9 minute read
So It Begins…
Robert Frolichstein, MD FAAEM
Allow me to introduce myself. I was born and raised in St. Louis, MO and remain a lifelong St. Louis Cardinals fan. Please don’t stop reading if you are a misguided Cubs or Yankees fan. I attended college at Southern Illinois University-Edwardsville, a small school near St. Louis. I went there to play baseball and study wildlife biology because I loved baseball, hunting, and fishing.
I left college with four important foundations that have helped form the rest of my life. A relationship with a young lady who is my wonderful wife of 32 years and mother of the four best kids in the world. A realization that I should allow God to shape my life. An acceptance to medical school. The sense that I loved being part of a team.
The Army put me through medical school at the University of Missouri-Columbia and trained me as an emergency physician at Brooke Army Medical Center. The Army also solidified my understanding that it is personally satisfying to be part of something that is bigger than the sum of its parts.
After leaving the Army I joined Greater San Antonio Emergency Physicians. I found another team to join! As I became more involved in the organization of my group and the medical staff leadership of the hospitals, I learned that physicians need to take an active role in shaping the policies and processes of the hospitals and groups in which they work. If physicians don’t act in their own best interests, and those of their patients, then we all know what happens. Someone else who doesn’t care about either physician or patient will make the policies and shape the culture.
I have been a member of AAEM since the late 1990s after my residency was fortunate enough to have Dr. Bob McNamara come to speak to us. It was soon after “The Rape of Emergency Medicine” was published. If you have not read the book, do so. It details the evolution of staffing companies by “suits” who owned contracts and filled the schedule however they could. Sometimes using physicians of questionable quality and ethical standards all with the goal of making money rather than actually caring for patients. I remember being appalled at the situation described in the book and thankful that AAEM was watching my back. It still is.
Mistakenly, I did not get involved in The Academy until many years later when my group needed their help. Help they did and in an attempt to repay a debt I felt, I became involved. I am a relationship driven person and the relationships I developed in those early days with Mark Reiter, Kevin Rogers, Bob McNamara, and others helped me become more involved. One thing led to another and here I am—President of AAEM. I never set this position as a personal goal. I just looked for ways I could help. I am humbled and thankful that I was chosen to be the President.
Many have asked what are you going to do during your term? What is your goal? I guess the short answer is that it is not about me and what I want to do. It is about what AAEM should do. Specifically, about what you, as members, believe we should do. My job is only to lead those efforts. I do have some thoughts on what I feel The Academy should focus upon in the near future.
AAEM holds itself to be the champion of the individual emergency physician. In my experience and from what I see, emergency physicians are struggling. We need a champion. This is a tough job and being made tougher for myriad reasons. There are clinical reasons our job is difficult—increasing complexity of disease, an aging population, and more diagnostic and therapeutic tools available to us make each patient more complex than a dozen years ago. Emergency physicians are okay with that. We like that. We trained for that.
However, there are other non-clinical challenges that make our jobs hard. Patient crowding, boarding, decreased reimbursement, metrics, and increased supervision of non-physician practitioners are some of the many other struggles we face each and every day. At the root of all those non-clinical issues is the corruption of the patient physician relationship by others to achieve their goals. Their goals, whether it be the hospital or the owners of the group that employs you, are not necessarily aligned with the goals of the patient physician relationship. How can AAEM be the champion of the emergency physician?
AAEM is actively exploring what an AAEM union looks like and how this might help physicians to improve the conditions under which they are compelled to care for their patients. I have been part of a task force developed to explore the idea of an AAEM union and we have had many intriguing conversations over the last several months. We have talked with Dr. Michelle Weiner, the Union President in Detroit that united the physicians at her shop in attempts to improve their situation. Can that be replicated in other areas? Can AAEM make that happen? Will it have a beneficial effect on our practice? These and others are questions that The Academy will continue to explore over the coming months. Unions tend to be a bit controversial in this country. Any tool used unwisely can create harm and unintended consequences. This can certainly be said about unions. However, it is hard to deny that they have helped oppressed workers in many areas. My sense is that many if not most emergency physician are feeling oppressed. Strikes are not the only action unions can take to help their members. It will be exciting to see how this all unfolds. Stay tuned.
The Academy is well situated to help physicians to capitalize on the growing interest in the harmful effects of private equity investment in aspects of our healthcare delivery system. AAEM has long stated that lay ownership has no business in the running of emergency physician groups. Groups have a fiduciary duty to do what is in the best interest of their owners. They are obliged to do this. Just like you and I are obliged to put the patients’ best interest first. Those that utilize private equity investment (PE) as a financial tool immediately accept that their fiduciary duty now lies with that PE firm. Doesn’t it make sense that the best model would be that the owners of the group are actually the physicians who work for the group? Or at least that the contract owners and managers believe that their primary duty is to the physicians they employ.
Thankfully, others are starting to hear the drum that we have been beating for decades. The FTC had a workshop exploring the ramifications of PE investment in our healthcare system. Featured prominently was our very own Immediate Past President, Dr. Jonathan Jones, who spoke powerfully of the impacts of PE that he has seen on his practice. Senator Peter’s office has launched an investigation of the impact of PE in healthcare and their office had discussions with me and several other key Academy leaders. We then asked our members to contact the Senator’s office. Reportedly they spoke to over forty physicians about the negative impact PE has on our practice and patient lives. AAEM needs to keep this conversation going at a national level. Frankly, most decision makers don’t care much about what AAEM says about this. They will care what the FTC says or a Senate report says. We will continue to have these conversations and generate further discussion on this topic.
I think that this is where we should focus our efforts over the next several months. Ultimately, I will lead The Academy in the direction it wants and needs to go. That is my job. I feel I work for each member of AAEM. Y’all (that is proper English in Texas) do the work of this organization. I think when you join AAEM it ought to be a decision you make not because AAEM can do something for you but rather you can do something to make AAEM better. I plan on trying to involve as many of you as possible in the work of The Academy over the next couple of years. Don’t wait for me to call you though. Reach out to me. I want to hear and understand your expertise, interests, and passions. Together we will figure out how to channel those into something beneficial for AAEM. I look forward to serving you for the next two years and again, I thank you for trusting me to lead this fantastic organization made fantastic by each of you.I think that this is where we should focus our efforts over the next several months. Ultimately, I will lead The Academy in the direction it wants and needs to go. That is my job. I feel I work for each member of AAEM. Y’all (that is proper English in Texas) do the work of this organization. I think when you join AAEM it ought to be a decision you make not because AAEM can do something for you but rather you can do something to make AAEM better. I plan on trying to involve as many of you as possible in the work of The Academy over the next couple of years. Don’t wait for me to call you though. Reach out to me. I want to hear and understand your expertise, interests, and passions. Together we will figure out how to channel those into something beneficial for AAEM. I look forward to serving you for the next two years and again, I thank you for trusting me to lead this fantastic organization made fantastic by each of you.
