, practicing emergency physicians who want to take care of patients and be fairly paid for it vs. corporations that care about nothing but increasing share price and CEO compensation. It’s the same old “scrubs vs. suits” conflict James Keaney wrote about in The Rape of Emergency Medicine.

Just as a man can serve only one master, a professional society can take  only one side in the battle for the soul of our specialty. The Academy has chosen its side. In my opinion, so has the College.

— The Editor

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