Democratic Group Practice Section Newsletter - May 2008, Vol 2, #1
George W. Molzen, MD, FACEP, Chair, Democratic Group Practice Section
Timothy Seay, MD, FACEP
At the last meeting of the Democratic Group Section, the discussion revolved around two major issues. These were:
- If the mission of the section is to promote democratic group practice, how could this best be accomplished?
- What exactly is a democratic group anyway?
After much discussion, it was felt that in order to fulfill our mission (or address issue number 1, we needed to define what a democratic group is. To this end, a task force was formed and produced a draft statement. This was put on the section e-list so all members would have a chance to comment – and many did.
As one would expect, there are many different opinions about how a democratic group should be defined. It was no surprise that our commenting members wanted to mold the Definition to fit their particular democracy. While most can agree on practices that are not democratic, there are many practices around the country that some would consider democratic and some would not. We have similar problems whenever we try to define something that has gray areas. Classic examples include pornography with the famous "I can’t define it but I know it when I see it" saying, to what exactly is a political liberal or conservative, to the definition of a drug versus a nutritional supplement. In all these areas, there are differences in opinion about the definition. We came to realize that we needed a foundational document that all "Democracies in EM" could support. We realized that these were business democracies, and our definition needed to support its own tenants and that the business democracies of EM would have to stretch around those tenants and not the other way around.
As a democratic group, it seemed the most democratic to let you, the members of the section, decide how we should define a democratic group practice. To that end two definitions surfaced one by the task force and one by a section member, Ron Hellstern, MD FACEP(E). One was selected by a vote of the email checking membership (the task force section, many thanks to Ron for his insightful and valuable philosophy). This version was modified to include the thoughts of those of you in the Section that participated and we now have a great document to go to the Board of Directors of ACEP for consideration/modification and, hopefully, adoption.
Once we have the ACEP Board input and approval of a document that defines Democracy in Emergency Medicine, we can move on to the important work of promoting democratic group practice as the ideal practice and supporting our members as they continue in their group practice or start a new democratic group practice. This is the fun and exciting aspect of our section development. It brings a tremendous resource to the College and its members. We can be the ones to mentor those who wish to start a new democratic group practice. We are the ones who appreciate that while it is the best practice, it takes the most work on the part of the members of a democratic group practice to make the practice work. We can be the ones to counsel other members that while it does take work, the benefits of a democratic group practice in one of its various forms greatly outweigh the disadvantages.
One of the next projects the section may tackle will be to develop a data base of our members and the exact type of practice in which they work so we can match them as mentors to others in similar groups. There is no need as they say to reinvent the wheel; if a member has a problem or concern with their group, chances are it has been addressed in the past by others in the section and a solution/answer or solutions/answers already been developed. In this way I hope we can all help each other and strengthen the concept of democratic group practices within ACEP.
Draft policy statement
Definition of Democracy in Emergency Medicine Practice
To be considered by the ACEP Board of Directors in June 2008
Emergency medicine democratic groups are defined by their governing structure which should be in writing and available for review by potential new members.
Democratic groups should be governed by a body that is subject to change by fair and transparent elections that embody a one-vote-one-person structure and philosophy or a representative vote recognizing equity ownership/seniority within the group.
The governing body (or the electorate) should have complete control over the finances and decision making in the group. Financial equity in the group should be structured in such a manner that a new member has a realistic set of expectations as to his/her potential costs, liabilities, and benefits, before making the decision to join the group.
All members/owners of the group should have:
- a right to petition the governing body for redress and grievances,
- access to a fair due-process procedure
- freedom to speak (within the business confines of the group and in a non disruptive manner) that should be exercised without fear.
- an equal and realistic ownership opportunity within the group.
With democracy there comes obligation; there is a fiduciary responsibility to the group and a non-fiduciary responsibility for all member/owners.
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ACEP 2007 Council Report for the Democratic Group Practice Section
Angela Siler Fisher, MD
Thank you for allowing me to serve as your Councilor. I want to thank Dr. Jay Kaplan who served as the Alternate Councilor for this year’s Council meeting. I would be happy to discuss any of the meeting business, your comments, questions or concern. Please contact me via email at firstname.lastname@example.org.
- President-elect – Nick Jouriles MD, FACEP
- Vice Speaker – Arlo Weltge MD, FACEP
- Board of Directors
o Andrew Bern, MD, FACEP
o Raymond Johnson, MD, FACEP, FAAP
o Sandra Schneider, MD, FACEP
o Andrew Sama, MD, FACEP
- Resolution 8 Chapter Membership Requirement – Bylaws Amendment: NOT ADOPTED
This resolution (see below) would have allowed non-EM residency trained physicians to be members of state chapters (which is not supported by current ACEP policy). The intent of the resolution was to increase state chapter membership in rural areas where fewer EM residency trained physicians practice. The concern of the Council was that this would result in unintended consequences that would delink national and state chapter membership.
- Resolution 11: Fellowship: ADOPTED
The Council has previously considered many resolutions regarding the definition of college fellowship. Last year the Council passed a resolution which required current EM board certification to retain the designation of "fellow" to the College. This resolution removed that requirement.
- Resolution 21: Single-Payer Health Insurance: REFERED TO B.O.D.
There is current ACEP policy supporting universal healthcare. There was much discussion about the distinction between universal healthcare and single payer systems, of which there are many.
- Resolution 32: Emergency Ultrasound Credentialing and Accreditation: ADOPTED
Asks ACEP to study US credentialing concerns and address long and short-term accreditation issues.
- Resolution 36: Training and Credentialing of Emergency Physicians for Various Forms of Patient "Sedation" in the Emergency Department (ED): ADOPTED AS AMENDED
Requires ACEP work with the Joint Commission and the American Hospital Association to recognize board certified emergency physicians as competent to perform sedation procedures and oppose the imposition of credentialing requirements on EP’s by other specialties.
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2007 Annual Meeting Minutes
American College of Emergency Physicians
Democratic Group Practice Section Meeting
Washington State Convention Center
Wednesday October 10, 2007
Section members participating included: George W. Molzen, MD, FACEP, Chair; D Michael Bear, MD, FACEP; Diana L Fite, MD, FACEP; Ali Osman, MD; Victor S Ho, MD, FACEP; Robert E. Suter, DO MHA FACEP; Timothy Seay, MD, FACEP; Angela Siler Fisher, MD; Shkelzen Hoxhaj, MD, FACEP; Raymond Iannaccone, MD, FACEP; Elizabeth Patterson, MD, FACEP; Theodore I Kloth, MD; Wesley A Curry, MD, FACEP; Ellis Weeker, MD, FACEP; Gary Yee, MD, FACEP.
Others participating in the meeting included: Margaret Montgomery, RN, MSN, staff liaison and Linda L Lawrence, MD, FACEP, ACEP President.
- Welcome and Introductions
- Section Business
- Next steps
Major Points Discussed
- Dr. Molzen welcomed everyone to the meeting and participants introduced themselves and provided information about their group structure.
- Dr. Molzen opened discussion on defining a democratic group. Elements discussed for inclusion in the definition were: group members have a voice in operations and able to change governing board, financial transparency, governance through free and fair elections and an opportunity for equal ownership, and the right for redress and due process. It was pointed out that democracy does not replace a group having a hierarchy and that with rights comes responsibilities both fiduciary and non-fiduciary. Other elements discussed included one vote per person, freedom of speech without retribution, reasonable opportunity for ownership, and leadership opportunity.
- Dr. Seay will draft a definition for the section to review and comment on. The section members will be asked to vote on a definition. Dr. Fisher will draft a council resolution based on the definition that is developed
Section members present were asked to write articles about how your group works and submit to the newsletter editor.
Dr. Fisher provided a report on the Council meeting and focused on the following resolutions: a bylaws resolution to de-link chapter and national was defeated, the fellowship resolution to recognize legacy physicians was passed, and the single payer resolution was referred to the Board. Section members then discussed ways to increase membership in the section. Polling resident members was suggested to ensure their needs were being met. Sending letters to residency directors about sponsored membership was discussed as one way to encourage resident participation. Ways to encourage democratic groups to support having 100% of their group members join the section were discussed. Section leaders will contact democratic groups to encourage membership support.
Section leadership positions are for two year. No elections were required this year and the leadership remains the same. Section officers are as follows:
|George W. Molzen, MD, FACEP
|| Section Chair
|Theodore I. Kloth, MD
|Patricia D. Short, MD
|Wesley A. Curry, MD, FACEP
|| Newsletter Editor
|Angela Siler Fisher, MD
|Jay Kaplan, MD, FACEP
|| Alternate Councillor
- 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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