Emergency Physician Rights and Responsibilities
Revised and approved by the ACEP Board of Directors April 2008
Revised and approved by ACEP Board of Directors July 2001
This policy statement replaces one with the same title approved by ACEP Board of Directors September 2000
The American College of Emergency Physicians (ACEP) believes that high-quality emergency care is best provided when emergency physicians practice in a fair and equitable environment. To provide guidance to physicians and others with respect to contractual arrangements involving the practice of emergency medicine in any setting, ACEP hereby adopts this statement of Emergency Physician Rights and Responsibilities.
Emergency physicians typically practice in a hospital-based setting. In nearly all cases, such practice is pursuant to a contractual arrangement on which practice at the hospital is based. The legitimate purpose of such contracts is to ensure the efficient and reliable staffing of the emergency department (ED). However, such contracts also often limit or eliminate the rights physicians otherwise have under the medical staff bylaws and contain other provisions that may compromise the professional autonomy of physicians. Consequently, such contracts may harm the public interest.
This guidance should be of value to hospitals, physicians, and professional or business entities contracting with individual physicians or groups of physicians for the provision of emergency care in hospitals. It is anticipated that these guidelines will benefit the profession and the public. These guidelines are not intended to dictate individual contracting practices; rather, ACEP members must make independent determinations regarding their employment and contractual relationships with hospitals, practice groups, and other entities based on their individual circumstances.
Rights of Emergency Physicians
- Emergency physician autonomy in clinical decision making shall be respected and shall not be restricted other than through reasonable rules, regulations, and bylaws of his or her medical staff or practice group.
- Emergency physicians have a right to expect adequate staffing and equipment to meet the needs of the patients seen at the facility and to have the institution provide support to improve patient safety. Emergency physicians shall be provided such support and resources as necessary to render high-quality emergency care in the ED setting and shall not be subject to adverse action for bringing to the attention of responsible parties deficiencies in such support or resources when done in a reasonable and appropriate manner.
- Emergency physicians shall be reasonably compensated for clinical and administrative services and such compensation should be related to the physician qualifications, level of responsibility, experience, and quality and amount of work performed.
- Emergency physicians shall not be required to purchase unnecessary, unneeded, or excessively priced administrative services from a hospital, contract group of any size, or other parties in return for privileges or patient referrals.
- Emergency physicians shall be provided periodic reports of billings and collections in their name and have the right to audit such billings, without retribution.
- Emergency physicians shall be accorded due process before any adverse final action with respect to employment or contract status, the effect of which would be the loss or limitation of medical staff privileges. Emergency physicians' medical and/or clinical staff privileges shall not be reduced, terminated, or otherwise restricted except for grounds related to their competency or professional conduct.
- Emergency physicians who practice pursuant to an exclusive contract arrangement shall not be required to waive their individual medical staff due process rights as a condition of practice opportunity or privileges.
- Emergency physicians shall not be required to render anything of value in return for referral of patients by a hospital (e.g., through the awarding of an exclusive contract) other than assurances of reliability and high-quality care; nor shall emergency physicians receive anything of value in return for referrals of patients to others.
- Emergency physicians, both independent contractors and physician employees, shall be represented in the contract negotiation process between hospitals and those payers providing reimbursement for emergency services. Emergency physicians are entitled to fair rights and reimbursement pursuant to such contract agreements.
- Emergency physicians shall not be required to agree to any restrictive covenant that limits the right to practice medicine after the termination of employment or contract to provide services as an emergency physician. Such restrictions are not in the public interest.
Responsibilities of Emergency Physicians
- Emergency physicians bear a responsibility to practice emergency medicine in an ethical manner consistent with contemporary emergency medicine principles. Emergency physicians must maintain current emergency medicine knowledge and skills through independent study and continuing medical education (CME) activities.
- Emergency physicians should exhibit attributes of professionalism in the ED including: altruism, accountability, duty, honor, integrity and respect.
- Emergency physicians should participate in medical staff and/or hospital affairs with the support of the ED medical director.
- Emergency physicians should gain knowledge of the basic principles of documentation, coding and reimbursement, practice expense costs, and other applicable physician administration costs, to assist in accurate billing for their services and to properly interpret practice revenue and expense information which they receive.
- Emergency physicians must maintain knowledge of and compliance with major federal and state regulations that affect the practice of emergency medicine, such as the Emergency Medical Treatment and Active Labor Act (EMTALA) and the Health Insurance Portability and Accountability Act (HIPAA) of 1996.
Emergency physicians who are employees, contractors, or principals of a practice group, have certain duties and responsibilities to the group and are accountable to the best interests of the group. Efforts detrimental to the welfare of the group are inappropriate and may expose the individual to legal liability.