Democratic Groups

CHW-Meriten-EPMG Redux

Introduction
by Robert McNamara, MD FAAEM
AAEM President

The following is a letter to me from Norm Label MD, the current President of EPMG in California. (Please do not confuse the EPMG of CA with the group of the same name based in Michigan). This letter is a result of an ongoing dialogue that I have had with Dr. Label regarding the Catholic Healthcare West (CHW) matter. This story has been detailed before but, briefly, AAEM and CAL/AAEM opposed CHW's creation of a physician practice management subsidiary, Meriten, through the purchase of the "old" EPMG. We supported emergency physicians who took legal action against this move resulting in CHW's divesting of Meriten. In addition to preserving independent ED groups in CHW, another result of this action was the formation of a "new" EPMG. Below Dr. Label details the structure of the "new" EPMG and you will note that it embodies many of the fairness principles that AAEM stands for. For practicing emergency physicians in CA it appears that the outcome of this matter has been favorable on all sides of the issue. For AAEM and CAL/AAEM, acting on behalf of the physician at the bedside is the core of our mission.

Dear Dr. McNamara:

Nearly six months have passed since Emergency Physicians' Medical Group (EPMG) reestablished itself- along with Sutter Emergency Medical Associates and EPMG/NorthWest-as an independent operation, fully in charge of its own destiny. EPMG is thriving because of our democratic environment that offers our physicians, whether newly graduated residents or long-time medical directors, a wide variety of benefits and a strong voice in the operations of our medical group.

What does democracy mean at EPMG?

1. Shareholder Status: In today's world, newly graduated residents do not want to sit on the sidelines in their medical group. They want to play an active role and an equal role in the decisions of the group they choose. Many groups offer differing levels of shareholder status to their members, with more senior members wielding the most power. At EPMG, each member gains shareholder status after one year in the organization and boardcertification. And all shareholders are equal. Our practice has been: one person, one vote.

2. Salary and Scheduling. Our salary structure also is equal. All members from newly graduated residents to seasoned physicians to medical directors receive the same hourly rate at a facility. Scheduling also is democratic with weekends, nights and holidays distributed evenly from the day a physician joins the group.

3. Governance: EPMG clinicians elect a Board of Directors each year. The board makes the key decisions on everything from pension plans and salaries to operational issues. The board's actions are disseminated to all members through regular communications. Medical directors conduct monthly meetings with their physicians where company-wide information and site-specific information are discussed. The board is responsive to the comments and concerns of all shareholders, newly joined or long-term.

The combined resources of EPMG, SEMA and EPMG/NorthWest allowed us to start our first day of operations, after the buy-back from Catholic Healthcare West, with 30 successful emergency department and urgent care contracts, a newly acquired solid management team, and a dedicated administrative staff, under the supervision of a board of emergency physicians from all three medical groups.

Our strong financial base offers our physicians and newly graduated residents other benefits:

• job security through secure contracts with satisfied hospital partners

• leadership training allowing them to become involved in the broader community of emergency medicine early in their practices as well as in the leadership of EPMG

• continuing medical education through EPMG's nationally recognized Center for Emergency Medicine Education

The future bodes well too. We continue to recruit and retain the best clinicians. We are dedicated to growing strategically and intelligently. We are determined to maintain an excellent clinical and management reputation. We are committed to sustaining the financial and professional needs of our members.

Sincerely,
Norman Label, MD
President, EPMG
Roseville, CA