AAEM position statement on the Emergency Medicine Workforce

[taserlaser]

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AAEM Position Statement on the Emergency Medicine Workforce | AAEM - American Academy of Emergency Medicine

AAEM was established in 1993 to promote fair and equitable practice environments necessary to allow emergency physicians to deliver the highest quality of patient care.

www.aaem.org

I think this provides a good contrast between leadership between our different disciplines. Just thought I would put this out there as a discussion point.

 

[radoncradonc]

	2018​	2019​	Relative Change
Med onc	553​	573​	1.036166365​
Rad onc	193​	207​	1.07253886​

Residency positions. Data from NRMP

Med oncs have this new thing called immunotherapy where they can routinely offer 10% improvement in OS. Isn't Jimmy Carter still alive 3 years after brain mets from melanoma? In rad onc all we get is hypofrac for prostate and breast where 1/2 of our revenue is taken away. Plus residency expansion out of proportion of course.

 

[seper]

ED docs are decisive and confident.
Silly RadOncs will continue to dread reaction from lawyers from a statement like this.

 

[thecarbonionangle]

Who is the original source of the “antitust” line? It is so widely parroted...

 

[Chartreuse Wombat]

I am not a lawyer but the guy that wrote this paper is. He suggests that antitrust precludes accrediting bodies from using workforce as a consideration for approval. I was an RRC member for 6 years and the ACGME expressly forbids workforce as a consideration. Informally some of us (late at night over drinks) discussed jury nullification; essentially ignoring what the ACGME told us. We never did act on it.

 

[medgator]

I am not a lawyer but the guy that wrote this paper is. He suggests that antitrust precludes accrediting bodies from using workforce as a consideration for approval. I was an RRC member for 6 years and the ACGME expressly forbids workforce as a consideration. Informally some of us (late at night over drinks) discussed jury nullification; essentially ignoring what the ACGME told us. We never did act on it.

Technically, hospitals aren't supposed to force their employed physicians to refer exclusively to their employed specialists to capture downstream revenue. In practice, it happens all the time. You'll just never find anything like that in writing.

Basically it's an unwritten policy to advance the hospital's interest . No different than what should be happening here in the interest of the specialty

 

[thecarbonionangle]

EM always seemed very savy people. Was always impressed by the hustle. Field not for me but many make a killing, some burn out early. FIRE big for them. Not surprised their organization is much more decisive and actually are doing something about it.

 

[evilbooyaa]

No different than what should be happening here in the interest of the specialty

The first step to fixing a problem is admitting there is a problem. We haven't reached that step in the eyes of enough of the leadership, at least not yet.

 

[randomname2018]

The article gives a detailed analysis of stakeholders, winners/losers, and concludes that essentially independent self regulation is the only solution. Of the stakeholders listed only 1 would immediately benefit from residency restriction. In fact the others are previously mentioned in the "winners" category. So, how is it that we influence positive change?

 

[RANDO_Phantom]

Technically, hospitals aren't supposed to force their employed physicians to refer exclusively to their employed specialists to capture downstream revenue. In practice, it happens all the time. You'll just never find anything like that in writing.

Basically it's an unwritten policy to advance the hospital's interest . No different than what should be happening here in the interest of the specialty

This was all over the news in December.

 

[RANDO_Phantom]

ED docs are decisive and confident.
Silly RadOncs will continue to dread reaction from lawyers from a statement like this.

Wish we rewarded mavericks among our ranks, not sycophant toadies.

 

[deleted941485]

Wish we rewarded mavericks among our ranks, not sycophant toadies.

One does not become a career academic by making waves. If it wasn’t so sad it would be funny especially when the research paradigm in Rad Onc has become a vanishing act or just a tag along in some immunotherapy trial.

 

[seper]

What were the news? My contract (hospital chain-employed) explicitly says to refer within.

This was all over the news in December.

 

[medgator]

What were the news? My contract (hospital chain-employed) explicitly says to refer within.

In writing?

 

[seper]

Yes, the latest version signed in 2017 and it says something like "shall refer only within our healthcare network unless similar services are not available". Hospital admins do track outside referrals and call our chairperson with complaints.

In writing?

 

[maxxor]

Yes, the latest version signed in 2017 and it says something like "shall refer only within our healthcare network unless similar services are not available". Hospital admins do track outside referrals and call our chairperson with complaints.

Sounds like it would be fun to file a whistleblower complaint on that.

 

[deleted941485]

Sounds like it would be fun to file a whistleblower complaint on that.

Even if it does and new rules are proposed, guarantee hospital admin will still make your life a living hell if you refer out with any frequency. This beast was created and it continues to enlarge.

 

[medgator]

Sounds like it would be fun to file a whistleblower complaint on that.

Any good qui Tam action starts with getting your fallout plan ready, including having a new job lined up when that first legal motion goes out.

You absolutely will be blackballed by your current and any future employers once people find out you blew the whistle.... The payout could be nice though

 

[Reaganite]

Highly doubt there is a contract out there from a major health system that would blatantly state referrals must be kept within the system without some major caveats. If the health system has assumed financial risk for patient lives (i.e. basically acting as the insurer) then they can legally restrict referrals "within network" as many other insurance entities do. However, they absolutely cannot in any way influence your referral decisions pertaining to fee-for-service Medicare patients. If they are, please send me the contract and I'd be happy to file the qui tam lawsuit for you 🙂.

 

[Palex80]

	2018​	2019​	Relative Change
Med onc	553​	573​	1.036166365​
Rad onc	193​	207​	1.07253886​

Residency positions. Data from NRMP

Med oncs have this new thing called immunotherapy where they can routinely offer 10% improvement in OS. Isn't Jimmy Carter still alive 3 years after brain mets from melanoma? In rad onc all we get is hypofrac for prostate and breast where 1/2 of our revenue is taken away. Plus residency expansion out of proportion of course.

They can actually CURE patients with it. That's the point I've bee hearing all along. Patients who would otherwise have no chance of cure.
Depends on disease but any figure around 10-30% is possible for many diseases (melanoma, renal cell cancer, non-small cell lung cancer).
Immunotherapy is for the oncologists what allogenic stem cell transplantation was and is for the hematologists.

 

[scarbrtj]

Hey now. We probably make better doctors than lawyers 'round here. Absolutely legal to contractually limit referral patterns for employed physicians. Employed physician: good, stable benefits... but say goodbye to your soul lol. JK. But autonomy, who needs it.

Some hospitals include terms in physician employment agreements that require the physicians to refer within the hospital system unless (i) the patient expresses a preference for a different provider, practitioner, or supplier; (ii) the patient’s insurer determines the provider, practitioner, or supplier; or (iii) the physician believes that the referral is not in the patient’s best medical interests. A hospital that includes this type of contractual restriction must determine that it is reasonably necessary to effectuate the legitimate business purposes of the arrangement with the physician. The Stark Law specifically permits a hospital to impose these referral restrictions, subject to these exceptions/conditions.

Also see here: The Hidden System That Explains How Your Doctor Makes Referrals.

 

[seper]

Anyone still wants file a lawsuit with me (against an entity with a couple of billions in annual revenue).

 

[Reaganite]

Hey now. We probably make better doctors than lawyers 'round here. Absolutely legal to contractually limit referral patterns for employed physicians. Employed physician: good, stable benefits... but say goodbye to your soul lol. JK. But autonomy, who needs it.

Some hospitals include terms in physician employment agreements that require the physicians to refer within the hospital system unless (i) the patient expresses a preference for a different provider, practitioner, or supplier; (ii) the patient’s insurer determines the provider, practitioner, or supplier; or (iii) the physician believes that the referral is not in the patient’s best medical interests. A hospital that includes this type of contractual restriction must determine that it is reasonably necessary to effectuate the legitimate business purposes of the arrangement with the physician. The Stark Law specifically permits a hospital to impose these referral restrictions, subject to these exceptions/conditions.

Also see here: The Hidden System That Explains How Your Doctor Makes Referrals.

Like I said, caveats 🙂. Those exceptions are very broad. "Patient wanted to go elsewhere." And what defines best medical interest? "I think Dr. X is better than our in-network specialist." That being said, I agree this is a moot point. You're forced to send in-network regardless of the legality. People do keep track of your referrals and do pressure you under threat of replacement to send in-network.