Taking on CMGs

[TooMuchResearch]

I would never join a SDG currently unless their pay for Nonpartners are the same as a CMG.

If a SDG has a lower rate until partnership, requires dedicated Admin "Free" work, requires you to shoulder more holidays/weekends/nights........ I would run to the CMG.

Our group pays everyone for admin work/staff meetings.
Weekends/nights are equitable. Actually now better than equitable as we have several partners working only weekends or nights.
No competing local CMG, so no pay comparison available.

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[GeneralVeers]

GV, how is the most recent CMG at your hospital making on that promise? Did they finally "fix" the system issues?

They've had the contract for 90 days and so far the system issues remain. I'm very familiar with the system (and our medical directors are not) so I'm working with them to fix the easiest thing we can, which is length of stay to discharge. This number sucks right now and is 3 hours plus. A lot of it has to do with a process whereby midlevels are doing an RME on EVERY Patient that walks in and over-ordering. Rather than simply discharge the Centor negative pharyngitis, or the young person with classic flu symptoms, they are ordering throat swabs, flu tests, blood work and a lot of unneeded tests.

 

[EctopicFetus]

Agree with everything EctopicFetus said. My SDG is very similar to his current one in our approach. Our prepartner docs make more than all of the CMG spots in the area. Our partners make significantly more than the CMGs. It makes our job the most desirable in town and the area which helps us with recruiting. We run a tight ship and have a great relationship with both our C suite and our consultants. We stay active within the hospital and keep members of our group on the hospital board and chair several committees. We can and do outcompete CMGs. My biggest concern would be having the hospital get bought out or having a major change in our C suite as an incoming management team can always mess things up without reason.


Sent from my iPhone using SDN mobile

If timing was different I may have worked with you. In the end its a relationship and bottom line business. You have to have the relationships and prove you are good for their bottom line.

 

[EctopicFetus]

50%+ more than local CMG rate? Ectopic, you’re group must have one fat hospital subsidy. I can’t imagine admin wouldn’t be interested in a CMG willing to work without one.

$0.00

 

[EctopicFetus]

Our group uses a third party coding/billing company so presumably they're good at it.

How small does one need to be to maintain the presumption of Small democratic group?

Yes this. Our billing company does a few million charts a year and I know leaders of many billing companies in EM. They understand THEIR business is at risk.

 

[Arcan57]

What effect does a VC selling a CMG have on the CMG? Do they then lose some contracts to the benefit of leaner SDGs/CMGs until their (the CMG's) returns improve? Is this all theoretical or are there historical examples?

Large CMGs follow a cycle that's fairly predictable and usually has minimal impact on the day to day operations of the company. VC provides infusion of capital, company focuses on M&A, spends a ton of money as a private company. CMG starts making money off their acquired contracts and go public with an IPO which pays off the VC handsomely. Stock price goes up as the contracts mature into stable revenue streams. Once the velocity of the CMG's growth starts to slow down or they need another hit of cash to acquire more contracts or branch into other areas of healthcare (anethesia, hospitalists, post-acute care), VC (possibly same one that owned them before) takes them private. Then the cycle repeats.

 

[deleted65604]

I worked for a contract management group that had poached the contract from a democratic group. We did great for a couple of years, and then the administration switched management groups. En masse, we all signed up with the new group. Then the new contract management group got bought out by a capital management group. We bled doctors during the turbulence and then the two national corporate management groups merged. I ended up working for the same employer except merged into a new national supergroup. We couldn't hire new docs. Then they opened up a free-standing ER and told us that we would staff us even though we were already 30% understaffed. I jumped ship after 5 years when it became obvious that they would be perpetually short staffed and that really crappy locums working in the department would be a permanent gig.

I left that hospital and went to a new hospital staffed by a democratic group. I was slave labor for a democratic group for 2 years and now am partner. I realized that I was underpaid by the CMG by at least 30%. After 9 years, my former hospital is now begging the physicians to form a private group so they can get rid of the CMGs. The CMGs underperform as their physicians feel no ownership. Is this just a local thing I'm seeing? It is going to be a rough transition to form a new group de novo as the crutch of the CMGs cripple physicians' ability to run their own group.

 

[Arcan57]

I worked for a contract management group that had poached the contract from a democratic group. We did great for a couple of years, and then the administration switched management groups. En masse, we all signed up with the new group. Then the new contract management group got bought out by a capital management group. We bled doctors during the turbulence and then the two national corporate management groups merged. I ended up working for the same employer except merged into a new national supergroup. We couldn't hire new docs. Then they opened up a free-standing ER and told us that we would staff us even though we were already 30% understaffed. I jumped ship after 5 years when it became obvious that they would be perpetually short staffed and that really crappy locums working in the department would be a permanent gig.

I left that hospital and went to a new hospital staffed by a democratic group. I was slave labor for a democratic group for 2 years and now am partner. I realized that I was underpaid by the CMG by at least 30%. After 9 years, my former hospital is now begging the physicians to form a private group so they can get rid of the CMGs. The CMGs underperform as their physicians feel no ownership. Is this just a local thing I'm seeing? It is going to be a rough transition to form a new group de novo as the crutch of the CMGs cripple physicians' ability to run their own group.

Honestly, it sounds like your former hospital's admin is the problem, not whatever physician group is/was staffing the ED. C-suite can suffer from "grass is greener" syndrome also. Constantly reshuffling the ED's management may be their way of not dealing with the really difficult task of fixing the in-patient factors that are almost always reason for "underperforming" EDs. It's easier to fire the coach then it is to drop in-patient LOS, make the floor responsible for a patient the moment they're admitted, or smooth surgical schedules.

 

[GeneralVeers]

Honestly, it sounds like your former hospital's admin is the problem, not whatever physician group is/was staffing the ED. C-suite can suffer from "grass is greener" syndrome also. Constantly reshuffling the ED's management may be their way of not dealing with the really difficult task of fixing the in-patient factors that are almost always reason for "underperforming" EDs. It's easier to fire the coach then it is to drop in-patient LOS, make the floor responsible for a patient the moment they're admitted, or smooth surgical schedules.

It's a way for the hospital executives to point to something they are doing to "fix" the problems. "See we are going to improve HCAPS by 2 percentile points by getting a new ED group that promises X,Y, and Z!"

 

[deleted109597]

Honestly, it sounds like your former hospital's admin is the problem, not whatever physician group is/was staffing the ED. C-suite can suffer from "grass is greener" syndrome also. Constantly reshuffling the ED's management may be their way of not dealing with the really difficult task of fixing the in-patient factors that are almost always reason for "underperforming" EDs. It's easier to fire the coach then it is to drop in-patient LOS, make the floor responsible for a patient the moment they're admitted, or smooth surgical schedules.

This. Admin doesn't understand ED and throughput. They have a leaking boat. Rather than fix the leaking boat, they put a new captain in. His wheel doesn't steer the ship, but he's told he's the captain. When that boat runs into things and sinks anyway, it's his fault.

 

[Arcan57]

This. Admin doesn't understand ED and throughput. They have a leaking boat. Rather than fix the leaking boat, they put a new captain in. His wheel doesn't steer the ship, but he's told he's the captain. When that boat runs into things and sinks anyway, it's his fault.

There's no more disheartening a moment as a director as when you realize that you're firmly middle management.

 

[Dr Mantis Toboggan]

Responsibility without power = the worst. I’ll never be an ED director again.

There's no more disheartening a moment as a director as when you realize that you're firmly middle management.

 

[The White Coat Investor]

A larger group obviously has a bigger anchor vs a 10 doctor group which would only survive in the boonies.

What makes all SDG, large or small, vulnerable is finances. The SDG have a much smaller ability to compensate for decrease in income, while the CMG has many more ways to compensate. No different than Walmart vs the mom/pop no matter how personable the mom/pop owners are. Eventually the customers will go where it is the cheapest and walmart can keep prices down much longer than any Mom/pop.

This is and will likely happen to most/all SDGs.

SDG with 100 docs doing well, making alot of $$$, everyone is happy, CS is happy b/c everything is going well and all the medical staff is happy with a well run/competent ER. Docs make 250/hr all in which is above the market where CMGs paying 225/hr all in. Can't get a job with the SDG because no one ever leaves.

Year 1 - Insurance starts to push out high deductible/copay plans and patients start to not pay them. SDG docs now make 240/hr,. still happy
Year 2 - Slowdown in economy, more uninsured/medicaid patient. SDG now makes $230/hr, still happy
Year 3 - Insurance starts to delay payments, contests Emergency Need, deny paments. SDG now makes $220/hr. Docs start to worry, still happy to be independent with similar pay as CMG.
Year 4 - CS opens a Freestanding ER or takes on a crappy Hospital contract and requests SDG to cover it without any stipend. SDG now makes $210/hr. Docs not happy. But volume has gone up and need to hire another another doc, but instead after much debate hires 2 APC which will increase the bottom line. SDG now makes $235/hr. Everyone is happy with income but now have to deal with APCs.
Year 5 - CS sees how good FSERs are for business as a feeder of inpatient admissions. They plan to build 2 more and guess who has to cover it without a stipend. SDG starts to plan for this and decrease MD hours, adds more APC hours. FSERs open up, pay overall goes down but blunted by having 1 less doc and adding 2 more APCs. Pay is now $225/hr. It is much harder to hire good docs vs the CMGs b/c the jobs are essentially the same without the admin headaches. SDG continues to keep the group together relatively easily b/c these entrenched docs love being owners. New docs can care less and just punches the timecard, and do very little Admin work. Most admin work falls on the owners.
Year 6- More headwind. Insurance headwind. Payermix headwind. More FSERs on the horizon. More Metrics to deal with. Billing becomes more expensive to run. SDG owners are all worn down and they start to consider selling out.
Year 7 - CS is tired of paying the hospitalist stipend and CMG comes in with a great proposal. CMG will run the hospitals program without a stipend and thus saving the hospital 5 mil a year. CS goes back to SDG and given their past exceptional care, gives SDG the "opportunity" to keep the ER contract if they run the hospitalist program. $5 mil is essentially the Bonus for the owners and will end up being a $25/hr paycut. The SDG is looking down at the barrel of their pay being $200/hr for Partners. How are they going to attract anyone at that rate? What do they know about running a hospitalist group?
Year 8 - Guess what happens? SDG will not run the hospitalist group and thus will either be terminated or if lucky get "bought" out to keep stability.

Yes. Walmart will eventually put you out of business

Wow. That's incredibly detailed and accurate. I think we're in 5. Done the hospitalist thing off and on. Deal with the FSER thing off and on. Seen pay drop off and on. Dealt with insurance and volume issues.

What's unique about Utah? Maybe it's just luck but we're all doing the best we can. No CMGs here yet.

The problem is to fight off CMGs you have to get bigger. And when you get to a certain size, it feels an awful lot like working for a CMG. Our group was 6 or 8 docs when it banded together with three other groups in 2002 or so. That group of 50 or 60 docs gradually picked up others and now our group is a division of 18 in a 300+ doc group across three or four states. Still an SDG? Well, kind of. But my vote doesn't go as far as it would have twenty years ago. It doesn't even go as far as it did 9 years ago when I joined the group. But we're not a CMG....yet. In fact, our more likely risk at this point is hospital employment. But if you drop our pay low enough, maybe that won't look too bad.

 

[Apollyon]

Wow. That's incredibly detailed and accurate. I think we're in 5. Done the hospitalist thing off and on. Deal with the FSER thing off and on. Seen pay drop off and on. Dealt with insurance and volume issues.

What's unique about Utah? Maybe it's just luck but we're all doing the best we can. No CMGs here yet.

The problem is to fight off CMGs you have to get bigger. And when you get to a certain size, it feels an awful lot like working for a CMG. Our group was 6 or 8 docs when it banded together with three other groups in 2002 or so. That group of 50 or 60 docs gradually picked up others and now our group is a division of 18 in a 300+ doc group across three or four states. Still an SDG? Well, kind of. But my vote doesn't go as far as it would have twenty years ago. It doesn't even go as far as it did 9 years ago when I joined the group. But we're not a CMG....yet. In fact, our more likely risk at this point is hospital employment. But if you drop our pay low enough, maybe that won't look too bad.

Come back to the Practicing Physicians forum. You WILL fit in!

 

[Backpack234]

Want to fight the CMGs? Manage your finances well for 5-10 years and get yourself to financial independence. Then you can start thinking with your heart and your brain way more than with your wallet. Create other streams of income so that you're not fully dependent on medicine. Encourage other docs you know to do the same. Also, become more active in groups like ACEP and AAEM to push the agenda more toward physician rights and away from CMGs. Then, somehow, find a way to stop graduating residents from filling the spots you didn't fill.

Problem is, The CMGs and insurance companies are starting their own medical schools because they know that an increasing supply of docs means more control for them.

 

[TooMuchResearch]

Come back to the Practicing Physicians forum. You WILL fit in!

How do I get access to that place?

 

[VA Hopeful Dr]

How do I get access to that place?

@Winged Scapula

 

[Winged Scapula]

@Winged Scapula

How do I get access to that place?

@Winged Scapula

Follow instructions here:

https://forums.studentdoctor.net/threads/request-doctor-verification.1289374/

 

[TooMuchResearch]

All I get is "You do not have permission to view this page or perform this action."

 

[Apollyon]

All I get is "You do not have permission to view this page or perform this action."

I got that, too, but wondered if it was because I was already verified. However, you confirm it!

 

[Winged Scapula]

All I get is "You do not have permission to view this page or perform this action."

Hmmm...probably because I linked the actual page and not the forum. Only those that have posted and staff can see the page.

Go to the Account Help page and follow instructions for Physician Verification

 

[TooMuchResearch]

Hmmm...probably because I linked the actual page and not the forum. Only those that have posted and staff can see the page.

Go to the Account Help page and follow instructions for Physician Verification

Thanks, I'll take a look.

 

[The White Coat Investor]

Want to fight the CMGs? Manage your finances well for 5-10 years and get yourself to financial independence. Then you can start thinking with your heart and your brain way more than with your wallet. Create other streams of income so that you're not fully dependent on medicine. Encourage other docs you know to do the same.

Check.

I think I'm already a member of the practicing physicians forum. I'll have to go by more often.

 

[Apollyon]

Check.

I think I'm already a member of the practicing physicians forum. I'll have to go by more often.

There was just a recent (2 or 3 days ago) upheaval due to coding. You may have to inquire again with @Winged Scapula .

 

[Old_Mil]

But more than that I would like to hear how EPs can push back and move toward taking back control of our practice environment.

Let’s start with a simple first step... Everyone let your ACEP membership lapse and join AAEM. Once we finally have regained control of our specialty’s Medical society, we can move forward.

Send me a message when that is done and I’ll let you know what to do next.

 

[TooMuchResearch]

Let’s start with a simple first step... Everyone let your ACEP membership lapse and join AAEM. Once we finally have regained control of our specialty’s Medical society, we can move forward.

Send me a message when that is done and I’ll let you know what to do next.

I did my part

 

[TheComebacKid]

The capitalist in me has often wondered... and just humor me for a second...

Is the answer to this problem MORE CMGs? One of the biggest issues I find with CMGs is the way that a single CMG can take over every ED in any given location, then set the wages they pay to physicians. It's an effective monopoly. Hospitals are buying their services from an Amazon.com instead of a mom and pop place (i.e. the SDG).

While I know there are a handful of big players out there in the CMG world, they tend to vary geographically with one group predominating an area.

Lets say theoretically in 20 years, every single community ED in the US will be run by a CMG. At some point, Envision and USACS will try to make a push to enter into markets that are dominated by TeamHealth, and maybe if they want to keep physicians in their group, offer to pay them more than the TeamHealth shop across the town?

I know the nuances of real life are much more complicated than this, and often times these capitalist principles don't pan out in the real world. But it's worth a thought.

 

[southerndoc]

We should be more concerned with how HR 1384 will affect our payments. Despite it's 100+ cosponsors, it is highly unlikely to pass this year. It will have a decent probability of passing when reintroduced in 3-5 years. Every 2020 Democratic presidential candidate has pledged their support of it. Health systems will be paid a general budget and not per patient treatment. So high utilizers will cost the health system. System upgrades must come out of a different budget (capital improvement budget) and not from the general budget.

If this passes, I foresee some drastic salary reductions.

 

[Dr Mantis Toboggan]

No question. Also I foresee being given a much harder time admitting people, especially readnissions (who need it because they still smoke, ignore their fluid restrictions, don’t take their medications etc).

I think we have a decade before the bottom starts falling out, but it could be less.

We should be more concerned with how HR 1384 will affect our payments. Despite it's 100+ cosponsors, it is highly unlikely to pass this year. It will have a decent probability of passing when reintroduced in 3-5 years. Every 2020 Democratic presidential candidate has pledged their support of it. Health systems will be paid a general budget and not per patient treatment. So high utilizers will cost the health system. System upgrades must come out of a different budget (capital improvement budget) and not from the general budget.

If this passes, I foresee some drastic salary reductions.

 

[TooMuchResearch]

Hmm, I'll have to read into this, but it sounds like I won't be cutting back my hours any time soon. Work for more now so I don't have to work for less later.

 

[BoardingDoc]

We should be more concerned with how HR 1384 will affect our payments. Despite it's 100+ cosponsors, it is highly unlikely to pass this year. It will have a decent probability of passing when reintroduced in 3-5 years. Every 2020 Democratic presidential candidate has pledged their support of it. Health systems will be paid a general budget and not per patient treatment. So high utilizers will cost the health system. System upgrades must come out of a different budget (capital improvement budget) and not from the general budget.

If this passes, I foresee some drastic salary reductions.

Concierge medicine, here I come.

 

[ski89]

We should be more concerned with how HR 1384 will affect our payments. Despite it's 100+ cosponsors, it is highly unlikely to pass this year. It will have a decent probability of passing when reintroduced in 3-5 years. Every 2020 Democratic presidential candidate has pledged their support of it. Health systems will be paid a general budget and not per patient treatment. So high utilizers will cost the health system. System upgrades must come out of a different budget (capital improvement budget) and not from the general budget.

If this passes, I foresee some drastic salary reductions.

I wonder though if such a drastic cut in physician reimbursement might lead to increased retirement of those late into their careers leading to increased scarcity of physicians. More scarcity would result in strong bargaining power to keep reimbursement from falling too far. In addition, one would hope that a nationalized system might come with lower malpractice costs as you see now for those working for the VA. Lastly one would hope that if such drastic change physician salaries did occur that it might also come with loan forgiveness for those of us early in our careers with a high debt burden.. maybe this is all wishful thinking but just trying to be optimistic.. will certainly be interesting to see how far left the dems go in 2020. It may blow up in their face.

 

[southerndoc]

I wonder though if such a drastic cut in physician reimbursement might lead to increased retirement of those late into their careers leading to increased scarcity of physicians. More scarcity would result in strong bargaining power to keep reimbursement from falling too far. In addition, one would hope that a nationalized system might come with lower malpractice costs as you see now for those working for the VA. Lastly one would hope that if such drastic change physician salaries did occur that it might also come with loan forgiveness for those of us early in our careers with a high debt burden.. maybe this is all wishful thinking but just trying to be optimistic.. will certainly be interesting to see how far left the dems go in 2020. It may blow up in their face.

Yes, you are correct and this is another byproduct of a single payer system that I did not mention. Attrition will increase with more retirements and frustrated docs leaving practice, but there are a ton of DNP's just waiting to move in. Overall cost to provide care will be reduced as non-physician doctors will charge less.

Doubt you will see loan forgiveness. That requires increased tax revenue to pay for. Afraid you'll be on your own.

Call me a conspiracy theorist... or come back here in 10 years and you might be saying I had it predicted correctly.

 

[Vandalia]

Y but there are a ton of DNP's just waiting to move in. Overall cost to provide care will be reduced as non-physician doctors will charge less.

I strongly disagree with this. If I can make a diagnosis and charge $150 with no imaging or testing, and a NP/PA charges $100 but needs $1500 in testing to make the same diagnosis, who is charging less? The current payment/insurance structure rewards midlevels since they test more, making the hospital more. Knowledge and skill are not rewarded, in fact they are a negative.

On the other hand, in the scenario where a fixed amount of money is provided for care, physicians are rewarded since they are far cheaper, when everything is added up. This is dated, but when I was in the UK with the USAF, I don't remember any mid-levels in the NHS.

 

[TooMuchResearch]

I wonder though if such a drastic cut in physician reimbursement might lead to increased retirement of those late into their careers leading to increased scarcity of physicians. More scarcity would result in strong bargaining power to keep reimbursement from falling too far. In addition, one would hope that a nationalized system might come with lower malpractice costs as you see now for those working for the VA. Lastly one would hope that if such drastic change physician salaries did occur that it might also come with loan forgiveness for those of us early in our careers with a high debt burden.. maybe this is all wishful thinking but just trying to be optimistic.. will certainly be interesting to see how far left the dems go in 2020. It may blow up in their face.

Nah, increasing physician scarcity just gives the gov't the last push to replace us with NPs.

 

[ski89]

Yes, you are correct and this is another byproduct of a single payer system that I did not mention. Attrition will increase with more retirements and frustrated docs leaving practice, but there are a ton of DNP's just waiting to move in. Overall cost to provide care will be reduced as non-physician doctors will charge less.

Doubt you will see loan forgiveness. That requires increased tax revenue to pay for. Afraid you'll be on your own.

Call me a conspiracy theorist... or come back here in 10 years and you might be saying I had it predicted correctly.

Oh I don’t think you’re a conspiracy theorist. You may well be right. To your first point I agree that DNP creep is relevant to this discussion and is of equal concern. And as far as loan forgiveness, my point was not that this would come along with a Medicare for all plan, but that any candidate that supports Medicare for all would also support a loan forgiveness program, Bernie being a prime example. Now whether or not such a forgiveness program would cover graduate loans is another story..

 

[Birdstrike]

The biggest stand you can take against CMGs is to not work for them. Do you have what it takes?

 

[GonnaBeADoc2222]

The biggest stand you can take against CMGs is to not work for them. Do you have what it takes?

Nope. Cause where I live currently the local community/academic shop wants 250 more hours a year out of me for $30k less money, and one of the local "small groups" is even worse. Much better for me to travel for a CMG, choose my schedule, work less, and make more money.

 

[TooMuchResearch]

The biggest stand you can take against CMGs is to not work for them. Do you have what it takes?

I think we'll avoid takeover at least long enough to recoup the non-partner pay cut and come out ahead, though hopefully much much longer. The job is good and largely controlling the job, within the confines of what the hospitals will allow, is great.

Edit: I'm a SDG employee.

 

[Birdstrike]

Nope. Cause where I live currently the local community/academic shop wants 250 more hours a year out of me for $30k less money, and one of the local "small groups" is even worse. Much better for me to travel for a CMG, choose my schedule, work less, and make more money.

In your case the CMG is offering a better deal and therefore there's no reason to "take on" the CMGs. Perhaps there's a reason CMGs are so successful?

 

[gro2001]

Yes, you are correct and this is another byproduct of a single payer system that I did not mention. Attrition will increase with more retirements and frustrated docs leaving practice, but there are a ton of DNP's just waiting to move in. Overall cost to provide care will be reduced as non-physician doctors will charge less.

Doubt you will see loan forgiveness. That requires increased tax revenue to pay for. Afraid you'll be on your own.

Call me a conspiracy theorist... or come back here in 10 years and you might be saying I had it predicted correctly.

When you put it that way, it seems to make sense, but when you look at other countries with single payer, it's not like they are flooded with midlevel providers. Quite the opposite.

 

[gro2001]

Let’s start with a simple first step... Everyone let your ACEP membership lapse and join AAEM. Once we finally have regained control of our specialty’s Medical society, we can move forward.

Send me a message when that is done and I’ll let you know what to do next.

This thread has inspired me to let go of ACEP. Membership was expiring yesterday and I did not renew. Will join AAEM when my new CME budget rolls around. So what's next?

 

[Old_Mil]

The capitalist in me has often wondered... and just humor me for a second...

Is the answer to this problem MORE CMGs? One of the biggest issues I find with CMGs is the way that a single CMG can take over every ED in any given location, then set the wages they pay to physicians. It's an effective monopoly. Hospitals are buying their services from an Amazon.com instead of a mom and pop place (i.e. the SDG).

While I know there are a handful of big players out there in the CMG world, they tend to vary geographically with one group predominating an area.

Lets say theoretically in 20 years, every single community ED in the US will be run by a CMG. At some point, Envision and USACS will try to make a push to enter into markets that are dominated by TeamHealth, and maybe if they want to keep physicians in their group, offer to pay them more than the TeamHealth shop across the town?

I know the nuances of real life are much more complicated than this, and often times these capitalist principles don't pan out in the real world. But it's worth a thought.

I'm no socialist, but I really do wonder how compatible with providing health care capitalism is. In the end, capitalism is about providing a good or service for a profit. Increasingly, it has become about trying to wring out every cent of profit on every transaction. Government run health care is no better than a for profit model because in the end, every agency looks at its budget similarly to how a corporation would and attempt to keep the maximum amount of dollars in house for care and feeding of the bureaucracy.

In contrast, the charitable motive (at least in theory) should be about advancing a cause. In such a model, charitable care is much more compatible with advancing the cause of patient health and wellness than a for-profit model. But if you take away the profit motive entirely, then innovation stops which is why East Germans were driving Trabants in the 80s and West Germans were driving Mercedes and BMWs.

 

[Old_Mil]

This thread has inspired me to let go of ACEP. Membership was expiring yesterday and I did not renew. Will join AAEM when my new CME budget rolls around. So what's next?

Glad to hear it. The problem with ACEP is that it dilutes the voice of EPs and patients by giving corporate medicine and midlevels a seat at the table. Joining AAEM is a good step, but what you've done is the key - cancel or let your ACEP membership lapse. If we don't silence, or at least turn down the volume of the voices in our own specialty who are working against our interests there won't be a future. So yes, I'm quite a bit more militant on this issue than probably even AAEM's founders. Co-existence is no longer a possibility.

ACEPs typical response - we lobby for you - is a nonstarter. Our largest specialty group will by default become our lobbying agency. It's the adminsitrative structure and voice of ACEP that stands at cross purposes to pit docs that must be ended.

Think like a Teamster today.