Why I continue to support ACEP

[Hercules]

I’m posting this to offer the counter argument to all of the anti-ACEP viewpoints. I think many here see the ACEP vs AAEM argument as a binary one on which you should only support one. I’ll go ahead and spoil the ending by saying that view strikes me as somewhere between oversimplification and naivety.

Disclaimers: I’m the president of a very high functioning SDG, so obviously I’m going to be against a lot of the pro-CMG stances that ACEP supports and in favor of AAEM’s pro SDG stances. I am also the state president of ACEP in Alabama, so in theory I should be pro-ACEP and anti-AAEM.

For me, and I think anyone who thinks all of the issues through to their conclusion, there is both room and a need for both organizations.

I love that AAEM speaks out on issues that are important to many of us who are in the trenches as well as those of us running SDG’s. I think it makes for good PR and makes us feel better about issues often. I think they provide valuable resources to help out the individual and the group of EM docs looking to start/maintain an SDG. So I support them in this. I feel ACEP fails to accomplish those things. Unfortunately though it seems apparent to me that AAEM lacks the clout, power/money, and network to accomplish certain important goals.

Having been involved in ACEP for the past 12 years, I feel like I may have a better handle on all of the things that they do for us. Do they pick the large CMGs over the individual EM doc on several issues? I think so. Do they lobby and support causes that are pivotal to both the large CMGs and the SDGs/individual? Unquestionably yes. To claim otherwise would display ignorance. The most obvious category for this is going to be financial both in the form of surprise balance billing as well as through the RUC process. We have discussed balance billing on here before, and I can tell you that ACEP has had this on the radar and been working on this for years already. As far as the RUC process, if you don’t know how the RUC affects CMS as well as private insurance reimbursement, please take a second to read this article:

ACEP4U: How ACEP Works Behind the Scenes to Ensure Appropriate Medicare Reimbursement - ACEP Now

ACEP Now offers real-time clinical news, news from the American College of Emergency Physicians, and news on practice trends and health care reform for the emergency medicine physician. ACEP Now is an official publication of the American College of Emergency Physicians.

www.acepnow.com

Here’s the key quote:

“ACEP is the only emergency medicine organization with a seat at the RUC table.”

So AAEM has no ability to influence this process which ultimately determines much of the reimbursement in our field. Now you can argue that AAEM should get a place at the table, but “should” doesn’t do a whole lot for me/you or my/your paycheck.

I know my opinion goes counter to many on here, so I thought I would go ahead and put my reasoning in one post instead of commenting each time it comes up. I will continue to support both ACEP and AAEM because I feel they each are uniquely situated to accomplish different sets of goals that are both extremely important to me as an EM physician in an SDG.

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[TooMuchResearch]

Hmm. I generally respect your opinion, and this post provides a lot of ammo, so to speak, as well as your credentials. As much as I dislike their CMG ways, you have convinced me of my short sightedness, and I will rejoin and donate to the PAC.

 

[TooMuchResearch]

Looks like I've got a bunch of CME money left to burn this year (despite replacing some "work" electronic devices).

 

[DeadCactus]

My belief has always been that you join ACEP to protect you from the government and insurance companies. You join AAEM to protect you from ACEP. These aren't competing agencies. We should be a member of both, make our opinions known to both, and support both financially.

 

[gamerEMdoc]

I'm support both organizations. Yes, ACEP isn't doing anything to protect EM from CMGs. But they do a ton to protect us from the government both on a national and state level. Both organizations have their merits.

 

[deleted859535]

Agree with "both" philosophy for all the same reasons above, member of both, fellow of both.

 

[Groove]

Agree with "both" philosophy for all the same reasons above, member of both, fellow of both.

Ditto.

 

[Backpack234]

You make a good argument to support ACEP, but also a great argument to build more support for AAEM. ACEP is the traditionally larger player, which is why they have more clout. I wonder what AAEM would accomplish if they were able to network and build that as well?

I can't comment too much since I don't know the specifics of each organization, but I have a question. Are the benefits to SDGs and individual docs a main goal of ACEP or simply an external benefit/side benefit of their efforts to grow CMGs?

 

[deleted436726]

EM attending I worked with recently: "The only reason I give money to ACEP is because I get to put FACEP after my name"

 

[thegenius]

What does FACEP really confer? Non-medical people don't know what it means. And most medical people don't know what it means besides having another acronym after your name. Like your part of a special society

John Doe MD, FACEP, FDEMAP, EDMAP, CEPCPE, FAGNG, FUPUP, BURBR, BUBSUSBS, SUP, WHASUP, FUDYDUDY

 

[TooMuchResearch]

I interpreted it as Eff ACEP.

What does FACEP really get to confer? Non-medical people don't know what it means. And most medical people don't know what it means besides having another acronym after your name. Like your part of a special society

John Doe MD, FACEP, FDEMAP, EDMAP, CEPCPE, FAGNG, FUPUP, BURBR, BUBSUSBS, SUP, WHASUP, FUDYDUDY

 

[EctopicFetus]

Ditto.

Also ditto but ACEP to me is like swallowing medicine as a kid. You don’t like it but you know you need to and should.

 

[Birdstrike]

Whether or not you support, meaning "give money to," your specialty medical society comes down to whether or not you think the group on question benefits you. If you don't feel any given group serves your needs, you'd be a fool to give them money. If you feel a group does support your needs, you'd be a fool not to.

 

[thegenius]

Whether or not you support, meaning "give money to," your specialty medical society comes down to whether or not you think the group on question benefits you. If you don't feel any given group serves your needs, you'd be a fool to give them money. If you feel a group does support your needs, you'd be a fool not to.

Problem is I don’t know if the group (ACEP, AAEM) benefits me. Do they have an accomplishments page?

 

[Birdstrike]

Problem is I don’t know if the group (ACEP, AAEM) benefits me. Do they have an accomplishments page?

I don’t know if they have accomplishments pages, but they should. You’re right, in that sometimes it’s hard to tell who a given organization actually serves.

 

[GeneralVeers]

I don’t know if they have accomplishments pages, but they should. You’re right, in that sometimes it’s hard to tell who a given organization actually serves.

The problem with that is they would list their accomplishments, but omit the things they do which represent the CMGs. It would be great to have a 3rd party publish all of the initiatives they have spearheaded, and we can decide whether or not they are helping or hurting us.

 

[RuralEDDoc]

I don’t get the “ACEP promotes CMGs” argument. ACEP, like essentially all specialty societies, is neutral on the business practices of EPs. Just like ACOG doesn’t tell OBGYNs how to run groups or structure practice, ACEP doesn’t tell EPs how to structure their group or whether or not to accept employment, join a CMG, etc. The argument that ACEP supports CMGs over other practice environments doesn’t hold up to scrutiny.
The ACEP board composition changes every year, but recent history has less then half of board members working for CMGs.
Join ACEP. Support the specialty society that has Congress’ ear on reimbursement and many other issues you care about. Also support AAEM if you wish. But don’t freeload on the work of thousands of other Emergency Physicians in support of the specialty and then complain about how its done, that doesn’t help anybody.

 

[TooMuchResearch]

I don't see ACEP as neutral on the issue.

I don’t get the “ACEP promotes CMGs” argument. ACEP, like essentially all specialty societies, is neutral on the business practices of EPs. Just like ACOG doesn’t tell OBGYNs how to run groups or structure practice, ACEP doesn’t tell EPs how to structure their group or whether or not to accept employment, join a CMG, etc. The argument that ACEP supports CMGs over other practice environments doesn’t hold up to scrutiny.
The ACEP board composition changes every year, but recent history has less then half of board members working for CMGs.
Join ACEP. Support the specialty society that has Congress’ ear on reimbursement and many other issues you care about. Also support AAEM if you wish. But don’t freeload on the work of thousands of other Emergency Physicians in support of the specialty and then complain about how its done, that doesn’t help anybody.

 

[GeneralVeers]

I don't see ACEP as neutral on the issue.

Agreed. One only has to look at the list of "Diamond Sponsors" of the ACEP SA. You can't tell me that these groups like USACS, Envision, and Teamhealth contribute millions of dollars but have no influence over policy. They aren't stupid and wouldn't waste that much money if it didn't benefit their business to do so.

 

[Birdstrike]

Agreed. One only has to look at the list of "Diamond Sponsors" of the ACEP SA. You can't tell me that these groups like USACS, Envision, and Teamhealth contribute millions of dollars but have no influence over policy. They aren't stupid and wouldn't waste that much money if it didn't benefit their business to do so.

I never felt like ACEP represented me, but instead the people making working conditions intolerable, such as hospital administrators, corporate mega-groups, and government bureaucrats. Follow the money, and there you are, right at the doorstep of those groups. For this reason I stopped paying attention, and dues, to ACEP very early in my EM career.

Surgical and procedural subspecialty societies on the other hand, seem to do a much better job of aggressively supporting their doctors, mainly through laser-focused attention towards lobbying for reimbursement.

 

[RuralEDDoc]

For this reason I stopped paying attention, and dues, to ACEP very early in my EM career.

And that’s the problem - now you (and all other EPs with the same attitude) have no idea that ACEP is just as laser focused on maintaining reimbursement as other specialties. Why would they leave money on the table, what CMG would that benefit?
The CMGs are staffing companies. CMGs advertise through ACEP for a reason, and not because they are buying off the leadership of the organization. USACS doesn’t advertise on your local radio station because that would be a waste of money. But huge booths at ACEP and all the print media? That’s exactly the audience they want to reach (***I also despise USACS and wouldn’t work for them unless I had no other option).
This specialty is currently in the fight of the decade if not century for fair reimbursement The anti-ACEP bias on this forum and on EM Docs hurts the specialty, weakens our bargaining power, and will take food from us and our families for decades to come.

 

[GeneralVeers]

And that’s the problem - now you (and all other EPs with the same attitude) have no idea that ACEP is just as laser focused on maintaining reimbursement as other specialties. Why would they leave money on the table, what CMG would that benefit?
The CMGs are staffing companies. CMGs advertise through ACEP for a reason, and not because they are buying off the leadership of the organization. USACS doesn’t advertise on your local radio station because that would be a waste of money. But huge booths at ACEP and all the print media? That’s exactly the audience they want to reach (***I also despise USACS and wouldn’t work for them unless I had no other option).
This specialty is currently in the fight of the decade if not century for fair reimbursement The anti-ACEP bias on this forum and on EM Docs hurts the specialty, weakens our bargaining power, and will take food from us and our families for decades to come.

ACEP and the CMGS want to maintain reimbursement.....and keep it for themselves. They are for profit companies whose goal is to pay doctors as little as possible and make as much profit as possible for non-physician owners and administrators. I would support them if they were committed to keeping physician salary at least stable, but we know Envision, TeamHealth and USACS all want to expand residencies, and drive physician costs down.

 

[Birdstrike]

And that’s the problem - now you (and all other EPs with the same attitude) have no idea that ACEP is just as laser focused on maintaining reimbursement as other specialties. Why would they leave money on the table, what CMG would that benefit?
The CMGs are staffing companies. CMGs advertise through ACEP for a reason, and not because they are buying off the leadership of the organization. USACS doesn’t advertise on your local radio station because that would be a waste of money. But huge booths at ACEP and all the print media? That’s exactly the audience they want to reach (***I also despise USACS and wouldn’t work for them unless I had no other option).
This specialty is currently in the fight of the decade if not century for fair reimbursement The anti-ACEP bias on this forum and on EM Docs hurts the specialty, weakens our bargaining power, and will take food from us and our families for decades to come.

You post did a great job of convincing me that ACEP does a terrible job of persuasion. If a large portion of their members or potential members think they represent interests other than their own, don't you think it's incumbent upon them to persuade them otherwise?

These techniques are not secret. Persuasion are the bread and butter of sales and marketing. For ACEP to blame the people who have lost faith in ACEP is perhaps the worst way of persuading them back. It's my impression that most EPs feel ACEP serves CMGs and hospital administrators as opposed to their personal professional interests (reimbursement) and practice quality (job satisfaction). Yet how many times do you mention those?

Job satisfaction: 0
Reimbursement: 2

Yet how many times did you mention CMGs?

Five times ( CMG x3, USACS x 2)

Correct me if I'm wrong, but those ratios seem about right for ACEP. 5 parts CMGs needs, 2 parts reimbursement and 0 parts job satisfaction.

That's EM leadership in a nutshell.

How about ACEP first address it's marketing and persuasion crisis and win the hearts and minds of EPs back, rather than wearing the blindfold as more and more get pulled into the burnout grinder?

It's not that hard. Read some books on persuasion. Hire some marketing and sales experts. Take some surveys of EM docs and find out what they really care about, instead of the 4 hundred millionth survey to a patient to find out if waiting an extra two minutes for their non-emergency will leave them with a deficit of warm and fuzzy feels. Start talking to individual EM docs about what's important to them, as opposed to telling them, "Sorry, it has to be that way, because what's important to MBAs is everything and what makes your life better is s**t. Comprende?

Then, how about we reverse those ratios and have ACEP make 5 positive accomplishments for improving EP job satisfaction, for every two measures to improve reimbursement and 0 real accomplishments to benefit already bloated and caressed CMGs? How about putting CMGs needs on the back burner for awhile and give them the meaningless lip service and empty platitudes EPs have been given for years. Then start fighting for what will improve EP job satisfaction and career longevity for once, not what those in the CMG board rooms want. Increasing reimbursement a half percent and another idealistic “guideline” that ignores the pressures and constraints we’re under in the real world, isn’t enough. Make Emergency Physicians work lives better. Period.

Maybe if they do this, they can improve job satisfaction for EPs. Because reimbursement will only get you so far, if you hate your job and spend more time thinking about exit plans than how fortunate you are.

If they do these things, they won't get me back in an ED, but they might make life better for those working in EDs in the future so they don't have to dream about other different careers and other hemispheres.

 

[RuralEDDoc]

I respect your opinion and hope ACEP leadership reads your post as it addresses the heart of the perception problem (ACEP leaders do read this forum, BTW).
In my own little court of opinion, I’ll apportion much of the blame for ACEPs reputation problem on ACEP. But I also have to respectfully blame the haters on this forum and others who incessantly trash ACEP - this poisons the mind of medical students and residents who enter the specialty with an anti-ACEP bias without giving the organization a chance. Many people have no idea that ACEP:
Publishes clinical guidelines to make our practice easier and more defensible
Supports research and articles on the dangers of hospital boarding, psychiatric boarding, and the problem of tying patient satisfaction to physician reimbursement
Actively promotes legislation on the state level to deal with the psych boarding crisis
Fights insurance companies (privately, publicly, and in the courts) as they try to screw physicians out of fair reimbursement
I could go on and on.
I would encourage anyone who has read this far to go to ACEPs website and take a look around. You’ll likely be surprised with the breadth of issues that the organization has addressed or is actively addressing.

 

[GeneralVeers]

ACEP has failed to address the things that are important to me. Fighting the government and insurers to maintain our ability to bill and collect money is a given and has to be an integral part of any organization.

In my view they have failed to even take a stand on a host of issues that are critical for us:

1. Lack of education for residents about the business of EM. How many ACEP SA courses talk about salaries, $/pts, and what you should expect to get as an EP? Absolutely none, because I would have attended them.

2. Failure to call out CMG's bait and switch tactics they use to trick new residents. Companies should not be allowed to claim "physician ownership" unless there are real, tangible shares in a company.

3. Complete silence on the proliferation of sub-par residencies, and the destruction of our future earnings by over-supply

4. Management of CMGs by private equity firms and non-medical people as a threat to EPs directly

5. Not fighting the term "provider" as it relates to our specialty. I didn't go to "Provider School".

6. Not demanding that ALL groups and companies that employ EPs be required to provide monthly data on how much was billed, and collected in each physician's name.

 

[deuist]

7. Failure to push through meaningful medical malpractice reform.
8. Inability to get it's CMG bosses to stop requiring merit badges such as BLS, ATLS, etc.
9. Failure to stop the insanity regarding documentation for billing purposes.
10. Unwillingness to push against screening creep in the emergency department: domestic violence screening, hypertension screening, HIV screening, etc.

 

[Fox800]

1.-100. The rising tide of MLPs in emergency medicine, replacing physician positions for CMG profit.

 

[GeneralVeers]

1.-100. The rising tide of MLPs in emergency medicine, replacing physician positions for CMG profit.

I somewhat disagree. More midlevels have meant an almost doubling of my salary in the past 10 years.