AAEM NEWS FROM THE EDITOR’S DESK
The Rape of Emergency Medicine Andy Mayer, MD FAAEM — Editor, Common Sense
The morals and lessons from Keaney’s book sound as true to me today as they did almost thirty years ago when I first read it.
I would like to propose a challenge to each
of you and it is to read a book. Have you ever read Jim Keaney’s “The Rape of Emergency Medicine?” If so, how long ago? Maybe now is the time to read it for the first time or to reread what to many was the call to arms for action when the Academy was founded. It was initially released in 1992 anonymously by “The Phoenix.” At the time, there was a significant danger of losing your job for speaking out for many of the issues which led to the founding of the American Academy of Emergency Medicine (AAEM). Many of you might consider it ancient history but the themes are relevant today. The book is available for free on the AAEM website to read online or download. It is a quick read and will not take much time. Read “The Rape of Emergency Medicine” here: https://www.aaem.org/about-us/our-values/history The characters and business practices portrayed in the book may seem humorous and on a superficial analysis only relate to controversies of the past. The book decries the rise of the corporate practice of emergency medicine and the attempt to destroy the independent practice of our specialty. The rise of the “suits” from kitchen schedulers to the goliath corporate management groups is portrayed by some memorable characters. The exploitation of the “scrubs” by these nonpracticing physicians and their relation to the early leadership of organized emergency medicine is a topic which each of you needs to know about, understand, and reflect upon. Please consider that these issues are not things of the past. They are not historical curiosities to be relegated to the dustbin. The suits have in many cases sold out for untold millions of dollars to private equity corporations. These corporations are often publically traded for-profit multibillion dollar corporations as opposed to the kitchen scheduler of old. This makes them more and not less dangerous to our profession. These corporations control the careers of thousands of emergency physicians and it is hard to believe that their motivation is anything but the bottom line and the return on investment to their shareholders. Improvements have been made by the organizations who are supposed to represent and protect each of us and our specialty. Hard lessons have been learned and some of the situations described in the book have been at least partially corrected. Some battles have been hard fought and won and others have been lost. Sadly, our profession contains a large number of “scrubs” who have become the automatons which some of the characters portrayed in the book. These clinicians do not concern themselves with the “business” of emergency medicine and continue
These clinicians do not concern themselves with the “business” of emergency medicine and continue to sign the non-compete clauses humorously described in the book. They surrender their due process rights and continue not knowing what is billed and collected in their name.
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COMMON SENSE NOVEMBER/DECEMBER 2020
VS to sign the non-compete clauses humorously described in the book. They surrender their due process rights and continue not knowing what is billed and collected in their name. Maybe you say that it does not matter and that the suits have won and that there is no point in struggling against the system. Maybe you will doggedly work with blinders on while striving to meet whatever metric is thrown in front of you. Your only ambition may be able to ignore the rest and complete your career by checking off the shifts on each schedule. However, maybe now in the time of COVID you may rekindle the spirit and be spurred into action or at least interest. The morals and lessons from Keaney’s book sound as true to me today as they did almost thirty years ago when I first read it. At that time, I was working part-time at an EmCare facility and I felt exploited and was outraged. Consider the irony of AAEM’s long fight for the value of board certification in emergency medicine. The Academy fought long and hard and made this the core issue for our organization. The numbers of board certified emergency physicians are growing and more and more of our emergency departments are becoming staffed with all board certified emergency physicians. That sounds great but new obstacles have arisen which also threaten our future. There had always been a presumed logic that there were not enough board certified emergency physicians to staff all of our nations emergency
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