Common Sense

Do You Work at a CMG? AAEM Needs You!

By now, the kids are back in school, academic centers are getting swamped with rotating medical students, and everyone else is planning and preparing for the holidays. This will be my last article for 2018, so let me take this time to wish everyone a safe and happy holiday season. The idea for this article came to me while I was traveling. An emergency physician asked me “Why does AAEM really hate Contract Management Groups (CMGs)?” I replied that “hate” is a strong word and that AAEM opposes lay corporate CMGs, as laws in 38 states restrict or prohibit lay ownership of medical practices. We had a nice conversation about AAEM’s positions regarding CMGs. I also noted some parts of AAEM’s mission statement:

A specialist in emergency medicine is a physician who has achieved, through personal dedication and sacrifice, certification by either the American Board of Emergency Medicine (ABEM) or the American Osteopathic Board of Emergency Medicine (AOBEM).

The personal and professional welfare of the individual specialist in emergency medicine is a primary concern to the AAEM.

The Academy supports fair and equitable practice environments necessary to allow the specialist in emergency medicine to deliver the highest quality of patient care. Such an environment includes provisions for due process and the absence of restrictive covenants.

Then, I heard the real question behind this: “Does AAEM not like doctors that work for a CMG?” To this, I had to laugh, and my reply was simple — “I work for a CMG.” (Note: I hold no CMG leadership position other than at my local hospital, and I do not have any ownership/stock/options, bonuses, or anything of that nature other than my hourly rate and my chairman stipend).

AAEM is the only organization that fights for the physician, the “pit doc.” AAEM wants every board certified emergency physician to become a member. In fact, our most recent membership survey showed that more than 23% of respondents work for a CMG or locum tenens company. I believe it is extremely important for all physicians to join AAEM, but especially physicians who work for a CMG. AAEM not only welcomes you with open arms, but AAEM’s mission is to fight for your rights on all levels. When we changed and rebranded our logo, the shield represents the idea of advocacy, with AAEM as the defender of emergency medicine. The torch represents our role as a leader, lighting the path toward physician autonomy.

AAEM stands up for the emergency physician, and not the multibillion dollar CMG that profits on the backs of the physician.

Now, this is not an article about CMGs, but about the importance of physicians working for CMGs realizing that they must be involved in their future and not only think in the short-term. Unfortunately, many emergency physicians focus on what appears to be an attractive job in the short-term, and do not fully consider their long-term career. Every month, AAEM is contacted by several emergency physicians asking for our help with a practice rights issue (such as termination without due process). The vast majority are working for large national CMGs, and often signed contracts that they did not properly understand.

Emergency medicine is not in its infancy anymore, we are now a well-established specialty. Emergency medicine residencies are increasing. Between 2000 and 2010, the numbers of emergency physicians increased by 44.6%, more than any other specialty.1 As of 2018, there are more than 230 ACGME accredited emergency medicine residency programs.

However, as the emergency physician supply has increased, and emergency department patient volumes have leveled off nationwide, this has put large employers of emergency physicians, particularly the largest CMGs, in the driver’s seat. In my county (Miami-Dade) of 2.8 million people, there is not a single independent emergency physician group left, as all EDs are controlled by CMGs, except for the public hospital. The number of allopathic emergency medicine residencies in South Florida has increased from one to four in just three years. Incredibly, all of these new emergency medicine residencies are operated by different CMGs, except for one operated by the public hospital. Currently, the job market for emergency physicians is favorable. However, this may quickly change in a number of years, as the number of residents graduating per year in Miami Dade county has increased from five to 47 over the course of several years.

So, if you are an emergency physician working for a CMG you need to join AAEM — the organization that represents the emergency physician.

AAEM will fight for your rights at the state and federal level, as well as offer our excellent, free Scientific Assembly, and so much more, for the price of your last steak dinner with several of your friends. You would never consider driving your car without car insurance, but so many physicians continue to practice without considering about the potential minefields in their career. We not only want you, but we need you. Together, we can shape the future of emergency medicine.

Reference:

1. Reiter M, Wen LS, Allen BW. The Emergency Medicine Workforce: Profile and Projections. Journal of Emergency Medicine. 2016;50(4):690-693.doi:10.1016/j.jemermed.2015.09.022

2. Hall MK, Burns K, Carius M, Erickson M, Hall J, Venkatesh A. State of the National Emergency Department Workforce: Who Provides Care Where? Annals of Emergency Medicine. 2018;72(3):302-307.doi:10.1016/j.annemergmed.2018.03.032