Common Sense


Issue: May/June 2022

Author: Jonathan S. Jones, MD FAAEM

It was wonderful to be in person again at AAEM22.  If you made it, I hope you had an excellent time, learned some great things, and made some fruitful connections.  If you couldn’t make it, I hope that you can join us next April in New Orleans.  And if you want to learn some great things, remember that all members have free access to AAEM online which has over 100 lectures with CME credit.  Talks from SA22 have not yet been uploaded but will soon.  And if you want to make some connections, help build the Academy, or just explore an interest, then please check out the multitude of sections, committees, and interest groups.  I especially want to make everyone aware of our two newest interest groups, Rural Medicine and Mature Physicians (the counterpart to the current Young Physicians Section.

Now, about me and what I would like to help the Academy accomplish as President over the next two years.  I am a community physician in Jackson, MS.  I previously was an academician for over a decade, having served as a Residency Program Director and Vice-chair for Education.  And while I still value academic medicine, I wanted more of what led me into EM in the first place – direct patient care.  I find purpose in caring for my patients.  I know we all do.

We chose this specialty because we want to help people when they are most vulnerable.  We want to help anyone, anywhere, with any problem.  We work long hours.  We work nights.  We work weekends and holidays and miss important events with our families and friends.  And I don’t think many of us really mind this.  After all, people get sick and injured at all of these times and someone needs to be there to help them.  I want to be that person and I know you do to.  We enjoy the complex mental and physical challenges of caring for every condition which may enter the ED.  And I’m not sure about you, but I’ll admit, that at times, I also enjoy the simple smiles and laughter from the completely healthy toddler who is brought in for no apparent reason other than parental reassurance.  I enjoy when I have a bit of extra time to spend at the bedside as I did recently with an incredibly friendly and committed yet poorly controlled diabetic.  She couldn’t understand why her glucose was still way too high.  Someone in her clinic told her to stop drinking soft drinks, which she did.  Yet no one informed her that sweet tea wasn’t the ideal substitution.

We all have similar stories.  But why do I relate that story or for that matter write the entirety of the paragraph above?  It’s because this is what we should be doing.  This is what we should be spending our time on.  Our greatest challenges should be deciding what exact rhythm the patient has, whether the patient’s dizziness is actually a stroke, or how best to manage the airway in a patient with facial and neck trauma.

But those are not actually the greatest challenges that I face.  Much more challenging is convincing my hospitalist to admit the IV drug user who has been to the emergency department 100 times over the last two years typically with nothing wrong other than hunger, but who now likely has endocarditis.  Or convincing my CEO that despite the fact that we have a part time hematologist, the patient in front of me in fact has a critical and life-threatening condition and needs to be transferred immediately to the tertiary hospital because our hospital just simply will not give this patient the best chance of survival.  Or convincing said CEO and CMG groups that I am not just a warm body with a license and that there is an actual difference between a board-certified emergency physician and everyone else.

These are the battles that the Academy is fighting for you.  These are the battles you are fighting as part of the Academy.  These are the battles that I want to help us win.

I have three specific goals for the Academy over the next two years:

  1. Empower all of our members
  2. End the corporate practice of medicine
  3. Ensure true due process rights for all physicians

Empower Our Members
This will be my primary focus as President.  The success of the Academy depends on the success of its members, each and every one.  Everything we have ever achieved has been achieved through the hard work and dedication of many people.  And if we are to achieve the other listed goals, it will take every single one of us.  But honestly, while true, that’s just boilerplate.  What do I specifically mean?

You, and every other member, joined the Academy for a specific reason.  Every member’s reason is slightly different.  However, most reasons have one thing in common and that is that the member wants to make a difference, they want to contribute.  They have an idea that they want to explore, an initiative they want to start, or a goal to achieve.  I don’t know the individual reason each member joined.  And while I would like to know your individual reason for joining, I don’t actually need to know your specific reason in order to help you accomplish your goals.

I will start by:
Making communication simpler and more direct.  Done.  This is my personal email.  Send me anything, I will respond (and I’ll give you my cell too, but I learned posting that online is not the best idea).

Increasing transparency in decision making processes.  Done.  Brief agendas for all Board meetings will now posted on the website prior to meetings. Additionally, an online comment link is nearby.  You can submit questions, suggestions, or comments on any board agenda item or on a new business item. These can be submitted anonymously or with your name.  Prior to each board meeting, all comments will be sent verbatim to each board member who will be expected to read and consider them prior to the meeting.

Empowering Committees to create and do more.  Done.  Already each committee has been granted funds to use for any initiative they desire so long as it furthers the mission of the Academy.  We have excellent and capable leaders of our committees; we should entrust them to do what is right without overburdensome management.

Ending the Corporate Practice of Medicine
In December 2021 AAEM through the AAEM PG initiated a lawsuit in California, against Envision for the unlawful practice of medicine and violation on the state prohibition of the corporate practice of medicine.  This is the most significant action any medical organization, Emergency Medicine or otherwise, has ever taken in an effort to restore all practice decision to physicians.  The case is progressing well but it is still early.  We need continued support from all members and non-members alike.

While donations to the AAEM foundation are needed to support the legal effort, equally important is spreading the message, and not just to other Emergency Physicians.  Tell everyone you know, colleagues, friends, family, pets, everyone!  AAEM is not suing Envision for any financial gain.  We are not asking for a settlement.  We are suing Envision so that patients can receive proper care.  We are suing so that physicians won’t suffer moral injury by trying their best, yet being stymied.  Ask your non-medical friends, “When you visit an Emergency Department, would you like your medical decisions to be solely made by the physician or would you prefer if they were influenced or dictated by a private equity firm?”

In addition to the suit, we are advocating at the state and federal level for stronger protections for physicians against undue influence from corporations.  Please check out our campaigns on our website under Advocacy or click on Take Action Now.

Ensure Due Process Rights for Emergency Physicians
We are closer than ever to finally obtaining a federal law ensuring Due Process rights for all Emergency Physicians.  We have bipartisan sponsors of the bill in the House and close to having bipartisan sponsors in the Senate.  Since the Academy’s founding, obtaining true Due Process rights has been a goal.

Ensuring nonwaivable due process rights will allow physicians to better advocate for their patients.  It will curtail intimidation and retribution from unethical corporate groups as well as hospital administrators.  While simply having due process rights ensured won’t solve all of our problems, it will certainly be one giant step in the right direction.

Will we be able to accomplish all these goals in the next two years?  I don’t know.  But I will end with a bit about my thought process.  For years, I’ve always set what I call A, B, and C goals.  I always set my A goal as something nearly unobtainable, not impossible, but very difficult to achieve.  My B goal has been something which if I obtain it, I will feel happy, I will feel that I accomplished something worthwhile.  My C goal is the minimum of which I will be satisfied.  If I fail to meet my C goal, then I have failed and feel disappointed.

I don’t know exactly when it started and I don’t know why.  My earliest memory of my ABC goals is a high-school debate competition.  It was my first debate at a regional competition and my specific competition was the Lincoln-Douglas debate (I chose this because other members of the debate team told me it was the hardest…and because no one else signed up).  My A goal was to win the entire competition.  My B goal was to be in the top three.  My C goal was simply to represent Edgewater High School in a dignified manner.  I was only able to accomplish my C goal that day.  Sure, I was a bit disappointed, but not too much.  I knew I was capable, but I also learned that I needed to work harder.

I’ve been setting these goals ever since and they serve me well.  I often am able to accomplish my B goal and occasionally my A goal.  Sometimes I still fail to accomplish my C goal.  But this system helps keep me motivated, helps me continue to set targets which may at first seem unobtainable, and also keeps me from getting too dejected when it doesn’t go perfectly right.

My three goals listed above fall into those categories.  Ending the corporate practice of medicine is my A.  Honestly, we quite likely won’t accomplish this in the next two years.  But we sure need to try.  Ensuring due process is my B.  We are so close.  We have actual bills in Congress.  We have sponsors.  We have interorganizational support.  But we’re not there yet.  Empowering members is my C goal.  I must do this.  Failure to accomplish this will, quite simply, be a failure.

I close in asking for your help.  Give me advice, give me support, let me know how I’m doing.  Help us succeed.  Let’s go and knock these goals off the to-do list.

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