American Academy of Emergency Medicine

Crossing the Line

Hi Dr. Walker!

I am just a regular old ER doc trying to make a living, and a proud AAEM member who has really enjoyed the editorials regarding CMGs, particularly those regarding EmCare and Rebecca Parker.

I experienced Rebecca Parker and EmCare first hand while staffing Lake Health as a locums during the very time period you have written about. While advocating for myself, my patients, and my reimbursement, I was called names by EmCare directors, and Dr. Parker herself threatened my livelihood if I failed to comply with her edict of signing out and not billing for a minute over the shift unless performing critical care in a single coverage setting.

It’s been over 7 years now and I have managed to survive without EmCare, TeamHealth, ApolloMD, or Schumacher. I refuse to staff their contracts. I encourage any doctor I meet on the circuit to avoid them. After many discussions, a few major locums agencies also finally decided to cut ties with these companies, because they grew weary of vendor practices and companies claiming doctors and invoking 5 year non-competes.

I find it distressing that someone wrote about all this in 1998 in the now famous The Rape of Emergency Medicine, and yet ER doctors did not heed the warnings. I am only one person, and the effect of my personal black list is not far reaching. What can be done about the harmful effect these companies have on our specialty and patients?

I am willing to serve.

— Name Withheld on Request

Thank you for writing. I regret that we live in a world where you had to ask us not to publish your name, but I understand the reasons for your request. As for your question on what can be done about the corporate staffing companies that prey on emergency physicians, I don't know what else AAEM can possibly do. The Academy does all it can to give emergency physicians the knowledge they need to protect themselves. It takes legal action whenever appropriate, feasible, and cost-effective. Now it has even formed the AAEM Physician Group (AAEM-PG), to support democratic independent groups and found new ones. The only avenue the Academy hasn't yet pursued is forming a union to protect those emergency physicians who are employees — and I'll bet that will happen in the next few years.

As for individual emergency physicians, all they can do is have the moral fiber to refuse management positions in companies that treat their colleagues unfairly. To our specialty's credit, and our profession’s, most do. But it takes only a small percentage of emergency physicians willing to violate their professional ethics to keep the contract management industry running.

That brings us to the real question: what more can ACEP do? Those EPs who are members of ACEP should think long and hard about that question, and take it to ACEP leaders like President Rebecca Parker. And they shouldn't accept fears of violating antitrust laws as an excuse to avoid the issue — because that is a lie. If antitrust laws were a legitimate concern in the effort to protect individual emergency physicians from predatory exploitation, the feds would have come after AAEM 20 years ago.

— The Editor

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