What Ever Happened to "How May I Help You"?
Issue: January/February 2018
Author: David A. Farcy, MD FAAEM FCCM
“We need your brain power, your expertise, your ser - vice, your involvement, and your infectious energy. Two heads are better than one, and three better than two. This is your opportunity to ‘pay it forward’ and improve the services AAEM members enjoy!” — Kevin Rodgers, MD FAAEM
We are living in strange times. The medical field is being challenged on all sides. I am about to show my age with an analogy comparing the Millennial generation with our beloved specialty of emergency medicine. Let me preface this by saying I am in no way attacking Millennials, but merely illustrating a problem affecting our specialty. Millennials are often described as lazy, entitled, selfish, and shallow — the “what about ME, ME, and ME” mentality. It would be unfair to say that the Millennials are the only ones who think like this, as the philosophy of “what can you do for me” carries through Generation X, Y and yes even Baby Boomers as well.
We can see this inward-focused attitude increasing in recent years. According to the National Institutes of Health, 58% more college students scored higher on a narcissism scale in 2009 than in 1982. 1 TIME Magazine in 2013 noted that Millennials “believe in being recognized with award or trophy and study showed that 40% believe they should be promoted every two years, regardless of performance.” 2
Managing the New Workforce: International Perspectives on the Millennial Generation co-author Mr. Lyons writes that “this generation has the highest likelihood of having unmet expectations with respect to their careers and the lowest level of satisfaction with their careers at the stage they’re at.” 3
Does this sound familiar to you?
When I think of emergency physicians, there are several personality traits that come to mind — positive traits that describe the vast majority of us: energetic, resourceful, efficient, creative, and caring. On the other end of the spectrum the negative traits commonly seen are: fear, greed, anxiety, and submission. All these negative flaws contribute to our increasing rate of burn out. By identifying problems in our profession and making changes, we can improve both patient care and our practice environment.
1. Fear: We live in a litigious society. Ask any emergency physician his or her primary concern — it is usually a lawsuit. I’m currently reviewing the corroborating affidavit served in a malpractice claim against me. The opposing expert has been practicing for 20 years and only practices cruise ship medicine, but listed 19 points alleging that I deviated from the standard of care. What if doctors, as a profession, only did the right thing and only agreed to review and provide expert testimony based on the merits of the case rather than simply rubber stamping an attorney’s affidavit for a large sum of money? A trial lawyer once told me, “It is an easy $5,000, Continued on next page just read the affidavit and sign it.” I told him that this issue could affect someone’s life and had the potential to destroy a doctor — both professionally and personally. He quickly replied, “Don’t worry about this, they will settle, again a quick $5,000.” I replied that the settlement would be on his record for five years. The point is “money” seems to be the common denominator for many of our problems and negative traits — make a quick buck at any cost, even if it is unethical and uncaring.
2. Greed: We all need to work together to support the profession. One major problem facing our specialty is CMGs (Contract Management Groups). Some people will do whatever they can for more money, without thinking of the repercussions or effects on their peers. Recently while traveling, I ran into one of my former residents. During our talk, when I asked him how his wife and kids were doing, and he responded, “Fantastic, I just bought a Ferrari.” I was dumbfounded; I asked, “Did you win the lottery?” He said no, he had a great new gig. I asked him to explain. He said, “I have a new position with my contract management group. I cover shifts that are not filled on that day and I get $500-$800 and sometime more. I am credentialed with several of their hospitals.” As some of you may suspect, he got an earful from me. When I asked him, “Have you ever wondered who and why you were covering?” The answer was “no.”
“By identifying problems in our profession and making changes, we can improve both patient care and our practice environment.” 3 JANUARY/FEBRUARY 2018 COMMON SENSE PRESIDENT’S MESSAGE Imagine if everyone in our specialty had a commitment to advocate for basic practice rights instead of selling our services to unethical corporate contract holders. If we as physicians stand together and protect each other, we can improve our profession. The CMGs are not evil, but they are for-profit companies that have a duty to maximize profits for their shareholders. Contract management groups and internal locums give CMGs the ability to terminate emergency physicians on the spot without a fair hearing or due process. But, if their supply of physicians was more limited, they would need to adjust their business model and provide a fair hearing and due process for their physicians. We work in a difficult industry amid massive change. We, as physicians, need to steer the changing system to make it work for us.
One recent example that has received lots of media attention was the Summa Health events in early 2017. The entire group at Summa Health stood together and made personal sacrifices to counter US Acute Care Solutions takeover of their contract. USACS had to offer exuberant rates —near $800 per hour to fill their shifts. The former staff members lost their jobs and USACS could not meet the ACGME requirements for faculty. Sadly, Summa lost its residency program and all of their residents had to scramble and find another residency. It is time for us to all work together toward a common goal. Do not let personal greed be your driving force — work to provide protections to all doctors practicing at a hospital.
3. Anxiety: I am anxious even while writing this column — my deadline, this lawsuit, and about the potential negative outcomes. As a result of our own actions, we create our own anxiety. Many emergency physicians work at a hospital, but simply show up, work the shift, and go home, and the cycle continues. You may have worked in your hospital for five years, but have never met the CEO, CFO, CMO, or CNO. Most do not sit on any hospital committees and are not involved in the hospital or community. In response, I hear, “You need to pay me.” Pay you for what? Your own job protection? Why do you think CMGs don’t allow you to talk to your C-suite: indifference or are they concerned you might take over their contract? I would encourage you to get involved in your hospital, meet your entire C-suite, join a few committees, go to the medical staff meetings and participate. Sure, you’re not getting paid, but the return on your time investment is exponential. The next time the CEO gets a letter of complaint about an ER doctor, instead of calling HR and asking, “Who is this doctor?,” he or she may think, “Oh, that is the emergency doctor I know, a standup individual who is involved in our hospital,” rather than simply asking the regional director of the CMG to remove this individual.
4. Submission: Well after reading this, many of you will shake your head and say, “What do you expect us to do, nothing will change; I work too much; I have no time” ... and there you have it. The circle completes, we lose all of our voices, and we go home and complain and complain but do nothing to change the situation.
So you might ask yourself, “How does this compare with the Millennial? This is about me making more money, me being freer, me being able to afford more ... me, me, me.”
We know the science. We are on the front lines providing medical care to the critically ill. Every day we deal with the unexpected. We are America’s safety net, but we do not take the time to invest in our profession. I always hear, “Why should I do this, nothing will change.” Change starts with us, one person at a time.
The Academy’s mission is to support fair and equitable practice environments necessary to allow the specialist in emergency medicine to deliver the highest quality of patient care including provisions for due process and the absence of restrictive covenants. By upholding the AAEM mission statement, many of our members working in democratic groups have successfully overcome these traits by making personal sacrifices for the greater good of the group — leading to better career satisfaction, longevity, happiness, and less burnout.
I encourage you to stop asking what we the Academy can do for you, but instead say, “What can I do for the Academy?” We are YOUR voice, the voice for each of you that does not speak. We are your voice in D.C., we are your voice with regulatory bodies like CMS, TJC, etc. We are your voice working with ABEM on board certification issues. We are your advocate.
Get involved! I urge you to join a committee and join our Advocacy Day, our Scientific Assembly; and if you are too busy, then just keep your membership active, renew it yearly, and donate money. Donate the proceeds of one shift a year — you don’t really have any excuses not to, especially if you have been out of residency for more than two years. Why? Because AAEM is the ONLY VOICE you have for fighting for you: your due process, your board certification, your wellness, and that’s just the beginning.
In the past few weeks, I have received several calls from members asking for help from the Academy regarding threats to their practices. Unfortunately, by the time AAEM is contacted, it is often too late. So I hope it is clear by now, that it is never too early to get involved. I challenge you to make a personal pledge that now is the time to invest in your future and career.
Alone we are a single voice, together we are stronger ... here’s to a brighter tomorrow.
- Stinson FS, Dawson DA, Goldstein RB, et al. Prevalence, Correlates, Disability, and Comorbidity of DSM-IV Narcissistic Personality Disorder: Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. The Journal of Clinical Psychiatry . 2008;69(7):1033- 1045. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2669224/
- Stein J. “Millennials: The Me Me Me Generation” http://time.com/247/ millennials-the-me-me-me-generation/
- Ng E, Lyons S, Schweitzer L. Managing a New Workforce: International Perspectives on the Millennial Generation. Northampton, MA: Edward Elgar Publishing, Inc; 2012.