Who Are We Fighting For?

A group of my old Navy buddies are making plans to get together at the American College of Emergency Physicians annual Scientific Seminar in the fall. A bunch of salty old Navy ER docs at a convention in Las Vegas - I can see the headlines now.

During a recent e-mail conversation, several old friends that have settled in several states gave me a taste of what to expect at the convention: a whole lot of complaining about the state of emergency medicine in this country. The men and women from New York, Florida, Massachusetts, and my state, Pennsylvania, are either in anger management or clinical depression sessions. The people from Texas, Colorado, and Wisconsin are focusing on patient care and educating students and residents.

The difference? An environment of professional satisfaction in the western states, fair compensation, and strict limits on medical malpractice nuisance lawsuits. Despite the differences between us, there is a general dissatisfaction with our professional organizations.

The two major professional organizations in emergency medicine are the American College of Emergency Physicians (ACEP) and the American Academy of Emergency Medicine (AAEM). ACEP is older, larger, sober, and politically very savvy and occasionally effective. AAEM is younger, brash, impatient, and very effective at harassing ACEP, though their political effectiveness is less proven. AAEM grew out of a frustration with the ACEP leaders and a perception that ACEP was more interested in protecting patients’ rights and access to care rather than representing the interests of the average “pit doc.”

Throughout the ‘90s leaders of AAEM and ACEP locked horns at every professional meeting, but slowly, ACEP was dragged back toward the center and refocused their political activities to promote legislation to provide legal and economic protection with inconsistent results. The situation in certain states improved markedly, resulting in a migration and surplus of physicians to those areas. Other parts of the country are still waiting.

The Obama administration illustrated the fallacy of their healthcare reform efforts when they failed to include ANY effort to control the single greatest destructive element in American society - trial lawyers - in the recent healthcare legislation.

One of my oldest and dearest and smartest (and saltiest) friends put it best when he wrote:

“I’m not too pleased with ACEP. Here in the People’s Democratic Republic of Massachusetts, we’ve had Obamacare light - Romneycare - and will soon reap the benefits of price controls and other fun things down the road. There’s a reason why most of the physicians who train here bolt the state the first chance they get, and it’s not the traffic. Revenues as a whole are down and our hospital is using it as an excuse to cut our salaries - or, as they would describe it, put 30 percent at risk to make us more productive. This, in one of the most litigious environments in the country.”

“ACEP sent out an e-mail of their statement when the law passed that “applauded” the efforts. I sent a reply - “You sold us out” - and got an answer back within an hour. I’m sure my comment wasn’t the only one. The fact they didn’t make a bigger deal about tort reform - probably the one thing that would lower health care costs - and rolled over like the AMA speaks volumes.”

“I’m fed up with ACEP and to a lesser extent AAEM. The trial lawyers, AARP, etc., have no trouble articulating who they “advocate” for - themselves or their dues-payers (old people in the case of AARP). Why do medical associations have this pathological need to advocate for “the patient” and then us? Aren’t we advocating for the patient? Who the hell advocates for us? I lean towards AAEM. ACEP didn’t please me with “grandfathering” some people for Fellowship status, and the organization as a whole seems to be dominated by do-gooders who think we can do everything in the Emergency Department, thus relieving the responsibility from whatever primary care physicians (or their MLPS) remain. Think about that when the demented nursing home patient comes in at 9:30 p.m. for “change in mental status” that started yesterday and is in septic shock and by the way no one ever addressed code status. When Obamacare dictates that you pull the plug on Grandma, who will they blame (and sue), you or our Messiah President?”

Couldn’t have said it better myself, Bluto.