Common Sense

Letters to the Editor

The Moral Arc

I just read your message in the recent issue of Common Sense. I have to say I have grown tired of the ACEP-bashing abundantly reproduced from AAEM's leadership over the years. You stated, "I want you to clearly understand the differences between the Academy and the College." Then, your examples imply ACEP must be on the side of corporations. Further, leadership of or even employment by staffing corporations, by default, means ACEP and its leaders must not be looking out for the individual physician. Not a "fair and balanced" description and one that does much to perpetuate the divide between the Academy and the College.

Interestingly, as I read through the rest of the magazine issue, it is apparent ACEP and AAEM share most of the same issues, direction, and priorities. In fact, I have noticed these similarities over many years.

I truly appreciate AAEM's desire to preserve the ideal work environment for the individual emergency physician. Indeed, that is why I have maintained my AAEM membership for over a decade. I have only ever worked for independent groups, aside from my time on active duty service with the US Navy. I would prefer to keep it that way.

With that being said, ACEP-bashing always points to some past or current leaders within ACEP who have been leaders or employed within large contract management groups. However, this "guilt by association" assumes some sinister plot to take advantage of individual physicians. I have not witnessed that to be true. Through the Florida chapter of ACEP, I had worked for years alongside a physician from another part of the state before it ever became known to me that he is a senior vice president with EmCare. Whenever he spoke, he always spoke with the individual physician's best interests in mind. I never heard him speak on behalf of EmCare or corporate medicine, for that matter.

In fact, most of the people I know today who work for CMG's, as well as many of the partners I have worked with in independent groups, want nothing to do with the business of emergency medicine. They want to clock in and clock out, get paid and leave the rest to someone else. Surely you know this type, also. However, no group would survive if it did not tend to the business of emergency medicine. The business of EM has costs and even a small group will find it needs to allocate some "administrative time" for their leaders in order to manage this business. I have not found a group where these leaders are willing to do so for free, on their own time, and only be compensated for the clinical work they do.

Yes, I don't want to be taken advantage of by any group skimming off the top of my hard-earned revenue just to line their pockets. Yes, I also recognize I will be required to contribute to the costs of billing, liability insurance, and "management" of my group.

I am happy to see AAEM maintain its principles of looking out for the "little guy." ACEP is hard at work for emergency physicians but does not become involved with contracts between a physician and their employer or group.

Yet, continually detracting from ACEP as an organization, and ACEP's leadership simply because of who they work for rather than what they say and do, has grown tiresome and seems out of touch with the ACEP I know well. The two organizations could do so much more if they worked together on common issues currently being tackled independently.

I implore you and AAEM's other leaders to simply agree to disagree with ACEP on some issues and to work together on others. No family exists without some differences of opinions on how things should be done. But, in the end, we are all the same family and can succeed together if we will work together.

Steven B. Kailes, MD MPH FAAEM FACEP


Thank you for writing. Your criticism is rational and articulate, and I appreciate the time and thought that went into your letter. In fact, your letter is so well done and on such an important topic that I have decided to devote my “From the Editor’s Desk” column in the Mar/Apr issue of Common Sense to replying to it and explaining my position.

— The Editor

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