Emergency Physician Contractual Relationships

Revised October 2012, January 2006, March 1999, and August 1993 with current title

Approved January 1993

Originally approved October 1984 with title "Contractual Relationships between Emergency Physicians and Hospitals"

As an adjunct to this policy statement, ACEP has prepared a Policy Resource and Education Paper (PREP) titled "Emergency Physician Contractual Relationships."   

Emergency physicians engage in many types of contractual relationships. Examples of important contractual relationships involving emergency physicians include those between:

  • Emergency physicians and third-party payers ("insurers");
  • Emergency physicians and health care facilities ("hospitals"); and
  • Individual emergency physicians and contracted emergency medicine organizations ("contracting vendors").

ACEP supports the following principles, which apply to these relationships.

  • Emergency physicians employed or contracted should be informed of any provisions in the employment contract or the group's contract with the hospital concerning termination of a physician's ability to practice at that site. 
  • The emergency physician should have the right to see and review the parts of the contracting entities' contract with the hospital that deals with the term and termination of the emergency physician contract.
  • ACEP supports the emergency physician receiving early notice of a problem with his or her performance and an opportunity to correct any perceived deficiency before disciplinary action or termination is contemplated.
  • All entities contracting with or employing emergency physicians to provide clinical services, either indirectly or directly, should ensure an adequate and fair discovery process prior to deciding whether or not to terminate or restrict an emergency physician's contract or employment to provide clinical services.
  • The interests of patients are best served when emergency physicians practice in a fair, equitable, and supportive environment.
  • Quality patient care is best promoted within a framework of fair and appropriate contractual relationships among various involved parties.
  • Business relationships that include emergency physicians are best defined within a written contract.
  • The emergency physician should have the right to review what is billed and collected for his or her service regardless of whether or not billing and collection is assigned to another entity within the limits of state and federal law.
  • It is the right of an emergency physician contracting entity to make an independent decision regarding all contractual arrangements that involve third-party payers and to be represented by legal counsel.
  • The contracting parties should be ethically bound to honor the terms of any contractual agreement to which it is a party and to relate to one another in an ethical manner.
  • Quality medical care is provided by emergency physicians organized under a wide variety of group configurations and with varying methods of compensation. ACEP does not endorse any single type of contractual arrangement between staff emergency physicians and the emergency department service contracting vendor.
  • Any issue pertaining to medical care must be reviewed and affirmed by a licensed emergency physician.
  • The emergency physician is individually responsible for the ethical provision of medical care within the physician-patient relationship, regardless of financial or contractual relationships.




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