I first heard of the American College of Emergency Physicians as an emergency medicine resident nearly 30 years ago. The organization has been and still is extremely helpful in establishing emergency medicine as a specialty, providing policies and guidelines to improve and standardize the way it is practiced. I also enjoyed attending CAPE conferences where I reunited with colleagues and shared ideas with like-minded people while absorbing new and useful educational material.
There were still signs, however, that the tentacles of corporate medicine were hiding behind ACEP’s facade of professionalism and university. Contract Management Groups (CMGs) backed by private capital have always had the largest booths and banners in the exhibit halls of CAPE Scientific Assemblies. Like Hansel and Gretel, it wasn’t hard to be won over by their bottled water, free parties and potential six-figure salaries.
Corporate medicine, the practice of medicine by non-medical personnel, is illegal in most states, but many CMGs circumvent the law by setting up local businesses to make a group look like it’s owned by a doctor. . You don’t have to look far to see that medicine’s desire to help those less fortunate and a corporation’s desire to maximize profits create a disastrous combination. Early in my medical career, drug companies gave doctors studies that narcotics weren’t as dangerous or as addictive as common sense and medical science would have us believe. Like Pavlov’s dog, I digested this information (along with the free meals) and incorporated this new dogma into my practice, not realizing that the studies were not only biased and flawed, but were intended to promote profit over safety. patients. Today, pharmaceutical company representatives are banned from many hospitals and emergency departments.
Emergency departments that use CMGs also produce spineless emergency managers who lack the incentive to advocate for patient or staff safety. After 9/11, at the busiest and closest trauma center to the World Trade Center, my ER manager was able to clean up our ER and cancel all elective procedures within an hour. He didn’t need the administration’s blessing to make the best decisions for his patients and staff. This is in stark contrast to today’s emergency service managers who are hired by CMGs. Their primary objective seems to be to preserve the lucrative contract at all costs.
Recently while browsing one of my social media pages I came across a statement that CAPE posted on their website when I was fired by my employer CMG for speaking out about the safety of my staff and of my patients at the start of this pandemic. (Dr. Lin is suing PeaceHealth, which operates PeaceHealth St. Joseph Medical Center in Bellingham, WA, and TeamHealth, the contract management group he was hired to work under, for wrongful termination. Read about his termination in REM. 2020;42:1; https://bit.ly/3f8RXfX.)
“CAPE is aware of the ER physician’s dismissal in Washington…We reached out and offered to connect him with resources to discuss what action could be taken.” Physicians should not and cannot be punished for advocating for workplace safety in such a high-risk environment.
My inability to find this page today has further fueled my concerns that CAPE may not be a true advocate of ER physician due process, which the university has repeatedly stated.
Hundreds of people, journalists, the American Academy of Emergency Medicine, the Washington State Nurses Association, the American Civil Liberties Union (which supports my wrongful termination suit), local organizations from EMS, unions, politicians, workers’ rights advocates offered me their support. groups, and even the local Native American nation. Buried among them was a message from a CAPE board member offering his support.
But unlike other groups that have supported me, CAPE’s links to the business world are more obvious. Has the college used my unfortunate situation to falsely portray a virtuous image or is it really interested in doing what is necessary to ensure due process for all emergency physicians? My apprehension only grew when I discovered that my state ACEP chapter did not support an internal due process resolution, but also that its president is a CMG employee against whom I sued for wrongful dismissal.
CAPE has an opportunity to be a true advocate for the bedside emergency physician and demonstrate that they offer more than just conversation. I ask my fellow physicians to join me at this year’s CAPE Scientific Assembly in calling on CAPE to adopt Dr. Robert McNamara’s Resolutions 29 and 44 in their entirety. (See Mitchell Li, MD, and Meghan Galer, MD’s article on these resolutions on p. 3.)
These will prohibit CAPE members from denying its members due process and will mandate transparency in billing for the hard work of all emergency physicians. This is a great opportunity for CAPE to demonstrate that it is not betrothed to corporate medicine or a private equity firm, as many of us on the front lines believe.
Access links in REM by reading this on our site, www.EM-News.com.
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Dr Linis the Emergency Supervisor for the Great Plains Indian Health Service in Aberdeen, SD, overseeing five emergency departments. It also recruits emergency physicians for the Indian Health Service.