Monday, January 05, 2009

Dada! Look at the Big Poop I Made!

Well I just love ACEP. ACEP is the American College of Emergency Physicians and they sit around and scratch their collective chins and wonder why those of us who work in non-academic institutions are so shitty. Here is an article which summarizes a 'report card' in which we get a 'D-'. I smell a set up for a bail out!

They even come up with some suggestions about how to fix our problems. Thank goodness.

My feelings about ACEP are detailed elsewhere but here's some refreshers. ACEP is the organization that has stood by and watched as EMTALA wrecked our health care system. They have never drawn a line in the sand, they have never pointed out that the inevitable consequences of EMTALA are the very problems detailed in the report.

It must be very heady to live in an ivory tower and speak in theoretical terms about the way things should be, here's the way things are...

1. Americans have come to expect their health care to be 'free' and EMTALA has made this possible.

2. Since you can 'always go to the ER', that's exactly what has happened, and ACEP has noticed that we are awash in uninsured patients who use us for primary care.

3. I have no idea what the Access to Emergency Services Act is, but unless it is a piece of legislation that puts at least a modicum of responsibility on patients to care for themselves and to find a way to either purchase medical insurance or contribute to the cost of their care it will be a disaster akin to EMTALA.

4. ACEP has made wonderful decisions in the past like getting television personalities to speak at their national convention and instituting the LLSA exam which requires us to pay them to take tests every year to make sure we are up to snuff on the latest bit of wisdom from the academy (like how the prevalence of rabies has changed in sub-Saharan Africa and how we can force our sub specialist colleagues to work for free).

5. ACEP, at every opportunity, has said 'how high' when the government has asked them to jump, and they lament that physicians are refusing now to give away their services and to weather malpractice climates in which the question is not whether one will be sued or not, but rather how many times.

6. ACEP has jealously guarded our specialty from other physicians who wish to become board certified but have not gone the traditional route. Let's be honest, a good family practitioner or internist can learn the critical skills needed to work in an ER in a year, and that's probably too much (if they train in a busy trauma center). And now, WOW! we don't have enough EM physicians. Three on this blog alone have quit full time ER work early in their careers due to the circumstances extant in the practice of Emergency Medicine that an organization such as ACEP could have averted had they even the germ cells of gonads in their collective body.

See you later ACEP. Thanks for nothing, and that pain in your ass... it's your head.


  1. I think they can get their head removed from their hiney at the ER, if I'm not mistaken. Don't you remove lodged items on occasion?

  2. That last line is killing me. And then Amanda's comment...thanks for the laugh tonight, although I am very sorry you have to deal with things that give you these kinds of posts to write.

    It seems really sad that there are wonderful kind caring doctors (like you guys) willing to help people and things are constantly thrown in their way preventing them from doing that until they just give up trying and find something else. I;m scared to think of who we will be left with...something I think about often lately. (that seems awkwardly worded, the whole comment, but I'm hoping you understand what I mean).

  3. I dropped ACEP a long time ago. Realized early on they didn't represent MY interests.

  4. I should have been a porn star, medicine is overrated. I can not believe I passed up on getting blown for a living, now I just do the sucking. (never a happy ending).

  5. Far from the Ivory Tower3:32 AM, January 06, 2009

    True story - I actually walked in on a patient and her boyfriend getting it on the other night (at least they were under some of our hospital blankets). Guess I should have waited a little longer after knocking.

    Not surprisingly she had government *cough* "insurance", meaning that I was paying for her to be there getting screwed while I was at the same time getting screwed by EMTALA.

    Though to be completely fair, judging by her looks and intelligence, I still may well have had the more desireable partner.

  6. Thats what y'all sheep get for bein all Board Certified and everything... ya put that cash ya save on Board Exams into something safe, like Sandy Koufax rookie cards, and its a Win-Win. Board Certification is highly overrated, I mean is YOUR WIFE BOARD CERTIFIED!?!?! HMMM? HMMM? Mine isn't, and she does just fine...could stand to improve a little on the Oral Exam though,


  7. "Provide financial incentives to end the practice of "boarding" patients in emergency departments in order to expedite the movement of patients to inpatient beds. The practice of leaving or "boarding" admitted patients in emergency departments until an inpatient bed becomes available in the hospital is the cause of the gridlock in emergency departments, resulting in long waits for treatment and ambulance diversion to other hospitals.
    Provide an alternate medical liability system for physicians who provide uncompensated care in an emergency department. The liability risk of caring for emergency patients is so great, it is deterring many medical specialists from being on-call to emergency departments and driving many emergency physicians out of practice.
    Increase Medicare payments to physicians who provide care in emergency departments. The continuing decline in payments for emergency medical care reduces resources to care for more patients, decreases access to on-call medical specialists who lack financial incentive to be on-call to emergency departments and makes emergency medicine unattractive to medical students who are choosing a specialty."
    These are the three objectives of the EMC Act they are trying to pass. Do all states have what Massachusetts enforced this year? All adults required to have Health Insurance or pay a tax?

  8. the EMC sounds great. by the time it makes it into legislation the result will be that the great salt lake will be immediately desalinted and that the smith family from los angeles is to be given tax breaks to open their new 'energy from toenail clippings' enterprise.

  9. Sorry, 911, I see you might not get the job you wanted...unless your first name is Sanjay.

  10. Amy, please tell me you are joking. Not Sanjay Gupta, the CNN correspondent? He did help with neurosurgery while embedded with an army unit in Iraq. I suppose that qulifies him for everything. That and his TV time.

  11. Yeah I am sure all the line items that end up on it or on the cutting room floor, spell disaster for alot of jobs for people of the American persuasion as is always the case.

  12. Amy,
    Yes, that Sanjay. *Sigh*
    I don't understand, 911's "cover letter" in the previous post was so perfect.

  13. I'm telling's because 911 didn't promise everyone a Yard-O-Beef...

    But yeah...Sanjay Gupta. Barack Obama really is our first celebrity President. I find it really amusing that Obama thinks he's the second coming of Jack Kennedy...but he's no Jack Kennedy.

  14. Damn, 911, this would make a great book...

  15. It's encouraging that ACEP has at least noticed that the ER is awash in uninsured patients.

    I'd think that being on the front lines of the EMTALA and AESA invasions would have ACEP irate over constant abuses of the system.

    Maybe ACEP guys and gals are really not the smartest folks in the room.

  16. dear john,
    they must be the smartest folks in the room... just look at all those letters behind their names!

  17. and john, you have woken the muse in me, whatever that may be, i hereby proclaim the MDOD theorem of inverse smarts...

    the number of letters behind one's name is inversely proportional to the number of blue-collar folks one knows, and therefore inversely proportional to what used to be known as 'common sense'.