AAEM Creates a ‘Physician Group’ to Bolster Small Practices

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Part of the ‘Go Big Or Go Home’ series
Two organizations known for supporting independent physician practices are making big moves to expand and gain economies of scale. The heads of AAEM and USACS explain how these initiatives will help them compete in an increasingly competitive marketplace.
Click here to read: EMP Makes Expansion Bid by Creating USACS

Physician-owned practices can offer significant benefits, and with a new initiative, AAEM brings collective experience and economies of scale to support them.

Since its inception, the American Academy of Emergency Medicine (AAEM) has been the strongest advocate in the house of medicine for physicians owning and controlling their own practices. Our new AAEM Physician Group initiative strives to make this kind of ownership a reality for more emergency physicians. Practices owned by a small subset of their physicians or entirely owned by lay corporations are much more likely to lack transparency, political equity, and financial equity. This can create conditions ripe for exploitation. Throughout its existence, AAEM has worked hard to promote equitable, democratic, physician-owned practices. We have educated our membership on the pros and cons of different practice models. AAEM has also created a variety of resources to help existing practices thrive and to assist physicians in starting their own emergency medicine practices. We have advocated aggressively in the political and legal arenas against infringements on physician practice rights and unfair work environments.


Despite AAEM’s efforts, physician-owned practices are under significant threat. Small practices may have difficulty developing and maintaining the infrastructure needed to be successful given the new reality of health care reform, accountable care organizations and value-based purchasing. The two largest for-profit emergency physician contract management groups, EmCare and TeamHealth, are now worth about $5 billion and $3 billion, respectively, and have been increasingly using their financial clout to acquire smaller practices. Likewise, they have enormous marketing and sales budgets that dwarf those of smaller competitors. It can be a lonely, dangerous world for a small emergency medicine group.

Local, democratic physician groups do offer several advantages. They are more likely to consist of physicians living in the community in which they work, who are more vested in the practice that they own. Ownership creates a greater sense of duty and responsibility for the functioning of the emergency department. Emergency physician owners are more dedicated to the hospital, the nursing and ancillary staff, their patients and the community. Democratic groups often offer superior compensation, practice rights, work environment and job satisfaction. As a result, they can attract and retain the most qualified emergency physicians.

For years, I’ve spoken with other AAEM leaders about ways to combine the advantages of small, democratic groups of physician owners with the economies of scale, expanded services and clout of large groups. Likewise, we have had many discussions on what can be done to minimize the time, resources, and risk to emergency physicians who want to create their own emergency medicine group, or who want to bring the control of their group back to the physicians actually practicing in their emergency department.


When I became AAEM President last year, we felt it was time to make this concept a reality. During our strategic planning retreat in May 2014, the AAEM Board voted to make the formation of the AAEM Physician Group our top priority over the next two years. We envisioned a new paradigm whereby smaller emergency physician groups could become part of a national collaborative with access to best-in-class practice management services provided at fair market value, while fully maintaining their local ownership and control. In addition, as part of the larger AAEM Physician Group, these practices would have significantly more clout and marketing/sales muscle when competing with much larger entities to maintain their contracts or consider expansion. Likewise, the AAEM Physician Group could actively seek new, high-quality emergency department contracts and then set up and install local, democratic groups at these sites. We developed a set of fairness principles that would be required for participating groups to meet (i.e. reasonable path to partnership, due process, political and financial equity) to ensure that the commitment to a fair, transparent working environment would be maintained. Penalties and/or removal from the AAEM Physician Group may occur if mission and operational guidelines are not followed (see the Fairness Principles sidebar).

One of the early decisions we contemplated was whether to build the AAEM Physician Group from scratch, or to partner with an existing company and refine and improve upon their existing offerings. The task force decided to put out a request for proposal (RFP) to better gauge what existing firms could offer. After an exhaustive process of on-site visits, research and discussions with existing and former clients, the task force recommended to the AAEM Board that we partner with physician practice management firm PSR.

PSR has been an outstanding partner and is committed to honoring AAEM’s dedication to creating successful, equitable emergency medicine practice environments free from exploitation. PSR already provides a comprehensive suite of top-notch practice management services to its many clients. The AAEM Physician Group will utilize many of these core services, while adding additional services to utilize the clinical, educational, operational and organizational expertise of the Academy. The AAEM Physician Group will create a comprehensive network where all component practices will maintain full, local ownership. Existing democratic group practices willing to commit to truly fair practice environments will now have a great option to improve their existing operations and better compete in an increasingly consolidated marketplace. In addition, as the AAEM Physician Group starts new democratic group practices, physicians interested in becoming a partner day one of their own new practice will have vastly increased opportunities to do so.

The AAEM Physician Group will be led by Dr. Robert McNamara. Dr. McNamara has served AAEM in many capacities in the past, including AAEM President. As CEO of the AAEM Physician Group, Dr. McNamara will not only lead general operations and management, but will also assist hospitals and independent groups with practice oversight and quality and risk oversight. Dr. McNamara will be assisted by the AAEM Physician Group’s Board of Directors: Drs. David Lawhorn, Bill Durkin, and Joe Wood, as well as the AAEM Physician Group staff.


The AAEM Physician Group will officially launch at AAEM Scientific Assembly in Las Vegas, NV this February. I am very excited about this initiative – the AAEM Physician Group has the potential to truly change the marketplace.


Mark Reiter, MD, MBA is President of the American Academy of Emergency Medicine, Residency Director of the University of Tennessee-Murfreesboro/Nashville, and CEO of Emergency Excellence.

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