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Democratic Group Practice Section Newsletter - May 2007, Vol 1, #1


circle_arrow From the Chair
circle_arrow Who Will Speak for Me?
circle_arrow Spotlight on Two ACEP Policies
circle_arrow October 17, 2006 Meeting Minutes

Section Newsletter Index



From the Chair

George Molzen, MD, FACEP

molzenThe Democratic Group Section is now an official ACEP Section with over 100 members. It was very surprising to me why it took so long to get 100 members to join. Given the huge energy, effort and emotion that swirled around "democratic groups" a few years ago when AAEM was being formed, I thought we might quickly become the largest Section in ACEP. Was I ever surprised.

Perhaps there are here, as is often the case, many factors that have led ACEP members not to join us. One of the first is that the definition of a "democratic group" is not easy to answer. I will wait until the next newsletter to address my thoughts on this topic. For now, suffice it to say that this definition was the topic of half of the last Section meeting in October and caused a task force to be formed.

What other factors might be in play here? I would hope that the main reason is that many in the College no longer see ACEP as "pro-contract group" in its outlook. This change in perspective is, I believe, mainly due to efforts of the College leadership to respond to these concerns over the past decade. The College has produced many policies, documents, and other products aimed at helping those members in Democratic Groups remain in the practice model they prefer.

Let me give you a few examples of how the College has responded to the needs of those in Democratic Groups. Here are a few of the policies passed.

  • Emergency Physician Rights and Responsibilities (Approved 2000; Revised 2001)
  • Emergency Physician Contractual Relationships (Approved 1984; Revised 1993; Revised 1999)
  • Agreements Restricting the Practice of Emergency Medicine (Approved 1995; Revised 2000)
  • Compensation Arrangements for Emergency Physicians (Approved 1988; Revised 1997; Revised 2002)

A newer policy, Promotion of College Policies on Contracting and Compensation (Approved by the ACEP Board of Directors April 2002) ties these 4 policies together and urges groups that meet the standards on these policies to prominently display in their exhibit promotional material or an advertisement that they:

  1. Comply with all ACEP policies in this area, or
  2. Substantially comply with all ACEP policies in this area.

If "substantially comply" is promoted, materials should be available for review indicating areas of noncompliance with referenced policies.

The policy on Emergency Physician Rights and Responsibilities is included in this newsletter. The other policies can be found at Just look under the orange "Practice Resources" tab and then under policies.

How about other documents you ask? The Practice Resource section of the ACEP web site is chock full of information papers and other documents designed to help emergency physicians in their group practice. Almost all are worthwhile and two of the best are:

  • Obtaining, maintaining, and retaining an emergency department contract
  • What to do when your contract is threatened.

It is probably apparent to all of us that the large so called "contract groups" did not need this information published. However, ACEP has attempted to level the playing field. It is my plan over the next few newsletters to review and examine these documents in detail. Again, these documents can all be found at Again, go to the Practice Resources tab and select "Issues by Category." Once there, look under administration or under contracts. You may even want to view the Democratic Groups tab.

There are other factors that may be causing members not to join our section. My generation (I am a boomer) is more oriented to independent practice. While employment is commonplace today in medicine, for my generation, small independent groups or even solo practitioners where the physicians were at-risk if revenues dropped were the norm. Many newer members, faced with the huge debt many face after completing residency, want a stable salary and do not want to be at-risk when and if revenues fall. To many of them, a job is a job. The issue of if it is in a democratic group or another style of practice is secondary to salary, lifestyle, location, etc. Thus the type of practice may not be as important to many physicians today. We will have to see how they feel after 10-15 years in practice. Our mission is to extol the benefits of democratic group practice so they realize this model is the best.

Another thought is that the "radical" ACEP members who were so upset with ACEP in the past have left the College for AAEM. If so, this is a shame because in my opinion, the College bent over backwards to address their concerns. In fact, there has not been a member of a "contract medical group" elected to the ACEP Board of Directors while working for one in over 10 years. Like them or not, the business sense the leaders of these "contract groups" is something we all can learn from. Again, this is the topic of another newsletter.

That brings us back to those of you who have chosen to join this section. Our purpose is to help, mentor, discuss, advocate and promote the practice of emergency medicine in a democratic group and support those who belong (or want to belong) to a democratic group. There is no doubt in my mind that a democratic group is the best possible practice style. The joys and rewards are immense. There is also no doubt that a democratic group practice is the most difficult to maintain for the rank and file member of the group. We need to come together to make the difficulties as small as possible.

So, I encourage you to find a colleague who is curious about democratic practice and invite them to join the section. I encourage you to use the section elist to answer questions that may arise as you continue your practice. Questions can be sent to me and I will put them out to the group and publish both the questions and answers in future newsletters.

Thank you for being a member. Please let me know what you would like from this section.






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Who Will Speak for Me?

Ted Kloth, MD, FACEP
Chair-elect, Democratic Group Practice Section
Previous Chairman of the Board - CEP Medical Group

klothIt came as somewhat of a shock to me when at the beginning of the Democratic Group Practice (DGP) section meeting at ACEP's Scientific Assembly in New Orleans, we were informed by ACEP administration that we were perilously close to losing our section standing because we were teetering on the bare minimum of participants needed to qualify as a section. When I paused to reflect, I was a bit baffled. Are all ACEP members satisfied with their practice and the governance of that practice? Do most feel that they have sufficient say in their practice and thus feel no need to be involved in a section that merely mimics what they already have? Are physicians that work in other than democratic practices really satisfied with their practice model or do they feel that speaking out or being seen as a part of this section might jeopardize their current work opportunity? Or is it that many in our College feel that the "democratic mantle" has been defaulted to AAEM? And if that is the case, what message are we sending to emergency medicine residents?

I offer these questions to perhaps stimulate discussion and get emergency physicians to think about their practice model and whether or not that model is right for them. And if not, what alternatives they might have.

The fact of the matter is that democratic group practices are thriving and are a very viable practice model for the future. The third largest group in the country (by volume) is a democratic group, and collectively democratic group practice may still be the predominant form of emergency physician group practice if you add up the solo, regional and national democratic group practices, compared to the investor or non democratic physician-owned groups. Certainly the complexity of the current clinical practice and management of the emergency department has increased to a point whereby it is more difficult for the single democratic group to compete against larger groups and satisfactorily address the hospital administration’s increasing demands. Despite this, many small groups have been able to succeed in the past and will do so in the future. In other instances, however, small groups have failed or have chosen to merge with other like-minded emergency physician groups to enable economies of scale and the development of programs and systems to meet administration expectations, while at the same time preserving the democratic structure of their group, individual income and the ability for each physician to have significant input into their practice. And yet the democratic section of ACEP languishes while other sections have thrived for years.

Perhaps the near loss of the democratic group section does not mean that democratic groups are becoming extinct. Perhaps what it might mean is that section membership has less relevance for the groups and their participating individual ACEP members. And that would be a shame.

ACEP has developed policies that support emergency physicians no matter in what type of group they practice. While there are many different types of practices that acknowledge the rights of emergency physicians, perhaps it is time that all members and groups that value and respect the individual physician and its members within the College urge ACEP to take a real stand for the individual emergency physician and against individuals and groups that control many ED practices across the country, and do not treat emergency physicians without equitable ownership fairly. In my opinion, a major goal of ACEP should be to actively promulgate the group practices in our midst that best represent the ambitions of many of its individual physician members - an elusive dream for many - a democratic group practice with equitable ownership and compensation determined by its practicing physicians.

ACEP needs to make and enforce the statement that emergency physicians should have the right and the power to decide how to practice group medicine and that groups that do not adhere to this concept, whose standards are unacceptable to the tenets and philosophies of the ACEP, and by inference the member emergency physicians, must change their ways so as to be acceptable

One objective of the section is to work with the College leadership to promote good, quality democratic groups. The best way to help accomplish this is to encourage all ACEP members you know who support this model of practice to join the section. The larger the section membership, the more power we will have to change the College in the ways we wish to see.

While I believe the democratic model best represents the individual physician, it is also clear to me that there may be other viable practice models that may be good for emergency physicians, and perhaps a discussion of different practice models might pave the way for the creation of a list of the best attributes a group model practice should optimally include.

The voice of this democratic section of the College needs to be heard and counted. I believe that over the years, ACEP has done many things it can be proud of, and with the support of the large and small democratic groups, and their members, ACEP can continue all its other worthwhile projects and at the same time, become the recognized voice of the individual emergency physician.



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Spotlight on Two ACEP Policies

Printed below are the two ACEP policies that are pertinent to the articles written by Dr. Molzen and Dr. Kloth.

  1. Emergency Physician Rights and Responsibilities
  2. Promotion of College Policies on Contracting and Compensation

Emergency Physician Rights and Responsibilities

Approved by the ACEP Board of Directors July 2001
This statement replaces one with the same title approved by the ACEP Board of Directors, September 2000
(Policy #400284, Approved July 2001)

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.

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 a hospital-based setting, ACEP hereby adopts this statement of Emergency Physician Rights and Responsibilities.

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

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. Emergency physicians shall be provided periodic reports of billings and collections in their name and have the right to audit such billings, without retribution.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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

  1. 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.

  2. Emergency physicians should exhibit professionalism in the ED in regard to behavior, attire, and reliability.

  3. Emergency physicians should participate in medical staff and/or hospital affairs with the support of the ED medical director.

  4. Emergency physicians should gain knowledge of the basic principles of documentation, coding and reimbursement, recruiting costs, coding and billing costs, 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.

  5. 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).

  6. Emergency physicians who are employees, contractors, or principals of a practice group, during the course of the relationship, have certain duties and responsibilities to the group. Active efforts, during the relationship, to interfere with or acquire a contractual relationship of the practice group may expose the individual to legal liability.


Promotion of College Policies on Contracting and Compensation

Approved by the ACEP Board of Directors April 2002
(Policy #400317, Approved April 2002)

The American College of Emergency Physicians (ACEP) has adopted and will continue to promote policies regarding physician employment and contracting. The following policies represent ACEP's position:

  • Emergency Physician Rights and Responsibilities (Approved 2000; Revised 2001)
  • Emergency Physician Contractual Relationships (Approved 1984; Revised 1993; Revised 1999)
  • Agreements Restricting the Practice of Emergency Medicine (Approved 1995; Revised 2000)
  • Compensation Arrangements for Emergency Physicians (Approved 1988; Revised 1997; Revised 2002)

ACEP intends that its promotion of these policies will:

  1. Ensure that emergency physician groups are aware of the referenced policies.
  2. Move emergency physician groups toward compliance with ACEP policies.
  3. Educate ACEP members about these policies.
  4. Provide ACEP members with effective tools to help them make informed choices during the employment and contracting process.

ACEP believes that wide promotion of these policies, using many different methods, will maximize their desired impact. As such, it is believed that self-promotion by individuals and groups that employ emergency physicians is valuable and desirable. For this reason, ACEP encourages any individual or organization providing grants, advertisements, or exhibits, at any ACEP venue or in any ACEP publication, to appropriately acknowledge their degree of compliance with any or all of the referenced ACEP's policies.

Those who choose to do so may prominently display in their exhibit promotional material or an advertisement that they:

  1. Comply with all ACEP policies in this area, or
  2. Substantially comply with all ACEP policies in this area.
    • If "substantially comply" is promoted, materials should be available for review indicating areas of noncompliance with referenced policies.

ACEP members should familiarize themselves with these principles and use them in their discussions about staffing situations. ACEP members are encouraged to question the individual or organization about his/her/its level of compliance and discuss with them areas where they may fail to comply with the referenced ACEP policies.




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October 17, 2006 Meeting Minutes

American College of Emergency Physicians

Democratic Group Practice Section Meeting

Scientific Assembly
Ernest N. Morial Convention Center
Tuesday, October 17, 2006
New Orleans, LA



Section members participating included: George W. Molzen, MD, FACEP, Section Chair;
Hazel Cebrun, MD; Wesley A Curry, MD, FACEP; Charles F Grunau, MD, FACEP; Michael D Hagues, DO, FACEP; Ronald A. Hellstern, MD; Shkelzen Hoxhaj, MD, FACEP; Jay Kaplan, MD, F Judy Hardage, MD ACEP; Theodore I Kloth, MD; Thomas W. Lukens, MD PhD FACEP; John S. Milne, MD; David C Packo, MD, FACEP; Rebecca B. Parker, MD, FACEP; Setul G Patel, MD; Michael P Rock, MD, FACEP; Alexander M. Rosenau, DO, FACEP; Timothy Seay, MD, FACEP; Patricia D Short, MD; Angela Siler Fisher, MD; Jules A Silver, MD, FACEP; Robert E. Suter, DO MHA FACEP; and Gary Yee, MD, FACEP.

Others participating in the meeting included: Margaret Montgomery, RN, MSN, staff liaison and Lance A Brown, MD MPH FACEP, Chair, Section Affairs Committee.


  1. Welcome and Introductions
  2. Discussion
  3. Section Business

Major Points Discussed

  • Dr. Molzen welcomed everyone to the meeting and participants introduced themselves and provided information about their group structure. It was decided to have an informal discussion as opposed to a formal educational program.

  • Dr. Molzen informed the attendees that the section had acquired the required 100 members and then declined to 98. The purpose for the section was discussed and there was agreement the section is to be a voice for democratic groups and to provide support to members that believe a democratic group is the best type of group structure. Section members discussed the type of support to be provided by section members. The importance of avoiding tortuous interference was addressed. Issues raised included equality vs. fairness, open books, fair compensation, pathways to partnership, management structures, due process, and fair business practices.

    It was pointed our that it will be important for the section to review the section objectives, define what the section is about, and to determine what residents want to know about democratic groups to better provide for their needs. The possibility of petitioning the Board for automatic enrollment in the section was raised. Section members were encouraged to talk with other members of their practice groups about joining the section.

Dr. Brown, chair of the Section Affairs Committee provided input on section grants, maintaining section membership, procedures for changing the section name, copyright issues for newsletter articles, revisions and adherence to operational guidelines, and issues related to maintaining section membership.

  • Section elections were held and the following officers were elected for two year terms.

     George W. Molzen, MD, FACEP,  Section Chair
     Theodore I. Kloth, MD   Chair-elect
     Patricia D. Short, MD   Secretary
     Wesley A. Curry, MD, FACEP  Newsletter Editor
     Angela Siler Fisher, MD  Councillor
     Jay Kaplan, MD, FACEP  Alternate Councillor

    Section members agreed that the section objectives should be reviewed and democratic group practice should be defined. Dr. Kaplan, Dr. Seay, Dr. Packo, Dr. Lukens and Dr. Hellstern will work to define the term democratic group practice. Section members will review the current ACEP information papers on democratic groups to determine if updating is needed. An additional objective to include shared governance, fair business practices and equal opportunity was discussed.

  • Appreciation was expressed for the luncheon provided courtesy of California Emergency Physicians. With no further business Dr. Molzen adjourned the meeting at noon.


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This publication is designed to promote communication among emergency physicians of a basic informational nature only. While ACEP provides the support necessary for these newsletters to be produced, the content is provided by volunteers and is in no way an official ACEP communication. ACEP makes no representations as to the content of this newsletter and does not necessarily endorse the specific content or positions contained therein. ACEP does not purport to provide medical, legal, business, or any other professional guidance in this publication. If expert assistance is needed, the services of a competent professional should be sought. ACEP expressly disclaims all liability in respect to the content, positions, or actions taken or not taken based on any or all the contents of this newsletter.

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