Dear CEO of (insert large CMG group)-
You have won. Your company, combined with the other 6 largest companies staffing Emergency Medicine have successfully conquered our specialty, and taken the vast majority of us as your workers. You have dominated the hospital marketplaces, masterfully combined with other specialty groups - Hospitalists, Anesthesia, Radiology - and have started to make unimaginable profits by combining your divisions, spinoffs, group acquisitions, and even each other into an unstoppable negotiating force based on economy of scale. You outbid, outcompete, and defeat all competitors vying for the majority of hospital contracts in the country. Some of you have even combined with the very hospitals you staff, and grow unimaginable joint ventures. You are truly masters of the universe, and have batted away all competition through business maneuvers and buyouts.
Because of your triumph, hospitals now have no choice but to invite you to sit at their table every time a contract group is up for bid, and allow you to give your presentation for why your company is better than any other group bidding for the same contract. You have even become masters at bidding against each other, with the hopes that a few small maneuvers or promises to hospital administrators will give you the edge to reap the profits from the work of your providers, and increase your dominance in the marketplace. From a business perspective, you are savvy, adaptable, and able to say whatever you need to get the contract you want. Because of you, the business of medicine has come a long way. Some of you, as CMG CEO's are even physicians yourselves.
I am humbled to write this letter to you, because not only do I work for you, I am part of your success, and I thank you for the opportunity to see my specialty change. It is this reason that I write this letter to you, and ask that you consider your dominance in the Emergency Medicine world, and begin to use it for reasons beyond earning your profits, but to enhance your profits, by gaining the loyalty of your providers.
Winning, managing and directing a contract is clockwork for you. Win the bid, schedule a transition date, figure out who you need to hire (and how to hire them), contract some doctors, and make a schedule. Find a leader that administration likes and have them run things for you on the ground, and presto - a new "local group" is born. I urge you, now, to consider the most important part of your mission, which is the retention of the shiny new contract you have just acquired. You see, every step from bid to group is done by your team, on your terms, and based on what the administration wants they are your customer, and you are their whipping boy.
Not one part of what you do to gain a contract actually involves the TEAM that will be put on the ground to keep the contract for you. They are hired, paid a meager hourly rate for putting their liability on the line, sacrificing their friends, families, holidays, weekends, nights, and vacations to keep their "job," while ensuring that you have a staffed schedule, a happy hospital administrator, and of course, metrics that keep you competitive. Not a single physician you employ or contract went to medical school with the eventual hopes of working an hourly rate they don't control, being graded for patient satisfaction, seeing as many patients as they can, and doing it as fast as they can while facing an endless list of core measure requirements. Your physicians do this because it's part of the job, and sadly, a series of obstacles that they must jump through, knock down and run around simply to care for their - YOUR - patients.
I am not writing this to whine, or ask for sympathy, but actually to present a business case that may give you the ability to completely give you stability, market value, physician loyalty, and a new model of practice in today's changing environment. You see, you have the keys to the kingdom.
As a contract management group with dominant market control and economy of scale, with the majority of Emergency Physicians in our nation, it is time you collectively joined to set the expectations of your sector. In ways no different than OPEC, you control the inflow and outflow of your oil. Why do you tolerate the potential loss of a contract because a local cardiologist at one of your hospitals does not like a physician because they don't speak fluent english? Why does an Emergency Medicine provider group have to displace their homes and their families because the anesthesia group contracted as a "bundle" with them isn't liked by the general surgeon?
The very fear you aim to avoid - the loss of business by losing a contract - is ironically something you are completely in the driver seat to control. Hospitals need Emergency Physicians, and more and more they need residency-trained and board-certified physicians. There are not enough of us to fill their ED's. Why do you and your competitors continue to permit your companies to be dictated by the people who need you? You don't need hospitals to hire you. You should set the price, you should make your terms, and define the rules of the game as a sector, as a market, and in collaboration with your competitors.
The NFL has several different teams, all of whom compete with each other, but have each agreed to be bound to the same rules on any field they play. The coaches and players may change, but the rules stay the same. If they are broken, there are penalties, sanctions, and suspensions. Even terminations. As physicians we have clinical guidelines, or rules that we practice by. Hospitals have their rules for kickbacks, inspections, and regulations. Why don't Emergency Medicine contract groups set their own rules?
Mr/Ms CEO, this is an opportunity for you and your fellow CEO's to seize the day and begin to negotiate on your terms, on the terms of your physicians that you hire, and for the patients they represent and treat. Join together, and set your own rules. Tell the national healthcare system that you own the controlling interest of all Emergency Physicians and speak on their behalf, as a sector - not as an individual company. Not as a college such as ACEP, but as an industry no longer willing to tolerate the abusive corporate process of contract competition.
If the leaders of Emcare, Teamhealth, Schumacher, ApolloMD, Hospital Physician Partners, Sheridan, CEP, EMP, etc unite, the industry of healthcare can only be strengthened while preserving individual corporate competition. Set the ground rules for your sport, and adhere to them as your own NFL, with each company following the same guidelines. Consider each hospital your playing field, subject to the same game rules as the rest of the league:
1) 1 year annual term contacts will no longer be accepted - 5 years minimum without a 90-day out clause. A good marriage has to make it work.
2) A new hospital administrative team cannot terminate your contract because they like another group. Good old boy connections and modern medical business can no longer exist.
3) Reimbursement will not be tied to physician metrics, but to provider compensation and volume. Don't hold the top 1% of intelligence, education, and training responsible for your inability staff radiology for a 30 minute X-ray read.
4) Hospitals will provide nursing resources, equipment, and throughput processes as basic requirements of your staffing. This means a true 4 to 1 nursing ratio, a fixed 2 to 1 critical patient ratio, and a system the prevents nursing callouts.
5) Provider metrics will be based solely on the provider's performance, and not the combined performance of the hospital department.
6) Emergency Physicians may not lose their contract due to termination of another contracted entity. If the hospitalist group is not pulling their weight, and they happen to be tied to the same contract as the ED, the ED physician is not to blame.
7) The Emergency Physician group will be the only deciding factor controlling the quality of their applicants. We know medicine, we know doctors, and we know risk - better than a medical staff office or hospital administrator.
8) Add any other areas you wish that commonly results in provider dissatisfaction, attrition, contract loss, increased group cot due to staffing requests, and other arbitrary business-damaging reasons.
Collectively, CMG's have more power than the hospitals that need to hire them. Wield your power for good and take away the hospital's ability to destroy your reputation, remove faith from your providers, and erode the foundation of our specialty. Stand up and say no. Empower yourselves and your providers and bring fairness, equity, and medicine back into healthcare. Create a doctrine for the business of Emergency Medicine and set and industry standard that no hospital can defeat, in your favor. If the hospital can't find a company to staff their department, and everyone plays by the same rules, it won't be long before you are in control.
The hospitals need you exponentially more than you need them. Please take our speciality back, and put it in the hands of the physicians that make your corporation possible.
Signed,
Emergency Physician.
