State Chapters
CAL/AAEM Update

Told You So!

by Antoine Kazzi, MD, FAAEM

Yes, this issue of Common Sense carries an "I told you so!" message from AAEM and CAL/AAEM to all of the "market forces" alike. To the Chief Officers of the healthcare corporations, to the other EM professional organization who chose to stay neutral, and to physician executives and clinicians alike, we said we shall stand in court against unfair business practices. In California, we certainly did. For nearly 3 years now, we have put your dues-dollars to action. We worked in court and in various public forums, to put an end to the corporate scheme of "vertical integration." In this issue of Common Sense, your AAEM and CAL/AAEM leadership is proud to announce to you - our members - that "We won!"

On June 4th, a press release - "Emergency Physicians' Medical Group Purchases Meriten Management Assets From Catholic Healthcare West" - stated: "With the sale of Meriten assets to the three physician groups, the alleged basis of the ACHP complaint - the claim that CHW's ownership of Meriten and EPMG violated the corporate practice of medicine bar and laws prohibiting fee-splitting arrangements - will no longer apply. It is anticipated that the lawsuit will be terminated as a result."

Side by side with a brave affiliation of physician groups (ACHP and the California Medical Association), AAEM and CAL/AAEM stood firm, loud and clear: the for-profit sale of physician groups to a hospital corporation breaches the ethical principles that prohibit the corporate practice of medicine. Most of all, we believe it entails kickbacks which are illegal. We were battling against the sale of the rank and file's income stream and direct control over their medical practice.

Most importantly, had we failed this would have resulted in a domino effect. Such sale of Physician Groups to hospital chains would have rapidly spread across the USA and to other hospital-based specialties. The pit doctors working today and the future graduates who would come later to work for vertically-integrated groups would have considerably suffered - losing income and autonomy to satisfy the bottom line of greedy executives in contract medical groups and hospital corporations.

Congratulations California Emergency physicians, AAEM, CMA, ACHP and CAL/AAEM! Thank you for your confidence and your support.

The First CAL/AAEM-CAL/ACEP California Business Forum
On June 7, CAL/ACEP and CAL/AAEM proudly held together the first jointly sponsored forum focusing on the business of Emergency Medicine: Physician Equity, Exit Strategies, Labor Laws and Group Citizenship in Emergency Medicine. Held during the 2001 CAL/ACEP Scientific Assembly in Santa Clara, and free to all CAL/ACEP and AAEM members, the forum was a major success. ALL speakers and the program evaluations were rated across the board as a 5/5: "I thought this was the most relevant session I've been to in years."

The conference room was packed with nearly 100 attendees, including the CAL/ACEP and CAL/AAEM current and past leadership, ACEP and AAEM Board members.

Session One
"Emergency Medicine Practice Profiles in California: Description, Rights, Responsibilities and the value of Citizenship in your group" was moderated by Michael Bresler, MD FACEP, Past ACEP Council Speaker and CAL/ACEP Past-President and me (as CAL/AAEM President, CAL/ACEP and AAEM Board of Directors). One after the other, invited panelists presented all forms of practice profiles available to EPs (See listing below). Most of all, they openly discussed the important controversies pertaining to democracy, equity, partnership, fairness, due process, and entry and exit strategies into their own form of physician group. They openly spoke of the limitations, the advantages, and the pro and con of each practice model for both administrators and clinicians. They openly pointed to the areas where potential unfairness or abusive practice profiles could occur. They clearly indicated that the room for abuse existed in all forms, and in some more than others. Many spoke of the senselessness and wrongfulness of the sale of physician groups as contract holders or senior partners retire from the practice of EM. They also clearly indicated how certain EPs consistently fail to attend to their non-clinical responsibilities towards the group. Group citizenship is then taken for granted. However, in a majority of settings, it simply is never offered as an option. Books are closed. Input into how the practice is run or into the staffing models and needs are never an option. The panelists were all remarkably open and direct in their acknowledgement of the shortcomings of all the practice models they represented.

1. Daniel Higgins, MD FACEP FAAEM CAL/ACEP Past-President - Single ED contract employer-employee model

2. Paul Kivela, MD FACEP CAL/ACEP Board of Directors - Single ED democratic partnership

3. Loren Johnson MD FACEP CAL/ACEP President-Elect - Large multiple-ED contract - employee-employer model - with offered equity

4. William Durkin, MD FAAEM AAEM Board of Directors and CAL/AAEM Secretary-Treasurer - Independent contractor model in a management corporation or single group

5. Howard Davis, MD FAAEM FACEP Board of Directors, CAL/AAEM and CAL/ACEP - Partnership of individual corporations model

6. Wesley Curry, MD FAAEM FACEP CAL/ACEP Past-President and President of California Emergency Physicians (CEP) - Large multiple-ED contract partnership

In the second session, a heart-to-heart discussion occurred between Dr. Mike Bresler, Dr. Richard Stennes, and myself. The subject was most controversial and addressed the Role of Professional Societies in Emergency Medicine.

Dr. Richard Stennes, MD MBA FACEP has previously served as a President for both ACEP and CAL/ACEP. Most remarkably, the members joined in, raising passionately and yet respectfully their concerns about the need for action to secure fairness in the business practice of EM, and the pro and con if ACEP were to join AAEM in taking an active role promoting one form of EM business practice model over another, or opposing legally certain forms of business practices by physician members or groups that support the organization. The discussion went on for over 30 minutes with credit and respectful criticism being given when either was due. At one point, the audience was prompted to indicate whether physicians belonged to AAEM, and a couple dozen hands were raised - indicating the value of participation and collaboration in ONE statewide Scientific Assembly. In other words, remarkably, everyone left Santa Clara proud of the proactive decision CAL/AAEM and CAL/ACEP took when they negotiated a reciprocal educational package for their members and to hold programs together. This was an obvious WIN-WIN for Emergency Medicine and our workforce!

CAL/AAEM appoints an Executive Director
Last but not least, CAL/AAEM's board has endorsed the appointment of Dr. Boris Lubavin as an Executive Director for the state chapter. Dr. Lubavin is volunteering his time and will be handling the administrative matters related to CAL/AAEM. Any questions can be addressed to him through our new CAL/AAEM email address: calaaem@aaem.org