ACEP ‘23

[FlaminHotER]

Anyone here at Acep in Philly?

I just had a great conversation with Dr. McNamara at the AAEM booth

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Members don't see this ad.

 

[deleted206819]

Fill us in on the unionization talk that is supposed to be happening, if you can.

We need to get some sort of union or cartel going especially if we are independent contractors. They can control us one by one but not if we are a union.

What the hell is the government going to do if a large majority of us become part of a union?

 

[FlaminHotER]

Fill us in on the unionization talk that is supposed to be happening, if you can.

We need to get some sort of union or cartel going especially if we are independent contractors. They can control us one by one but not if we are a union.

What the hell is the government going to do if a large majority of us become part of a union?

There is a talk from the FTC chair tomorrow about this exact thing

“You won't want to miss the closing session on Wednesday, featuring special guest Lina M. Khan, FTC Chair.

Beyond the Rhetoric - Conversations About Private Equity, Non Competes & the Future of EM
Lawton R. Burns, PhD, MBA
Lina M. Khan, FTC Chair
October 11 | 1:30 pm - 2:30 pm ET

It’s time for real talk about the business of emergency medicine. We have to view our issues through every lens – business, regulatory, legislative, and, most importantly, your perspectives from the real world where the rubber meets the road.

Dr. Lawton R. Burns, Professor of Management at the Wharton School, University of Pennsylvania, analyzes private equity trends in health care and will share his data with us. His summary of current healthcare economics will give us a true lay of the land.

On the heels of ACEP’s compelling testimony to the Federal Trade Commission (FTC) about consolidation, special guest Lina M. Khan, FTC Chair, will join us during the session to share the agency’s perspective on its work and how it could help protect EPs.”

 

[FlaminHotER]

I am hoping there is an open mic q&a tomorrow so we can ask if the ftc is going to go after companies like USACS next like they are usap

 

[Birdstrike]

There is a talk from the FTC chair tomorrow about this exact thing

“You won't want to miss the closing session on Wednesday, featuring special guest Lina M. Khan, FTC Chair.

Beyond the Rhetoric - Conversations About Private Equity, Non Competes & the Future of EM
Lawton R. Burns, PhD, MBA
Lina M. Khan, FTC Chair
October 11 | 1:30 pm - 2:30 pm ET

It’s time for real talk about the business of emergency medicine. We have to view our issues through every lens – business, regulatory, legislative, and, most importantly, your perspectives from the real world where the rubber meets the road.

Dr. Lawton R. Burns, Professor of Management at the Wharton School, University of Pennsylvania, analyzes private equity trends in health care and will share his data with us. His summary of current healthcare economics will give us a true lay of the land.

On the heels of ACEP’s compelling testimony to the Federal Trade Commission (FTC) about consolidation, special guest Lina M. Khan, FTC Chair, will join us during the session to share the agency’s perspective on its work and how it could help protect EPs.”

If you’re able to share slides or video of these presentations, please do so. I’m interested.

 

[JacobMcCandles]

I would be somewhat (and pleasantly) surprised if the talk ends up painting PE in a bad light.

 

[EctopicFetus]

I would be somewhat (and pleasantly) surprised if the talk ends up painting PE in a bad light.

Khan hates PE. Other legistlstirs are taking note. I anticipate a broad anti cpom bipartisan bill to be introduced in the next 6 months. I have no idea if it will pass but a few senators are interested.

 

[JacobMcCandles]

Khan hates PE. Other legistlstirs are taking note. I anticipate a broad anti cpom bipartisan bill to be introduced in the next 6 months. I have no idea if it will pass but a few senators are interested.

I hope so. Maybe it’s just me being optimistic but there seems to be some ground swell with regards to PE and insurance companies. The lobbying money will be tough to overcome but now that things are more in the light it’s getting tougher for politicians to defend it.

 

[FlaminHotER]

Dr. Cantor gave another phenomenal and hilarious presentation on PEM cases

Wish he had more than 1 hour to speak

 

[FlaminHotER]

Panel discussion yesterday

Quick summary

Before heading into Tuesday’s James D. Mills, Jr., Lecture at ACEP23, panelist Robert W. Strauss, MD, FACEP, said he was chatting with somebody in the back of the room and mentioned that serving in professional development as Chief Medical Training Officer at TeamHealth is his favorite part of the job.
Dr. Strauss said his goodbye started toward the stage. “And as I’m walking away, he said, ‘Good luck making it out alive.’”
The ice breaker generated a laugh from attendees. It also served as a segue to “A Primer and Discussion of EM Employment Models.” Candid discussion from experts looked at the pros and cons of different employment models, but a focus for moderator ACEP Immediate Past President Chris Kang, MD, FACEP; and panelists James G. Adams, MD, FACEP and Tracy G. Sanson, MD, FACEP, was the future of emergency medicine.
Panelists discussed the impact of private equity, the challenges of insurers and payment, and they agreed emergency medicine is facing enormous challenges and working out of the current crisis will take a unified voice.
“The crisis is raining down on emergency medicine,” said Dr. Adams, Senior Vice President and Chief Medical Officer of Northwestern Medicine, an 11-hospital health system. “What has been emergency medicine’s response? Adapt as we always do. That’s to your credit. I admire you for it, and now it’s time to stop.”
He said for some, there has been debate “whether United States emergency departments actually needed an emergency physician. How dare we have that debate.”
Dr. Sanson, who practices clinically as an independent contractor, began the discussion by looking back at how emergency medicine got here. She pointed out that a similar session she helped deliver in 2022 discussed that health care is sick, individuals are not OK, systems are not OK and generally, the United States is not OK.
Then, 2023 came, and it wasn’t any better.
Bankruptcy filings from OPXS (Optex Systems Holdings, Inc) and Envision, followed by the American Physician Partners “closing up shop, sending out an email on the 17th of July saying, by the way, after the 31st, we won’t be here anymore and had a total of 18 states, 155 EDs and 2,500 emergency physicians and other clinicians who were suddenly left standing bewildered and feeling rejected and quite abandoned.”
With other recent changes, such as Optum laying off nurses, Dr. Sanson said the panelists changed the session’s focus to how emergency medicine moves into its next phase.
“For the individual sitting here, I’ll tell you what made me say yes to doing this lecture,” Sanson said. “About a year ago, I felt an anger welling about where emergency medicine was. What happened to the emergency medicine that I trained in, that I grew up in, that we worked so hard to say we were emergency physicians? I saw it dissolving in front of us. One of the bright spots is that the FTC has (sued) the U.S. Anesthesia Partners, saying they were monopolizing and consolidating and re-setting some prices. I’m hoping there will be some checks and balances that continue to work in our favor.”
One of the challenges emergency medicine faces, Dr. Kang said, is consolidation. Dr. Kang, who is an attending physician at Madigan Army Medical Center in Washington state, addressed the ACEP Council on Saturday and encouraged ACEP Councillors to have the right discussion because it’s easy to oversimplify issues.
“Consolidation, corporatization, private equity, etc., they all may overlap, but they’re distinct,” he said. “If we’re going to have the right discussion, let’s have the right understanding. So let’s talk about consolidation.”
Dr. Kang turned to Dr. Strauss, who pointed out that in 2019, 62 percent of clinicians across medicine worked in hospitals, hospital systems and large groups. In 2022, that number grew to 74 percent. Of that group, 70 percent work in hospitals and hospital systems.
He said further consolidation could be inevitable when you look at recent trends, mostly because the pandemic created a lot of uncertainty, frustration, and financial frustration.
“Physicians want financial certainty, particularly in a decreasing reimbursement environment,” he said. “They want decreased complexity and the potential – we all do – to have more balance. EM is at high risk for consolidation.”
Dr. Strauss said there might be benefits to consolidation because size matters. A focused support staff working on programs to make emergency physicians’ practices more efficient could help in the time of greatest need. Success depends on how the emergency physician is treated.
“Physicians are valued, have access to optimal resources and are paid well at the highest percentages of net revenue. Done right also means the team and organization fights for your rights,” Dr. Strauss said.
When searching for a place of employment, Dr. Adams encourages emergency physicians to follow the money.
“The people who allocate the money are the only ones that have power,” he said. “It needs to flow through somebody who shares your values.”
Dr. Sanson said transparency is crucial and told attendees about an ACEP resource that was just released. ACEP Open Book, powered by Ivy Clinicians, uses data from emergency physician employers and allows potential job seekers to learn about employers. It includes data about compensation, number of patients, numbers of staff members, group or hospital size, and employer leadership.
“A presentation like this isn’t to give you absolutely all the information you need,” Dr. Sanson said. “It’s to pique your interest to go get more on your own. I did ask the question. How many emergency departments do we have in the United States? How many are military, VA? How many are health systems? How many are individual? I didn’t get good answers. I think one of the ways we’re going to progress and get to a better side of where are right now is if we have transparency and education for the individual physicians.”

Visit ACEP Open Book at openbook.acep.org.

 

[p1acebo]

There are no slides, it’s a discussing with a Q and A session.

I would say overall it wasn’t very helpful, sounds like the FTC acknowledges the frustrations with PE involvement but doesn’t take a strong stance on actually blocking all forms of involvement.

 

[bravotwozero]

Also worth noting that Khan hasn’t won a single case in court so far.

 

[FlaminHotER]

There are no slides, it’s a discussing with a Q and A session.

I would say overall it wasn’t very helpful, sounds like the FTC acknowledges the frustrations with PE involvement but doesn’t take a strong stance on actually blocking all forms of involvement.

Dr. McNamara dropped the mic at the end tho

 

[FlaminHotER]

Also worth noting that Khan hasn’t won a single case in court so far.

That’s a good point. I wanted to ask if they are going to stop the Kaiser merger or just let that go through like they have other merges

 

[p1acebo]

Dr. McNamara dropped the mic at the end tho

100% he did, he deserved the round of applause he received. The answer he received just wasn’t very satisfying.

 

[FlaminHotER]

100% he did, he deserved the round of applause he received. The answer he received just wasn’t very satisfying.

100%

It was a typical government no answer type of answer

 

[RustedFox]

What did Mac say that qualified as mic-drop?

 

[Apollyon]

Dr. Cantor gave another phenomenal and hilarious presentation on PEM cases

Wish he had more than 1 hour to speak

Richie is hilarious. A true gem.

 

[FlaminHotER]

What did Mac say that qualified as mic-drop?

I’m paraphrasing but the gist was how does Acep and the FTC allow the unholy presence of PE backed companies such as Team Health, Optum, Usacs (he didn’t say usacs specifically) in the halls of acep

He said a lot more but I couldn’t hear too good from where I was sitting

 

[EDThoracotomy]

Dr. McNamara dropped the mic at the end tho

I’m paraphrasing but the gist was how does Acep and the FTC allow the unholy presence of PE backed companies such as Team Health, Optum, Usacs (he didn’t say usacs specifically) in the halls of acep

He said a lot more but I couldn’t hear too good from where I was sitting

What was the response to this?

 

[FlaminHotER]

What was the response to this?

Everyone in the room started clapping and hollering support for him

 

[GassYous]

I don't know why they would put the usap lawsuit as a win for physicians. Yes I think PE is healthcare is negative but the actual opponent is the insurance companies. United is unilaterally decreasing reimbursements in anticipation of arbitration, using ghost codes (decreasing sedation reimbursement to people who don't provide sedation and increasing other reimbursements to those physicians to decrease payments to people who actually provide sedation), directly employing physicians (through sound anesthesia) with increased mid level presence (8 to 1 crna to md ratios), decreased pay, etc.

 

[EDThoracotomy]

Everyone in the room started clapping and hollering support for him

I love Mac. Guy is a legend.

 

[thegenius]

I don't know why they would put the usap lawsuit as a win for physicians. Yes I think PE is healthcare is negative but the actual opponent is the insurance companies. United is unilaterally decreasing reimbursements in anticipation of arbitration, using ghost codes (decreasing sedation reimbursement to people who don't provide sedation and increasing other reimbursements to those physicians to decrease payments to people who actually provide sedation), directly employing physicians (through sound anesthesia) with increased mid level presence (8 to 1 crna to md ratios), decreased pay, etc.

Multiple bad players. Insurance companies are terrible. PE is abhorrent. They basically take your hard earned money and keep it as profit, and pay down their debt which bought you in the first place. You liked 450K/year, until you realized you earned 530K/year and 80K went to a guy in a suit and a gal in a dress sitting in a nice office building drinking scotch at 3:30 PM on Friday, while you slave away managing 6 OR rooms.

 

[EctopicFetus]

Multiple bad players. Insurance companies are terrible. PE is abhorrent. They basically take your hard earned money and keep it as profit, and pay down their debt which bought you in the first place. You liked 450K/year, until you realized you earned 530K/year and 80K went to a guy in a suit and a gal in a dress sitting in a nice office building drinking scotch at 3:30 PM on Friday, while you slave away managing 6 OR rooms.

their margins are far more than that Not including debt service.

 

[FlaminHotER]

What did Mac say that qualified as mic-drop?

Much better write up of the point and question he was making

The ACEP23 Closing Session featured a tireless advocate of emergency physician autonomy face-to-face with a fierce opponent of corporate monopolization. Bob McNamara, MD, founder of AAEM, was at the microphone, while Lina Khan, Chair of the Federal Trade Commission, was broadcast on a massive screen. Dr. McNamara asked Chair Khan if the American College of Emergency Physicians would violate US antitrust laws by excluding employers from its conference exhibit hall for not abiding by ACEP policies.

McNamara's underlying question was: could ACEP kick out Envision, TeamHealth, Sound, and SCP from its trade show because private equity firms own them? Dr. McNamara received rousing applause from the audience. In response, Khan answered the question she wanted to be asked, not the one that was asked. Since Lina Khan didn’t answer, let’s dig into it.

When considering whether trade associations’ actions violate US antitrust laws, the Federal Trade Commission and Department of Justice use the “rule of reason.” Per the DOJ: “Under the ‘rule of reason,’ the courts must undertake an extensive evidentiary study of (1) whether the practice in question in fact is likely to have a significant anticompetitive effect in a relevant market and (2) whether there are any procompetitive justifications relating to the restraint. Under the ‘rule of reason,’ if any anticompetitive harm would be outweighed by the practice’s procompetitive effects, the practice is not unlawful.”

In other words, a trade association’s action that meaningfully limits competition within a market would violate the Sherman Act unless that action promotes competition in some other way.

The law firm Venable summarizes, “The courts and antitrust enforcement agencies (the U.S. Department of Justice and the Federal Trade Commission) generally have agreed that the mere existence of membership qualifications and standards is not unreasonable. On the other hand, restrictions that restrain competition or impose unreasonable restraints may be viewed as prohibited ‘group boycotts’ or ‘concerted refusals to deal.’”

The FTC sent a detailed letter to ACEP on this topic in 2004. ACEP solicited the letter to clarify the legality of the 2003 Council Resolution, “Certificate of Compliance.” The resolution included the following:

That ACEP will require emergency physician staffing groups to sign the following certificate and to comply with its terms as a prerequisite for their participation as an exhibitor or sponsor in any of the College activities and venues: “I confirm/certify that all of the following are true”:

1. With the provisional period not to exceed one year, our physician group provides our emergency physicians access to predefined due process. Our physician group, or its controlling entity, has a predefined mechanism that regularly and automatically provides all our emergency physicians the detail of their own professional charges and collections. This information shall be automatically provided to the physician on a quarterly basis.

2. Our physician group provides our emergency physicians: a) a predefined and reasonable pathway to full partnership that does not exceed three years, b) the review process and criteria used to grant full partnership, c) a predefined entry and exit policy, and d) the exact distribution of all shares held in the group. For the purpose of this certificate, a full partner is defined as an equal shareholder with equal voting status.

3. Our physician group, or its controlling entity, has a predefined mechanism that regularly and automatically provides all full partners: a) the total charges and collections for the group, and b) the distribution of all group income including all management and operational expenses including coding/billing/collecting, professional liability insurance, non-physician employee salaries, and physician administrative stipends. This information shall be automatically provided to the partners on a quarterly basis.

4. Our physician group provides our emergency physicians with the details of our governance process including the method of electing leaders and new partners, appointing medical directors and administrators and revising the bylaws.

5. Our physician group does not impose post-contractual restrictive covenants (i.e., non-compete clauses).

6. Our physician group, or its controlling entity, is wholly owned by practicing physicians.

—

Advocates of physician practice ownership would recognize these six elements as foundational to the battle against the corporate practice of medicine.

Key portions of the Federal Trade Commission letter to ACEP:

“The resolutions would establish rules concerning business practices of physician groups or firms that provide emergency physician services to hospital emergency departments (emergency physician staffing organizations). The proposed rules appear capable of harming competition in the provision of those services, and thus raise antitrust issues.”

“An antitrust analysis would consider both: (1) whether the exclusion of non-complying entities from ACEP activities and publications would likely have a significant effect on the ability of those firms to recruit emergency physicians and thus to compete in the market; and (2) whether the intent or likely effect of adoption of the rule would be to orchestrate an agreement among competing physicians to adhere to the prescribed model. The resolution advises members that they "need to work together to shape the practice environment." and further states that "[t]urning policy into practice is essential." It may be that the resolution is designed to suppress certain models for providing emergency department services, and thereby to restrict competition among emergency medicine providers.”

“Agreements among ACEP members not to do business except on the terms contained in the resolution, or a direct ACEP prohibition of its members' accepting employment on non-conforming terms, would raise serious antitrust concerns.”

Would raise serious antitrust concerns is lawyer-speak for, if you try to do this, you’ll end up in court.

Dr. McNamara responded to the FTC’s 2004 letter with an article published through AAEM. He wrote, “There are various ways to interpret this FTC opinion. ACEP has apparently chosen to take this matter as a chance to reinforce their fears about the antitrust boogey man.”

The Federal Trade Commission is no antitrust boogeyman. Google, Amazon, US Anesthesia Partners, health systems, and others are finding out the hard way that violating US antitrust laws has serious consequences.

The bottom line answer to Dr. Bob McNamara’s ACEP23 question to Lina Khan: banning private equity-owned emergency medicine groups from ACEP conferences or exhibit halls because most ACEP members disagree with those firms’ business models would violate US antitrust law.

 

[Mount Asclepius]

Much better write up of the point and question he was making

The ACEP23 Closing Session featured a tireless advocate of emergency physician autonomy face-to-face with a fierce opponent of corporate monopolization. Bob McNamara, MD, founder of AAEM, was at the microphone, while Lina Khan, Chair of the Federal Trade Commission, was broadcast on a massive screen. Dr. McNamara asked Chair Khan if the American College of Emergency Physicians would violate US antitrust laws by excluding employers from its conference exhibit hall for not abiding by ACEP policies.

McNamara's underlying question was: could ACEP kick out Envision, TeamHealth, Sound, and SCP from its trade show because private equity firms own them? Dr. McNamara received rousing applause from the audience. In response, Khan answered the question she wanted to be asked, not the one that was asked. Since Lina Khan didn’t answer, let’s dig into it.

When considering whether trade associations’ actions violate US antitrust laws, the Federal Trade Commission and Department of Justice use the “rule of reason.” Per the DOJ: “Under the ‘rule of reason,’ the courts must undertake an extensive evidentiary study of (1) whether the practice in question in fact is likely to have a significant anticompetitive effect in a relevant market and (2) whether there are any procompetitive justifications relating to the restraint. Under the ‘rule of reason,’ if any anticompetitive harm would be outweighed by the practice’s procompetitive effects, the practice is not unlawful.”

In other words, a trade association’s action that meaningfully limits competition within a market would violate the Sherman Act unless that action promotes competition in some other way.

The law firm Venable summarizes, “The courts and antitrust enforcement agencies (the U.S. Department of Justice and the Federal Trade Commission) generally have agreed that the mere existence of membership qualifications and standards is not unreasonable. On the other hand, restrictions that restrain competition or impose unreasonable restraints may be viewed as prohibited ‘group boycotts’ or ‘concerted refusals to deal.’”

The FTC sent a detailed letter to ACEP on this topic in 2004. ACEP solicited the letter to clarify the legality of the 2003 Council Resolution, “Certificate of Compliance.” The resolution included the following:

That ACEP will require emergency physician staffing groups to sign the following certificate and to comply with its terms as a prerequisite for their participation as an exhibitor or sponsor in any of the College activities and venues: “I confirm/certify that all of the following are true”:

1. With the provisional period not to exceed one year, our physician group provides our emergency physicians access to predefined due process. Our physician group, or its controlling entity, has a predefined mechanism that regularly and automatically provides all our emergency physicians the detail of their own professional charges and collections. This information shall be automatically provided to the physician on a quarterly basis.

2. Our physician group provides our emergency physicians: a) a predefined and reasonable pathway to full partnership that does not exceed three years, b) the review process and criteria used to grant full partnership, c) a predefined entry and exit policy, and d) the exact distribution of all shares held in the group. For the purpose of this certificate, a full partner is defined as an equal shareholder with equal voting status.

3. Our physician group, or its controlling entity, has a predefined mechanism that regularly and automatically provides all full partners: a) the total charges and collections for the group, and b) the distribution of all group income including all management and operational expenses including coding/billing/collecting, professional liability insurance, non-physician employee salaries, and physician administrative stipends. This information shall be automatically provided to the partners on a quarterly basis.

4. Our physician group provides our emergency physicians with the details of our governance process including the method of electing leaders and new partners, appointing medical directors and administrators and revising the bylaws.

5. Our physician group does not impose post-contractual restrictive covenants (i.e., non-compete clauses).

6. Our physician group, or its controlling entity, is wholly owned by practicing physicians.

—

Advocates of physician practice ownership would recognize these six elements as foundational to the battle against the corporate practice of medicine.

Key portions of the Federal Trade Commission letter to ACEP:

“The resolutions would establish rules concerning business practices of physician groups or firms that provide emergency physician services to hospital emergency departments (emergency physician staffing organizations). The proposed rules appear capable of harming competition in the provision of those services, and thus raise antitrust issues.”

“An antitrust analysis would consider both: (1) whether the exclusion of non-complying entities from ACEP activities and publications would likely have a significant effect on the ability of those firms to recruit emergency physicians and thus to compete in the market; and (2) whether the intent or likely effect of adoption of the rule would be to orchestrate an agreement among competing physicians to adhere to the prescribed model. The resolution advises members that they "need to work together to shape the practice environment." and further states that "[t]urning policy into practice is essential." It may be that the resolution is designed to suppress certain models for providing emergency department services, and thereby to restrict competition among emergency medicine providers.”

“Agreements among ACEP members not to do business except on the terms contained in the resolution, or a direct ACEP prohibition of its members' accepting employment on non-conforming terms, would raise serious antitrust concerns.”

Would raise serious antitrust concerns is lawyer-speak for, if you try to do this, you’ll end up in court.

Dr. McNamara responded to the FTC’s 2004 letter with an article published through AAEM. He wrote, “There are various ways to interpret this FTC opinion. ACEP has apparently chosen to take this matter as a chance to reinforce their fears about the antitrust boogey man.”

The Federal Trade Commission is no antitrust boogeyman. Google, Amazon, US Anesthesia Partners, health systems, and others are finding out the hard way that violating US antitrust laws has serious consequences.

The bottom line answer to Dr. Bob McNamara’s ACEP23 question to Lina Khan: banning private equity-owned emergency medicine groups from ACEP conferences or exhibit halls because most ACEP members disagree with those firms’ business models would violate US antitrust law.

I can’t tell from your posts if you are quoting entire articles without providing sources or maybe less likely using ChatGPT. I’m doubtful that you are writing these long posts. Clarification is important for determining validity.

 

[FlaminHotER]

I can’t tell from your posts if you are quoting entire articles without providing sources or maybe less likely using ChatGPT. I’m doubtful that you are writing these long posts. Clarification is important for determining validity.

Relax it’s from the em workforce weekly newsletter

Not Every Good Idea Is Legal

Also: Highly rated EM residency to close, less pay beyond the 4 walls, Doctors Council union, physicians sued for patients seen by PAs & NPs, and PE vs pets.

emworkforce.substack.com

 

[EctopicFetus]

Funny

Relax it’s from the em workforce weekly newsletter

Not Every Good Idea Is Legal

Also: Highly rated EM residency to close, less pay beyond the 4 walls, Doctors Council union, physicians sued for patients seen by PAs & NPs, and PE vs pets.

emworkforce.substack.com

the author of the newsletter thinks he is an attorney. Opinions on the law change (See Roe v Wade). What maybe held true in 2003 doesnt mean a ton today. New world. yes precedent matters but the author thinks he is some expert. What is missing is how the ACEP guy Stanton was about to poop his pants cause he didnt want Bob Mac to get a question in. Bob knows how to make the acep *****s look and feel stupid by asking simple questions they cant answer.

 

[FlaminHotER]

Funny

the author of the newsletter thinks he is an attorney. Opinions on the law change (See Roe v Wade). What maybe held true in 2003 doesnt mean a ton today. New world. yes precedent matters but the author thinks he is some expert. What is missing is how the ACEP guy Stanton was about to poop his pants cause he didnt want Bob Mac to get a question in. Bob knows how to make the acep *****s look and feel stupid by asking simple questions they cant answer.

Good point.

The funny thing is that Mcnamara got the very last question in, and boy it was good

 

[kidthor]

Wow. I’m an anesthesiolgist and we just had our annual meeting…. We had nothing as good as this sounds like it was. Man I wonder if I can invite Khan and McNamara come talk at our conference next year. The exact same PE douchbags are ruining anesthesia and nobody in my field seems to know/care.

 

[DeadCactus]

Wow. I’m an anesthesiolgist and we just had our annual meeting…. We had nothing as good as this sounds like it was. Man I wonder if I can invite Khan and McNamara come talk at our conference next year. The exact same PE douchbags are ruining anesthesia and nobody in my field seems to know/care.

No one in EM cared either when jobs were abundant and pay was ridiculous.

 

[kidthor]

No one in EM cared either when jobs were abundant and pay was ridiculous.

And then EM because a lesson for us all, except that nobody cares to pay attention!