Unclear on benefits of ACEP renewal...

[Pinner Doc]

I'm sorry if this is a dumb question - but I thought I'd put it out here:

I've been a member of ACEP through residency and in the past 2 years as a community EP. It's about that time of year again to renew, and fees are over $800 without any add-ons. It's out of pocket for me, not covered by work - although as an IC I suppose I could write some off.

Other than reduction in the ACEP conference price (which I will likely not attend this year anyway), the monthly journal and the "ACEP member" line on my CV ... what are the benefits to membership?

Do you keep up a membership? Why or why not?

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Members don't see this ad.

 

[deleted109597]

As an IC you can write it all off as a business expense.
It all comes down to advocacy. Your money helps them promote emergency medicine. You can help if you want, but if you don't want to do it personally, you can simply be a member.
I don't think anyone will think any less of you for not being a member, but your money should go to things that you think are important.

 

[DreamingTheLive]

I've heard from many attendings involved with ACEP that behind the scenes the core entity of ACEP is heavily/extremely-skewed towards mega-CMG type Emergency Medicine values.

I have no idea how true this is (Re: don't get panties in bunch), but if so, exactly what then are they promoting?

 

[TooMuchResearch]

I've heard from many attendings involved with ACEP that behind the scenes the core entity of ACEP is heavily/extremely-skewed towards mega-CMG type Emergency Medicine values.

I have no idea how true this is (Re: don't get panties in bunch), but if so, exactly what then are they promoting?

The Rape of Emergency Medicine covers this, though I'm told (on this forum) things have improved (?) somewhat in the past 22 years.

 

[name?]

I let mine lapse. Too much Team Health advertising in the throw away for an advocacy group in my mind. Some of their work is good. Some is garbage (tPA guideline). It's a lot of money without great benefit as far as I can tell.

 

[Pinner Doc]

As an IC you can write it all off as a business expense.
It all comes down to advocacy. Your money helps them promote emergency medicine. You can help if you want, but if you don't want to do it personally, you can simply be a member.
I don't think anyone will think any less of you for not being a member, but your money should go to things that you think are important.

If it were completely deductible and free to me, I'd have no issues renewing - but the cost reduction only ends up being 30% off.

 

[deleted109597]

Nobody makes you do it. But ACEP was overwhelmingly behind the correction of the asinine WA policy of not paying for "non-emergencies" such as cholecystitis.

 

[deleted206819]

As a resident and in 18 days to be an attending, I am pro-AAEM for the simple fact that they advocate for equity in physician management practices and for democratic group structures. Their annual membership for fellows is relatively inexpensive, scientific assembly is free, and they provide a lot of legal cover for community EPs.

 

[@JackShephard]

As a resident and in 18 days to be an attending, I am pro-AAEM for the simple fact that they advocate for equity in physician management practices and for democratic group structures. Their annual membership for fellows is relatively inexpensive, scientific assembly is free, and they provide a lot of legal cover for community EPs.

This seems like a better organization. I did see a lot of CMG advertising and advocacy in ACEP publications. If that continues, they are just like the government - with physicians 2nd or 3rd on their priority list.

 

[name?]

Nobody makes you do it. But ACEP was overwhelmingly behind the correction of the asinine WA policy of not paying for "non-emergencies" such as cholecystitis.

Absolutely true. Washington ACEP helped derail an insane policy and I am grateful for their efforts. It would have been painful to deal with the legal cluster that would have ensued had they not been so aggressive in fighting that particular piece of legislative hell. It was truly horrific how dangerous and stupid the policy was going to be. Kudos to WA ACEP for that.

Now I feel a bit guilty for letting it lapse. Thanks.

Too bad there's no AAEM in WA, because I much prefer that organization, it just doesn't have the same membership base to wheel and deal as well on a national level.

 

[deleted206819]

Absolutely true. Washington ACEP helped derail an insane policy and I am grateful for their efforts. It would have been painful to deal with the legal cluster that would have ensued had they not been so aggressive in fighting that particular piece of legislative hell. It was truly horrific how dangerous and stupid the policy was going to be. Kudos to WA ACEP for that.

Now I feel a bit guilty for letting it lapse. Thanks.

Too bad there's no AAEM in WA, because I much prefer that organization, it just doesn't have the same membership base to wheel and deal as well on a national level.

While ACEP towers in comparison to AAEM vis a vis membership numbers, I believe that it is absolutely necessary to help AAEM grow so that they are on a level playing field. If you and I don't protect our own brand, our jobs, and our rights then who will? I'm trying mightily to have the residents in my program become AAEM members in addition to ACEP and hope that that will get some of them to think about the choices going forward.

 

[Birdstrike]

As painful as it can be to write the check, when a specialty is under assault as mentioned in the above examples, there's no one to stand up and fight for and advocate for you, other than your academic societies. You don't have to agree with every stance they take, but they're your loudest voice of support. Pick your favorite one or two, and write the check without regret.

 

[DeadCactus]

You pay ACEP to protect you from the government and AAEM to protect you from ACEP...

 

[JMC2010]

You pay ACEP to protect you from the government and AAEM to protect you from ACEP...

Haha, this is spot on.

 

[Old_Mil]

Let ACEP lapse a couple of years ago. Don't regret it at all.

 

[Arcan57]

ACEP >> AAEM in terms of lobbying power. We as a specialty need that because there's a lot of stupidity regarding how to deal with emergency care, best illustrated with the Washington example. I like some of the idea of AAEM (especially on the medicolegal front) but can't reconcile myself to give money to a group that believes I'm selling out the specialty by working for a CMG.

 

[Birdstrike]

ACEP >> AAEM in terms of lobbying power. We as a specialty need that because there's a lot of stupidity regarding how to deal with emergency care, best illustrated with the Washington example. I like some of the idea of AAEM (especially on the medicolegal front) but can't reconcile myself to give money to a group that believes I'm selling out the specialty by working for a CMG.

I think the "selling out the specialty" argument was completely valid as long as small dem groups could compete and keep contracts. To the extent that CMGs outperform them, the argument falls apart. Small democratic groups are great, but you've got to cover the business side of the job, better than the CMGs. Fail to do that and you cease to justify your existence. The CMGs have the business aspect nailed down so tight, the SDGs are sitting ducks for the taking. Expect them to die off. The group I'm in, is multi-specialty. We've lost several of our ER contracts, and have zero plans to regain them or get new ones. Will be expanding the outpatient specialties, ancillaries, etc.

Why go battle for some ED contract and lose 20 docs over some BS administrator whim in 5 seconds?

 

[deleted206819]

I think the "selling out the specialty" argument was completely valid as long as small dem groups could compete and keep contracts. To the extent that CMGs outperform them, the argument falls apart. Small democratic groups are great, but you've got to cover the business side of the job, better than the CMGs. Fail to do that and you cease to justify your existence. The CMGs have the business aspect nailed down so tight, the SDGs are sitting ducks for the taking. Expect them to die off. The group I'm in, is multi-specialty. We've lost several of our ER contracts, and have zero plans to regain them or get new ones. Will be expanding the outpatient specialties, ancillaries, etc.

Why go battle for some ED contract and lose 20 docs over some BS administrator whim in 5 seconds?

Birdstrike,

Can you point to specifics where CMGs outperform SDGs? I'm joining a SDG in two weeks and want to help out where needed and want to shore-up our weaknesses and not give the CMGs a reason to come in and take our contract.

 

[deleted206819]

ACEP >> AAEM in terms of lobbying power. We as a specialty need that because there's a lot of stupidity regarding how to deal with emergency care, best illustrated with the Washington example. I like some of the idea of AAEM (especially on the medicolegal front) but can't reconcile myself to give money to a group that believes I'm selling out the specialty by working for a CMG.

AAEM doesn't say that you as a physician are selling out the specialty working for a CMG. AAEM states that the CMGs do not give emergency physicians a fair shake whether it is due process, compensation, restrictive covenants, corporate goals >> physician goals and patient welfare, and others. This also applies to SDGs and other 1-2 physician owned groups as well ...

This is what their part of their mission statement states:
5. The Academy supports fair and equitable practice environments necessary to allow the specialist in emergency medicine to deliver the highest quality of patient care. Such an environment includes provisions for due process and the absence of restrictive covenants.

 

[@JackShephard]

I think CMGs are the future, unfortunately.

The government wants to take physicians out of ownership positions. Expect them to continue their campaign to do just that.

 

[deleted206819]

I think CMGs are the future, unfortunately.

The government wants to take physicians out of ownership positions. Expect them to continue their campaign to do just that.

I find that the government's take on this to be obnoxious, demeaning, and anti-competitive. CMS and the ACA prevents physician owned hospitals from expanding and new physician owned hospitals from starting up only when accepting medicaid and medicare patients. It's telling that physicians are relegated to the role of an employee but cannot own or run their own facility. Which other industry has these types of restrictions in place?

 

[@JackShephard]

I find that the government's take on this to be obnoxious, demeaning, and anti-competitive. CMS and the ACA prevents physician owned hospitals from expanding and new physician owned hospitals from starting up only when accepting medicaid and medicare patients. It's telling that physicians are relegated to the role of an employee but cannot own or run their own facility. Which other industry has these types of restrictions in place?

There are numerous laws specifically against physicians, for example:

http://www.forbes.com/sites/theapot...ncy-matching-system-for-newly-minted-m-d-s/2/

In addition, the Match precludes an applicant from negotiating their salary or contract in any way. Dual degrees (MD/JD, MD/MBA, MD/MPH) are ever-increasing and many applicants will bring additional value to their hospital, yet are unable to be compensated for it. Additionally, it precludes less competitive applicants from accepting lower salary or early offers in exchange for a position.

Jung v. AAMC in 2003 challenged the Match on antitrust grounds, claiming that the collusion of hospitals within the Match artificially depressed wages. In response, Congress passed an explicit exemption for NRMP through the Pension Funding Equity Act of 2004, making legal challenges moot.

Nonetheless, labor statistics are daunting. Per the 2012 US Census, mean earnings for 25-34 year olds with a doctorate or professional degree are $74,626 or $86,440 respectively. The AAMC mean first-year resident salary was $50,765 for 2013-2014.

NRMP dodged the legal attack in Jung, but numbers don’t lie and a $23,861-$35,675 differenc

 

[Birdstrike]

Birdstrike,

Can you point to specifics where CMGs outperform SDGs? I'm joining a SDG in two weeks and want to help out where needed and want to shore-up our weaknesses and not give the CMGs a reason to come in and take our contract.

Someone with more direct admin experience could likely give you a more detailed answer, but I'll tell you what I've seen or heard. In some cases, maybe the SDG has a sweetheart deal with admin such as a monetary stipend for providing services (ie, good old boys network kind of stuff) then a new CEO comes along and chooses cheaper labor over past alliances. The old group is fired on the spot. In other cases, maybe the SDG is crappy with "metrics" and is slow or gives pushback over kow-towing to inappropriate patient demands to score high on Press-Ganey. In some cases, groups have given pushback over hospitals illegally demanding EM doctors have quotas to admit a certain percentage of patients whether they need it or not so the hospital can make more money. Then the old group is fired and a new group who has agreed to play the game (wink wink) is brought in. One example of that:

http://www.charlotteobserver.com/2014/01/02/4583725/doctors-allege-for-proft-owner.html

The business of medicine can be very sleazy out in the "real world," unfortunately. Reasons aside, the trend seems overwhelmingly in favor of CMGs knocking off SDGs. From what I've seen (and others feel free to refute if you've seen a different trend in your area) there is few if any SDGs out there that are in turn kicking out CMGs to keep the ratio of CMGs to SDGs constant.

My point: If CMGs take contracts from SDGs, and SDGs rarely if ever steal back a contract from a CMG, then it is completely inevitable that ultimately SDGs will eventually become as extinct as T. Rex, even if the process is slow. If the dominos only ever fall in the direction of point A to point B, eventually, no matter how fast or slow the process, one day you will end up at point B.

 

[EMIM2011]

http://www.epmonthly.com/features/current-features/acep-puts-a-gag-on-council-candidates/

 

[Old_Mil]

ACEP >> AAEM in terms of lobbying power.

This is one of those self fulfilling prophecies. If every boarded ACEP dues paying member quit and joined AAEM that would change overnight.

Sent from my Z10 using Tapatalk

 

[DocEspana]

There are numerous laws specifically against physicians, for example:

http://www.forbes.com/sites/theapot...ncy-matching-system-for-newly-minted-m-d-s/2/

I know your point was that there are numerous specific anti physicoan laws, and there are, you picked on a rather weak one. Ms. Ho has been characterized as a bit oblivious to the realities of what an open market for resident salaries would actually look like. And I know Jack (the author of this next link) personally. He had to watch his words very carefully on his rebuttal to not just call her oblivious to how an oversaturated market would actually work. http://www.forbes.com/sites/theapot...nts-but-youre-not-entitled-to-your-dream-job/

A wonderful example of doctors being targeted would be our inability to unionize. A law that, until 2010, prevented all physicians from ever unionizing at all or discussing fee schedules, lest we collectively bargain in the least. In 2010 the US supreme Court basically told the world that residents are exempt, but practicing physicians are definitely still banned from unionizing. (Mayo foundation v the united states. An truly brilliant court case. The question was do residents need to pay FICA if they are still in "education" not independent employment? The courts answer was "there is so much wrong here besides not paying a small tax. If you're going to treat them like employees then you better damn well let them do anything an employee can do. Including pay their taxes, have sick days, and unionize")

And to be fair, resident unions have been ABSURDLY successful at bargaining for great benefits and improvements in the four intervening years since they were allowed to exist. Not that the blocking of ohysician unionization is right, its not, but the sentiment that unionized doctors would command A LOT of influence is totally right. CIR is friggen amazing.

 

[Birdstrike]

A wonderful example of doctors being targeted would be our inability to unionize...practicing physicians are definitely still banned from unionizing...

Wrong.

Employed physicians absolutely can unionize. (Private practice physicians cannot.) With the overwhelming trend being towards physicians as employees, this becomes more of an option every day.

"Physicians who are hospital employees (or collective employees of a different large organization) may unionize. Physicians still in training now have an enforceable right to unionize under the National Labor Relations Act. Independent physicians who attempt to unionize will likely violate anti-trust laws."

http://blog.medicaljustice.com/can-doctors-form-a-union/


In fact, there is such a physician union that you can join today.

http://www.uapd.com/all-doctors-need-a-union/


"Today, about 60 percent of family doctors and pediatricians, 50 percent of surgeons and 25 percent of surgical subspecialists — such as ophthalmologists and ear, nose and throat surgeons — are employees rather than independent" -all of which have the ability to unionize.

http://mobile.nytimes.com/2014/02/1...ad-to-cheaper-health-care.html?referrer=&_r=0

 

[DocEspana]

Wrong.

Employed physicians absolutely can unionize. (Private practice physicians cannot.) With the overwhelming trend being towards physicians as employees, this becomes more of an option every day.

"Physicians who are hospital employees (or collective employees of a different large organization) may unionize. Physicians still in training now have an enforceable right to unionize under the National Labor Relations Act. Independent physicians who attempt to unionize will likely violate anti-trust laws."

http://blog.medicaljustice.com/can-doctors-form-a-union/


In fact, there is such a physician union that you can join today.

http://www.uapd.com/all-doctors-need-a-union/

Yea. I knew that. IDK why I didnt remember that this AM. Was just sort of passively commenting on him chosing a poor topic to reference for doctor-targeted laws and basically forgot the nuances of what i was putting out there myself.

 

[Hercules]

This is one of those self fulfilling prophecies. If every boarded ACEP dues paying member quit and joined AAEM that would change overnight.

Sent from my Z10 using Tapatalk

I get the idea and the dissatisfaction with ACEP but the scenario you describe reminds me of the political conundrum I used to have when I was younger. I used to vote libertarian and felt like if everyone quit voting for the usual democrat/republican candidates and elected a libertarian we would see some actual change and a less intrusive government. As I got older I still believed that but realized that scenario was never going to happen. I decided it made more sense to vote with the party that at least represented some of my interests as opposed to wasting my votes on a party that could never represent any of my interests since it couldn't gather enough votes to win.

That's long winded but sums up how I feel about ACEP and why I pay my dues. I don't agree with everything ACEP does but I realize it is the loudest voice for our specialty. If you disagree with what ACEP is doing, the get involved and push for change.

 

[deleted206819]

I get the idea and the dissatisfaction with ACEP but the scenario you describe reminds me of the political conundrum I used to have when I was younger. I used to vote libertarian and felt like if everyone quit voting for the usual democrat/republican candidates and elected a libertarian we would see some actual change and a less intrusive government. As I got older I still believed that but realized that scenario was never going to happen. I decided it made more sense to vote with the party that at least represented some of my interests as opposed to wasting my votes on a party that could never represent any of my interests since it couldn't gather enough votes to win.

That's long winded but sums up how I feel about ACEP and why I pay my dues. I don't agree with everything ACEP does but I realize it is the loudest voice for our specialty. If you disagree with what ACEP is doing, the get involved and push for change.

I believe that your analogy of voting for Libertarian vs Democrat / Republican is dissimilar enough to AAEM vs ACEP division that it just doesn't fit.

With AAEM and ACEP, you have two organizations that have existed for at least several decades with well established lobbyists on Capitol Hill and an (albeit major difference) physician members totaling 30,000 for ACEP and 8000-10,000 for AAEM. ACEP currently speaks for our specialty but that does not preclude us from changing affiliations and becoming members of AAEM. If there were equal number of physician members in both organizations, then external pressures would be placed on ACEP to change their policies to become inline with physician concerns.

Numerous people have tried to change ACEP from the inside by becoming involved in committees and leadership positions but the road to change has been paved with rejected resolutions, disparity between physicians and CMGs. Take a look at the (rejected) resolutions dual AAEM / ACEP members put through in the 90s and early 00s -- it's telling on who ACEP serves.