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- Sep 5, 2008
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Ive followed with great interest a series of recent articles in EM Resident written by Dr. Starr on the subject of organized EM. Most recently the article A Plea for Residents Unity caught my eye. Flipping through my fancy EMRA monthly, paid for by ads of various corporations known for employing non-residency trained physicians, hostile takeovers of democratic EM groups, restrictive covenants and engaging in the corporate practice of medicine, I cannot help but feel that his attempt to be unbiased was unsuccessful. I admire the calls for unity, but his presentation of this issue demonstrates either a failure to see the big picture or a blind following of ACEP dogma.
Why did EMRA support the motion to expand FACEP criteria when he clearly outlines that these issues should not be relevant for those training in 2008 and do not directly affect EM residents since 1999? Was EMRA so moved by the idea of honoring those legacy physicians that it approved something which is not relevant to and in no way benefits the members they represent (residents training in EM)? If EMRA was truly independent of ACEP, would it have been able to abstain from putting full support behind this irrelevant measure? Supporting this action, while knowing full well that most residents had no idea it was happening, little knowledge about the history of the topic, and no time to consider the potential implications of such action, was irresponsible. Now they have attempted to fight the huge backlash that occurred when word spread with a series of articles attempting to justify their position and actions. Dr. Starrs articles have essentially been the story of organized EM from ACEPs point of view. Hardly the unbiased presentation of facts he claims to put forward.
In light of recent legal challenges by AAPS/AEP to have an alternative board (BCEM) recognized for EM, would he lead me to believe that the implications of opening fellowship status to individuals trained in other specialties ends with the letters after their names? Perhaps one of those individuals is sympathetic to AEPs cause and testifies to that effect. They would make a compelling witness to attest to the fact that residency training is not necessary to achieve the highest level of professional recognition in EM. If our largest and most recognizable EM organization offers fellowship status to these individuals, I have little faith a court would be able to sort out the differences among us. If they can achieve FACEP status, why shouldnt they be allowed to pursue their desired career on equal footing with an EM board certification handed out by AEP? This will be their argument and the letters FACEP only improve their chances.
ACEP may not have intentionally opened Pandoras Box, but this action has done so. The ramifications of the new FACEP policy may not be fully realized for years. More than one EP out there realizes this is just another action highlighting the conflict of interest that exists among the leadership of ACEP. Some of these individuals have ownership stakes in contract management groups (CMGs) and would benefit greatly from the availability of cheaper labor for EDs in the form of alternative board certified, non-residency trained practitioners. Groups made up of these individuals can staff an ED for far less than a group of residency trained EPs. This would allow a CMG to undercut and subsequently replace a democratic group, thus furthering the corporate practice of medicine.
For most hospitals, all they want to know is if the group is board certified. Who handed out the certifications (ABEM or AEP) is not something they will trouble themselves with, especially if the individual representing the group has FACEP after their name. In a minority of instances, the malpractice insurance industry could prevent this by refusing to cover non residency trained physicians working in EDs, but this is not something we should depend on. These issues have direct implications for patients, as employees of such corporations are often denied due process and job protection when raising concerns about how care is delivered. In addition, I believe that ED patients are best served when a residency trained EP is at their bedside. I care too much about our patients and the safety net that EDs represent to sit on my hands and watch this happen. For that reason I will continue to fully support and spread the word about AAEMs cause.
Despite Dr. Starr and ACEPs continued emphasis that the only pathway to board certification in EM after 1999 is residency training, they do not realize that this promise rings hollow if those working behind the scenes for AEP and the CMGs succeed. If ABEM is not the only pathway to board certification, ACEPs policy will be rendered meaningless. Although they will never admit it, there are those within ACEP who hope this occurs. AAEM is the only EM organization currently willing to stand up and prevent this from happening.
When I think of ACEP, a quote from Braveheart always comes to mind. William Wallace says to Robert the Bruce, And if you would just lead them to freedom, they'd follow you. And so would I. Nothing would make me happier than for ACEP to unite the specialty by standing up and unequivocally denouncing the corporate practice of EM, CMGs, violations of due process, fee splitting, the AEP, non-transparent billing and restrictive covenants. That is what the specialty needs to achieve the unity Dr. Starr writes about and I dare to dream about the massive changes we could make if everyone was on the same page. We each have to ask ourselves why ACEP did not take this stance long ago and we might not like the answer. As a large portion of ACEPs funding comes from parties who would be less than pleased if this actually occurred, I will not be holding my breath.
~Loyal Minuteman of EM
Why did EMRA support the motion to expand FACEP criteria when he clearly outlines that these issues should not be relevant for those training in 2008 and do not directly affect EM residents since 1999? Was EMRA so moved by the idea of honoring those legacy physicians that it approved something which is not relevant to and in no way benefits the members they represent (residents training in EM)? If EMRA was truly independent of ACEP, would it have been able to abstain from putting full support behind this irrelevant measure? Supporting this action, while knowing full well that most residents had no idea it was happening, little knowledge about the history of the topic, and no time to consider the potential implications of such action, was irresponsible. Now they have attempted to fight the huge backlash that occurred when word spread with a series of articles attempting to justify their position and actions. Dr. Starrs articles have essentially been the story of organized EM from ACEPs point of view. Hardly the unbiased presentation of facts he claims to put forward.
In light of recent legal challenges by AAPS/AEP to have an alternative board (BCEM) recognized for EM, would he lead me to believe that the implications of opening fellowship status to individuals trained in other specialties ends with the letters after their names? Perhaps one of those individuals is sympathetic to AEPs cause and testifies to that effect. They would make a compelling witness to attest to the fact that residency training is not necessary to achieve the highest level of professional recognition in EM. If our largest and most recognizable EM organization offers fellowship status to these individuals, I have little faith a court would be able to sort out the differences among us. If they can achieve FACEP status, why shouldnt they be allowed to pursue their desired career on equal footing with an EM board certification handed out by AEP? This will be their argument and the letters FACEP only improve their chances.
ACEP may not have intentionally opened Pandoras Box, but this action has done so. The ramifications of the new FACEP policy may not be fully realized for years. More than one EP out there realizes this is just another action highlighting the conflict of interest that exists among the leadership of ACEP. Some of these individuals have ownership stakes in contract management groups (CMGs) and would benefit greatly from the availability of cheaper labor for EDs in the form of alternative board certified, non-residency trained practitioners. Groups made up of these individuals can staff an ED for far less than a group of residency trained EPs. This would allow a CMG to undercut and subsequently replace a democratic group, thus furthering the corporate practice of medicine.
For most hospitals, all they want to know is if the group is board certified. Who handed out the certifications (ABEM or AEP) is not something they will trouble themselves with, especially if the individual representing the group has FACEP after their name. In a minority of instances, the malpractice insurance industry could prevent this by refusing to cover non residency trained physicians working in EDs, but this is not something we should depend on. These issues have direct implications for patients, as employees of such corporations are often denied due process and job protection when raising concerns about how care is delivered. In addition, I believe that ED patients are best served when a residency trained EP is at their bedside. I care too much about our patients and the safety net that EDs represent to sit on my hands and watch this happen. For that reason I will continue to fully support and spread the word about AAEMs cause.
Despite Dr. Starr and ACEPs continued emphasis that the only pathway to board certification in EM after 1999 is residency training, they do not realize that this promise rings hollow if those working behind the scenes for AEP and the CMGs succeed. If ABEM is not the only pathway to board certification, ACEPs policy will be rendered meaningless. Although they will never admit it, there are those within ACEP who hope this occurs. AAEM is the only EM organization currently willing to stand up and prevent this from happening.
When I think of ACEP, a quote from Braveheart always comes to mind. William Wallace says to Robert the Bruce, And if you would just lead them to freedom, they'd follow you. And so would I. Nothing would make me happier than for ACEP to unite the specialty by standing up and unequivocally denouncing the corporate practice of EM, CMGs, violations of due process, fee splitting, the AEP, non-transparent billing and restrictive covenants. That is what the specialty needs to achieve the unity Dr. Starr writes about and I dare to dream about the massive changes we could make if everyone was on the same page. We each have to ask ourselves why ACEP did not take this stance long ago and we might not like the answer. As a large portion of ACEPs funding comes from parties who would be less than pleased if this actually occurred, I will not be holding my breath.
~Loyal Minuteman of EM
