Time to Stop the Fake News

This past month, it has come to my attention that an AAEM board member has been presenting slides with ostensibly false information. A careful review of documents and policies demonstrate the slides appear to be clearly factually incorrect. I reached out directly to that individual. After a prolonged discussion, the individual agreed to remove the slides from his presentation but refused to apologize or correct his misstatements.

He rationalized this was justified because he believed the information was correct. He acknowledged he never checked. He stated he received this information from a former AAEM leader(s) but refused to acknowledge his source(s).

This responsibility to fact check before maligning colleagues or other organizations is amplified with each position of authority that person holds including their position(s) in the professional organization, their title and position of authority at their place of employment, and their role as an educator.

We must take action to decrease or eliminate the proliferation of “fake news.” Projecting one’s own beliefs onto another organization or culture as the identifiable enemy rather than focusing and weighing the positive and negative qualities results in “splitting” or “all-or-nothing thinking.” This proliferation of mistruths creates fear and mistrust amongst physicians, undermines confidence in our professional organizations and damages our specialty. Throughout history, this strategy has been employed by extremists and dictators to unduly influence the public. This proliferation of “fake news” is currently being discussed in multiple publications including Anti-Social Media and Weaponized Lies: How to Think Critically in the Post-Truth Era. Emergency medicine needs to elevate ourselves and stick to actual facts.

I am hopeful that AAEM will investigate incidents of this type and hold its leadership to the same accountability that other organizations do. Indeed, everybody should have “due process.” I am hoping the facts will be examined and that no one will be afforded any special treatment.

When leaders engage in spreading untrue statements and remain unchecked, the credibility of the entire organization is undermined. It is difficult to trust someone or work with an organization who won’t police their own leadership. It is disturbing when these leader(s) are called out, they don’t, can’t or won’t supply the evidence to support their assertions and refuse to apologize and justify their actions because they thought or wanted their statements to be true.

To me, integrity matters. Perhaps, I expect too much. I was taught to own my actions and when I make a mistake, I should work to correct it. I was also taught that if my mistake was potentially harmful, I should apologize.

Going forward, let this be a call for everyone to check their facts before making public statements about colleagues and other organizations, be transparent to the source of those “facts,” and be accountable for their actions.

It is time to end the divisive vitriol and restore integrity, accountability, and unity to our specialty.

– Paul Kivela, MD FAAEM FACEP, ACEP Immediate Past President


Note from the Editor

Common Sense appreciates members sending in their concerns and comments. Dr. Paul Kivela is a member of AAEM as well as the immediate past-president of ACEP. He sent this letter to the editor. It relates to a slide used during a recent presentation by Dr. Howard Blumstein a past-president of AAEM.

Common Sense represents AAEM, which is an open and democratic organization which supports dialogue and discussion related to controversies in emergency medicine and the concerns of its members. The differences between the goals and aspirations of AAEM and ACEP certainly can be seen as one of these issues.

Common Sense will print the slide in question, Dr. Kivela’s letter to the editor and the responses by Drs. Howard Blumstein and Robert McNamara. The staff of Common Sense hopes you will carefully read these and see what you think. We encourage responses to this series.

– Andy Mayer, MD FAAEM, Common Sense Editor in Chief


Response: What About Those Original Bylaws?

Dr. Kivela correctly points out that one of Dr. Blumstein’s slides on the content of the original ACEP bylaws is not completely accurate. I find the intensity of the criticism (extremists and dictators?) a bit unusual as the slide presents a favorable view of these bylaws. Of the five bullet points, the first two are largely correct and in comparing them to what was in the original ACEP bylaws we see a specialty gone astray from the vision of the founders. The first Blumstein bullet says “Members cannot take part of other member’s professional fees.” The original ACEP bylaws state, “In the practice of medicine a physician should limit the source of his income to medical services actually rendered by him, or under his supervision, to his patients.” I see no measurable distinction between these two statements. Clearly this is not the case today where we see EM physicians including national leaders and who derive all or the majority of their income from the labors of ACEP (and AAEM) members. This current division of fees would have been an ethical violation under the original bylaws. Today it raises the issue of prohibited fee-splitting where an EM pit doc is giving up 20% or so of their fees for the right to be put on a schedule to see patients (there is a huge class action sitting out there for the taking).

Let’s examine bullet 2, it states “Members should control their own practice.” The original ACEP bylaws say “the emergency physician shall not associate himself in any fashion with any institution that permits medical practice by other than a physician.” If that doesn’t speak against a lay corporation running your practice what does? This statement is the essence of the prohibitions on the corporate practice of medicine that exists in most states. These prohibitions simply state doctors should control their practice to avoid the business interest interfering with the physician/patient relationship.

These concepts have been held forth since the early days even before AAEM was founded in 1993. The 1978 President of ACEP, Karl Mangold, said in the specialty’s major journal: “ACEP and other professional societies and many state laws support the policy that earnings derived from physician services belong to the physician.” (JACEP 7:245-248). Mangold’s statement speaks directly to Dr. Blumstein’s first two bullets. That is a referenced fact, not fake news.

The other bullet points are incorrect in that the bylaws did not specifically mention open books or restrictive covenants. Additionally, due process is not specifically mentioned but there is a statement that EM physicians should be medical staff members equal to all other physicians. In case you haven’t looked, due process is standard for them and one can deduce the founders valued that. I was in grade school when the original bylaws were written but they look pretty darn good to me. In fact, if we threw in that all full voting members need to be board-certified I deem that original document as true to the principles of AAEM. It has always bewildered me how AAEM is labeled as “radical” when today it is closer to the original intent of the founders of ACEP than ACEP itself.

Certainly, I can agree with Dr. Kivela that unity among the physicians in our specialty would be ideal but that would require ACEP to join us in actively pursuing three of the bullet points Dr. Blumstein listed: no fee-splitting, no corporate control, and open books. The benefit to the pit doc would be huge if that did occur. I have always said simply having every EM doc see what is paid in their name would radically change the practice of EM as the bedside physicians would demand that we regain control of our specialty.

– Robert McNamara, MD MAAEM FAAEM, AAEM Past President


Response

Since its inception, AAEM has had three core issues. The primacy of board certification in our specialty, economic exploitation of our peers, and unfair employment practices by those who seek to control our medical practice. It is that simple.

When I speak to young physicians, they are quick to grasp these concepts. They understand the financial motivations that drive those issues. They see how our colleagues enrich themselves, and their stockholders/owners, at the expense of those of us working in “the pits.” They feel the outrage that led to AAEM’s founding 26 years ago. It’s easy.

But then comes the hard part — where we must necessarily address how our specialty is dealing with those abuses. In what direction we are headed? And how do we have that discussion without including ACEP? ACEP is the elephant in the room. I don’t see how you can explain where we are going as a specialty without including the largest of the specialty organizations. That is obvious.

I always preface that discussion in my presentations by addressing the acrimonies of the past. I explain that I do not want to rekindle them. It’s too bad Dr. Kivela doesn’t give me credit. Conversely, however, when you talk about ACEP’s apparent lack of leadership on those core issues, it’s going to look bad. Because it is bad. It isn’t meant to be an attack. And I see a lot of heads nodding. Because it makes sense.

Audiences understand. ACEP continues to fill top leadership positions with never-been-board-certified doctors. How is that championing the importance of certification in our specialty? A disproportionate number of ACEP leaders are executives with, officers of, and/or equity holders in, contract holding corporations whose operation requires the exploitation and control of our peers. How can we expect them to formally and definitively push back against those abuses? We can’t. People get it.

Then the big finish. I tell audiences that ACEP really isn’t interested in me. I am too close to the end of my career. But ACEP is very interested in my audience — young physicians just starting off. In the audience sit people who will be members for 30-35 years. Future committee members, board members, and officers at state and national levels. Those are the folks both AAEM and ACEP want, or need. Of course.

Because of that, young physicians have power. I encourage audience members to exercise that power by asking direct questions of ACEP leaders. Why isn’t exploitation of our colleagues formally considered unethical? Why does ACEP make a statement of an emergency physician’s “rights” but then have no mechanism to defend those rights? Leaders of tomorrow should start demanding change today. It’s their future.

So the slide. I got rid of it even before Dr. Kivela called me and complained about a broad array of issues and people. I am not surprised by the vehemence of his letter. Ultimately the slide just did not fit into the flow of the talk or its ultimate theme. I still think the slide captured the spirit of the issue, although it has some factual errors. And I regret that. As I should.

Some folks respond poorly when I say “I think our core issues are the most important issues in our specialty. They are about professional and practice integrity and we are their champion.” It may well sting but that’s the way I see it, as do many others. I understand that we face many other issues. But how can we maintain our integrity as a specialty when violation of those core issues seems to be condoned through silence? We can’t.

One last thing. Someone please tell ACEP to stop sending me those “We miss you” recruiting letters. It would save them considerable postage. Obviously.

– Howard Blumstein, MD FAAEM, AAEM Past President

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