Twenty-five years ago Scott Plantz and I, in a coffee shop in the Little Italy section of San Francisco, came to the conclusion that ACEP was far too corrupt an organization to be representative of the workaday emergency physician. The new specialty had been hijacked by a group of exploitative profiteers who where literally becoming overnight fast-buck millionaires by skimming unconscionable amounts of money off of the Medicare-approved clinically generated fees of the yeomen and women seeing and treating the acutely sick and injured patients of America. Unnecessary third-party middlemen created shell companies which, unbelievably, went on to be traded on stock exchanges and to speculative hedge funds.
The original intent of AAEM was to dismantle these hucksters, and at great personal expense, mailers were sent out to thousands of emergency physicians to end this practice. The response was dismal. Less than a hundred doctors sent in a hundred bucks to join.
At the same time, SAEM was holding their annual conference in San Francisco. Robert McNamara and Louis Ling kindly gave me a room to speak in. Surprisingly to me, a large number showed up. Their objective was similar to mine but with one and ONLY one condition - the voting membership of the new organization be limited to board-certified physicians in emergency medicine only. Initially I balked, feeling a sense of betrayal to those who were victimized by confidence men and schemists but then again, no one was joining.
So a second wave of mailers went out, explaining AAEM would be like every other society of the American Board of Medical Specialties, and membership would be limited. After all, one couldn’t have a specialty society made up of a gumbo of weekend moonlighters, those waiting for a fellowship to open in GI or cardio, prison docs, student health docs and perhaps casino doctors all looking to take an exam and add to their resume.
Another huge surprise, the mailbox was full every day with hundreds and then thousands of new dues-paying members.
Yet another surprise, the mailbox was full of hate mail. Those who had missed the 1988 deadline for the practice track eligibility sent an avalanche of vitriolic responses and lawsuit-threatening letters. Even those idiots who were eligible, yes those who were being handed on a silver platter a board certification through the back door, but “forgot” to fill out the paperwork saturated the newly formed AAEM with almost lunatic screeds about the injustice.
I could only shake my head, finally calling many of them back to ask where they were on the first mailing. They had no good answer, but one leitmotif of answers amazes me to this day, “I would rather be certified and exploited than be treated fairly in my job and not certified.”
If anyone doubts the validity of their own certification just look at that history and the ensuing years of Daniels v ABEM. All of medicine needs AAEM and all of you are part of history as we continue the struggle of independent groups of emergency physicians to live and work in a community for a lifetime of continuity-of-care to the patients we serve.