let’s clear the air

              There is one thing that has become obvious in the tumultuous past year; emergency medicine is at an inflection point.   During the short 21 years since I started residency, there has never been a year when we so widely have worried for our safety, the stability of our jobs, and the future of the specialty. And never has ACEP been more important, since no other organization has the power, the reach, or the mission to represent and fight for us at the highest levels.  But among the gargantuan, tectonic forces at work to bring us to the point we’re at (the virus, the economy, revenue cycle pressures, increasing NPP autonomy, etc), there is one force we should talk about out loud, since it may be the most difficult to fight:  the ever-increasing power, reach, and mission of large EM staffing companies.

              When the ACEP Workforce Task Force delivered its findings and suggestions, several important facts came into clear relief; that the corporate proliferation of residencies, combined with a staffing model increasingly reliant on non-physician practitioners would soon have its intended goal of glutting physician supply and decreasing wages, forcing many of us out, and drying up the pipeline of high-performing students going into EM.  And while ACEP’s multifaceted approach to solving these problems is laudable, it doesn’t address the elephant in the room;  that unless the corporations stop hyperbolically increasing new resident production and reliance on NPPs, no solution is going to alter our course.

              The flipside of that elephant is the presence of CMG officers in the ACEP board.  Much has been said about the lack of conflicts that this represents, but those arguments fall flat.  The CMG’s do not have the same goals as front-line physicians;  their goals are different, and often opposite from practicing docs.  That doesn’t make them evil, and it doesn’t make their officers evil;  we do, however, have to acknowledge the fact that those goals differ.  And it would be strange and somewhat off-putting if the officers running those corporations don’t keep their corporate goals in mind.  Why, then, would we want to have people leading our organization (which I’d like to believe represents and defends us) when the goals of those leaders are sometimes the opposite of our goals?  Even if they recuse themselves from every potentially conflicted decision…why would we want that?  Why would we not just want a Board who represents solely the EM doc and the ED patient?

              I want to have a discussion about this issue, out in the open.  I want us to talk it out, and spend some time thinking about who we want leading this organization—this subject should not be taboo, and should not be spoken of in hushed tones.  Our members, the front-line ER docs who pay dues and send us to Council to represent them certainly don’t feel this way;  when I talk to them, they tell me quite frankly that they worry that ACEP doesn’t represent their interests, but those of the large corporations.  We can represent their interests, and the interests of ED patients.  We should, and we will.  And having this discussion, loudly and openly, will not only help us to come together as a specialty, but will show the members who are considering letting their ACEP membership lapse (or the younger physicians, who don’t want to join ACEP at all) that we mean what we say when we say we represent them

And when we elect our new Board members, my fervent hope is that, after having this discussion out loud, all summer, each of us in Council will vote for candidates who only represent working, frontline physicians—and not anyone else.  I think that our membership expects this.  And, if you’re interested in having someone on the Board who you know will actively fight these large and powerful interests, even if it is not an easy road, I hope you’ll vote for me.