Viewpoint: Give Me Due Process, Not Water Bottles : Emergency Medicine News


contract management, ACEP

I first learned about the American College of Emergency Physicians as an emergency medicine resident almost 30 years ago. The organization was and still is extremely valuable in establishing emergency medicine as a specialty, providing policies and guidelines to improve and standardize how it is practiced. I also enjoyed attending ACEP’s conferences where I reunited with colleagues and shared ideas with like-minded individuals while absorbing useful and new educational materials.

There were always signs, however, that the tentacles of corporate medicine lurked behind ACEP’s façade of professionalism and academia. Contract management groups (CMGs) backed by private equity always had the largest booths and banners in the exhibit halls of ACEP’s scientific assemblies. Like Hansel and Gretel, it was not difficult to be seduced by their water bottles, free parties, and potential six-figure salaries.

Corporate medicine, the practice of medicine by nonmedical personnel, is illegal in most states, but many CMGs skirt the law by setting up local companies to make it appear as if a group is physician-owned. One does not need to look far to see that medicine’s desire to help the less fortunate and a corporation’s desire to maximize profit create a disastrous combination. Early in my medical career, pharmaceutical companies gave physicians studies that narcotics were not as dangerous or as addictive as common sense and medical science led us to believe. Like Pavlov’s dog, I digested this information (along with the free lunches) and incorporated this new dogma into my practice, not realizing that the studies were not only biased and flawed, but were intended to favor profit over patient safety. Today, drug company representatives are banned from many hospitals and emergency departments.

Emergency departments that utilize CMGs also produce spineless ED directors who lack the incentive to advocate for the safety of patients or staff. After 9/11, at the busiest and closest trauma center to the World Trade Center, my ED director was able to clear our ED and cancel all elective procedures within an hour. He did not need the blessing of administration to make the best decisions for his patients and staff. This is in stark contrast to today’s ED directors who are hired by CMGs. Their primary objective appears to be to preserve the lucrative contract at all costs.

Recently, while scrolling through one of my social media pages, I came across a statement that ACEP posted on its website when I was terminated by my CMG employer for speaking out about the safety of my staff and patients at the beginning of this pandemic. (Dr. Lin is suing PeaceHealth, which operates PeaceHealth St. Joseph Medical Center in Bellingham, WA, and TeamHealth, the contract management group under which he was contracted to work, for wrongful termination. Read about his dismissal in EMN. 2020;42[5]:1;

“ACEP is aware of the termination of the emergency physician in Washington…. We have reached out and have offered to connect him with resources to discuss steps that could be taken. Physicians should not and cannot be punished when advocating for workplace safety in such a high-risk environment.”

My inability to find this page today has further fueled my concerns that ACEP may not be a true advocate for the emergency physician’s due process, something the college has stated numerous times.

I have been offered support by hundreds of people, reporters, the American Academy of Emergency Medicine, the Washington State Nurses Association, the American Civil Liberties Union (which is backing my wrongful termination suit), local EMS organizations, unions, politicians, worker advocacy groups, and even the local Native American nation. Buried among them was a message from an ACEP board member offering his support.

But unlike other groups who have supported me, ACEP’s ties with the corporate world are more obvious. Was the college utilizing my unfortunate situation to falsely portray a virtuous image or is it truly interested in doing what is necessary to ensure due process for all emergency physicians? My apprehension only grew not only as I discovered that my state ACEP chapter did not support an internally driven resolution to provide due process but also that its president is an employee of the CMG against which I have brought a wrongful termination suit.

ACEP has an opportunity to be a true advocate for the bedside emergency physician and demonstrate that it offers more than mere talk. I ask my fellow physicians to join me at this year’s ACEP Scientific Assembly to call for ACEP to pass Dr. Robert McNamara’s resolutions 29 and 44 in full. (See article by Mitchell Li, MD, and Meghan Galer, MD, about these resolutions on p. 3.)

These will prohibit ACEP members from denying due process to its members and will mandate transparency in billing for the hard work of all emergency physicians. This is a great opportunity for ACEP to demonstrate that it is not betrothed to corporate medicine or some private equity company as many of us who sacrifice ourselves on the front line believe that it is.

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Dr. Linis the ED supervisor of the Great Plains Indian Health Service in Aberdeen, SD, overseeing five emergency departments. He also recruits emergency physicians for the Indian Health Service.

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