Joining a professional medical organization provides many benefits. Members can network with other professionals who share similar interests and organizations provide access to many educational resources and conferences. Participating in a professional medical organization also allows members to work toward common goals improving the practice environment for physicians and improving the access and quality of care for patients.
It was 20 years ago that I submitted my application for fellowship in ACEP. The day I earned my “FACEP” designation, I was proud. I had reached the pinnacle of my profession. Residency trained, board certified in two specialties, and now a fellow of the organization that was the “leading advocate for emergency physicians, their patients, and the public.” When public officials and news organizations seek information about emergency medicine, ACEP was their first stop. And I was a fellow in that organization.
I became involved in the Medical Legal Committee and met some of the smartest and most influential people in emergency medicine. I remember sitting at the back of the room during my first meeting and thinking to myself “Wow. I can’t believe I’m part of this group.” Through the years, many of those people became mentors with whom I forged long lasting friendships. As I became more involved in the issues affecting emergency medicine, I was elected Chair of the Medical Legal Committee.
We had lively debates during meetings and the resulting policies and recommendations from our committee seemed to further the goals of improving emergency medical care. I remember creating my first policy statement: Admitting physicians have responsibility for a patient once the patient has been admitted to the hospital – even if the patient is being “boarded” in the emergency department. The policy passed through the ACEP Council vote with little debate. From that point forward, physicians could use ACEP’s policy as a basis for clarifying hospital admission policies and could use the policy as a defense against allegations that they failed to actively manage patients being boarded in the emergency department after admission. We really were improving the practice of emergency medicine.
Unfortunately, things have changed.
I proposed another policy: ACEP should extend the ethics procedure for reviewing expert testimony to include experts from other specialties. Currently ACEP members can only file ethics complaints against other ACEP members for egregious expert testimony. Once a complaint is filed, it is reviewed by the Executive Director and one or more committees, then referred to the Board of Directors. If disciplinary action is recommended, a respondent can request a hearing on the matter where evidence can be presented and witnesses can testify. However, non-ACEP members face no scrutiny. If a neurologist testifies about emergency medical care of a stroke, that testimony involves the standard of care for emergency medicine, yet the neurologist is not held to the same ethics standards as an ACEP member.
If the new policy was implemented, ACEP might not have standing to discipline egregious testimony from other specialties, but ACEP certainly could provide due process and issue a written letter of censure if outside experts provide inappropriate testimony about the practice of emergency medicine. ACEP could also notify an expert’s professional society and state medical board of such censure. During debate on the issue, one ACEP member quipped that ACEP’s current system for reviewing expert testimony is similar to having a home alarm system that guards against your own family members, but not against outside intruders. A former ACEP Speaker cautioned that ACEP had more than $20 million in assets that would be at risk from lawsuits brought by aggrieved experts. Nevertheless, the Council voted overwhelmingly in favor of the resolution and there were cheers after the vote.
Nothing happened. An internal e-mail from ACEP’s General counsel lamented that a “mob mentality” took over before the Council vote and that “nothing rational seemed to resonate at that moment.” She opined that a policy of reviewing outside expert witness testimony puts ACEP at significant legal risk and may amount to “witness tampering.” ACEP’s ethics procedures already amount to witness tampering with expert witnesses who are ACEP members if that is the case. The assertion that censoring experts who testify untruthfully could amount to “witness tampering” also demonstrates a lack of legal knowledge. An exception to any allegation of witness tampering is conduct intended to encourage a witness to testify truthfully – which is exactly what the policy was intended to do. I wrote many follow up e-mails to ACEP’s Executive Director over several years asking why the policy had not been implemented.
In one e-mail I provided excerpts from a neurosurgeon’s testimony against an emergency physician stating that it is the standard of care for an emergency physician to insert ventriculostomy shunts in the emergency department. The expert admitted he had not had any emergency medical experience since medical school. After receiving that e-mail, ACEP’s General Counsel said that ACEP had decided not to “carry out the will of the Council” due to issues regarding “jurisdiction and potential liability.” What about the potential liability of ACEP members subjected to egregious testimony? I remember thinking to myself “is ACEP really protecting its members or is ACEP just protecting ACEP?” I considered canceling my ACEP membership in protest. After expressing that intent to one of my mentors, she implored me “Please don’t do it! ACEP needs people like you to speak out.”
I helped draft another policy at the request of the then-current ACEP president. This policy called for states to consider activities involving medical expertise – such as expert witness testimony and insurance coverage determinations from physicians working for insurance companies – as the practice of medicine. Egregious testimony or egregious denials of insurance coverage for patients could then be reviewed by state medical boards and could subject the offending physicians to licensure actions. ACEP supposedly had support for this measure from several other professional organizations and the ACEP Board was reportedly looking forward to implementing the policy. The policy got shelved before the Council meeting. Another pocket veto that took away potential protections to emergency physicians and to patients.
I drafted a white paper about indemnification clauses in physician contracts. Indemnification is a legal concept requiring one party to pay all costs and expenses related to damages another party suffers. If a hospital is sued for a physician’s actions and an indemnification clause is in place, the physician would have to personally reimburse the hospital for all expenses related to the lawsuit. Indemnification clauses can also negate medical malpractice insurance coverage. Indemnification agreements pose a significant financial risk to all emergency physicians. Ask an attorney to personally indemnify you for anything and you’ll be mocked.
Insurance companies have even taken notice of the risk of indemnification – some medical malpractice insurance applications now ask physicians if they have previously entered into any indemnification agreements with other parties. The white paper I wrote for ACEP condemned any form of indemnification in physician contracts. Despite condemning others who demand indemnification from ACEP members, ACEP ironically demands indemnification in its own contracts. Earlier this year I was invited to provide three presentations about medical malpractice at the upcoming ACEP Scientific Assembly. ACEP’s physician speaker agreement contains a broad indemnification agreement which ACEP refuses to remove. Because of this, I turned down the invitation. I’ve been invited to speak in many venues and ACEP has been the only organization to demand indemnification.
ACEP’s Medical Legal Committee was created to develop policies and work on legal issues affecting the practice of emergency medicine. Last year, the Committee received a survey inquiring into which of six gender identities and nine sexual orientation categories respondents fit, whether respondents had experienced “discrimination,” and if there was a “need for more diversity.” The survey sought no information about Committee members’ work experience, professional interests, research, or other areas of diversity. Questions on how answers to those survey questions would help the Medical Legal Committee in its mission were dismissed and a modified questionnaire was submitted to the ACEP Board without further discussion.
I also became disappointed with ACEP’s message boards. In keeping with the advice I was given many years ago, I sometimes “spoke out” about unpopular opinions. However, I also tried to encourage debate about those opinions. When I posted new information about COVID treatment, I was warned not to discuss ivermectin because it was “too political.” When I mentioned the word “ivermectin” in a follow-up post, ACEP censored me. Egregious posts in which ACEP members suggested that patients refusing the COVID vaccine should be refused insurance or even refused medical care went uncensored. Scholarly debate on ACEP message boards apparently can’t occur when positions run counter to ACEP’s political views.
During committee appointments, ACEP makes each member agree to a “fiduciary duty” to other ACEP members. That’s quite a high bar. Fiduciary duty means that each committee member must put the interests of all other ACEP members above his or her own interests. Agreeing to such a duty puts committee members in an untenable position. What if a committee’s action helps most ACEP members but harms a minority of ACEP members? Have the committee members breached their fiduciary “duty” to those that were harmed? Could the committee members be liable to those members for such a breach? Committees work hard on behalf of all ACEP members, but this silly agreement is just another example of how ACEP seeks to protect itself at the expense of its members. How ironic that ACEP demands a fiduciary duty from its members when it won’t agree to that duty itself.
I’m a member of other emergency medicine organizations including AAEM and ACOEP, both of which seem to better focus on the interests of emergency physicians and our patients. I recently renewed my memberships in both those organizations but rejected ACEP’s requests to renew my membership. Now there’s one less dissenting voice in the ACEP echo chamber and one less middle-aged cis-gendered white guy skewing ACEP’s diversity statistics.
ACEP is a once great organization that has strayed from its mission. ACEP has come to value diversity of gender more than diversity of thought. By censoring ideas that are contrary to its political ideology, ACEP values directives more than it values discourse. ACEP appears more interested in furthering the interests of ACEP than with furthering the interests of ACEP members.
I cannot continue to support such an organization. Leaving ACEP will mean I forfeit my once-coveted FACEP designation. It will also mean that I won’t see my mentors, friends, and colleagues at future ACEP meetings. While I’ll miss those times, I’ll also look forward to helping AAEM, ACOEP, and other emergency medical organizations work toward better protecting our profession, our physicians, and our patients.
Disagree with these opinions? Write me and we can discuss them. I promise I won’t censor you.
18 Comments
Thank you for making a stand. Too few are willing to do so. Politicized, race and gender fixated medicine is no longer medicine, or science, and serves no one well.
I’m glad to know you are in the field, standing for actually issues.
Agree! Thanks for sharing more insight, and also for your insightful comments in EM Monthly.
Thank you Dr for a very nice article and I’m sad to see you or anyone else go through this. Medical Fascism is a terrible thing and denies patients the ability to hear all treatment options. Unfortunately, the medical community is as “woke” as can be and I’m not sure the best way to combat this.
Bill, so sorry to hear. I remain a member of ACEP and as someone who restarted the Medical Legal Committee after a multi year hiatus (many years ago), not pleased at your observations and experiences. Your move seems well considered although it is an unfortunate loss for ACEP.
Good luck on your journey and I hope your thoughts galvanize some reasonable responses.
Dan Sullivan
Dan, YOU were/are one of those mentors I mentioned whose opinions and guidance are so valuable. While our paths may have diverged a little, I’m sure our destination is the same. The fight is far from over.
Interesting read. Thank you for posting.
Hi,
Will ACOEP or AAEM pick up the gauntlet that ACEP refused to do?
Thanks,
Wm Craig Sanford MD FACEP
I both loved and was saddened by the reality and truths you wrote of, while reading your most excellent article. My Highest and warmest regards from a brother in arms. I am myself a white middle aged FP physician working EM locum tenens in rural America in 3 states. Your described accurate and emphasized points were remarkably unbiased, unemotional and well thought out…which is, in and of itself impressive given the uphill, biased, self interested and selfish (and therefore emotional) motives and treatment you have received from ACEP. When exactly…and WHY…did professional organizations with the sacred privilege and responsibility of healing people replace their most valued members with political alliances instead, who neither share nor value the mission or interests of those of us who do? Your very well written article highlights yet another symptom of a deeper and more frightening reality and disease in America and throughout the world and in EVERY organization, not just in medicine.
Thanks to everyone for their comments and support on this difficult decision. I didn’t take the decision or its consequences lightly. I have confidence that I can enlist the support of other professional organizations to better advance the interests of emergency physicians and our patients. Mark Plaster and EP Monthly have helped fulfill that goal for more than 30 years and I encourage everyone to continue supporting this magazine and its mission.
Bill, Thanks for your thoughts, including your criticisms. When an organization makes these kind of mistakes,
criticism is crucial. I completely understand, and think your proposal about dealing with expert testimony makes incredible sense. ( I see alot of bad testimony on my cases as an expert witness)
Like you, I’ve served on ACEP Committees for decades, and also complained and criticized ACEP policy on some issues since the early 1990’s. ACEP leadership can be deaf and dumb. So I completely understand why you quit. But, and here’s the bottom line.
Do you really mean what you said? (eg, Or, like in a political debate, are you too upset to see another perspective?)
You have been a leader on these issues, so thank for what you have done, and what you do. Will respect your answer either way.
But I do have an exhortation/ question for both you, and for ACEP. Would you come back if things changed?
Hopefully some senior ACEP leaders will respond, or if you would consider this, I’ll ask them for you.
Tony,
I have enjoyed collaborating with you through the years. As I said in the article, I’ll miss those interactions in the future.
I can’t say that I’d never come back to ACEP, but ACEP’s actions and politicking aim it in a trajectory away from that possibility and also distance it from the principles upon which it was founded. Unfortunate that the inattention of ACEP’s leadership has driven the organization to this point.
There has to be a motivation to change and ACEP simply doesn’t have that motivation. ACEP has lost its focus. Perhaps loss of membership dues from members who disagree with ACEP’s actions may provide motivation to change. Time will tell.
Dr. Sullivan.
Sad to read.your interesting and well supported and explained article. I am one.pf the dreamers that once upon a time.was feeling and thinking on my career and specialty like you feel abpit and put my weighted dreams and ideals on ACEP, to find or become a lighthouse to ACEM the organisation I cofounded years ago, and now the feeling.is almost the same. You are not alone. The majority of members has no intention even of stand up and rise their hands and speak out to fight for values, ideals, and the dream that is being respected, useful and well treated by institutions and other specialties. They can easily speak for themselves benefit and are thinking on their immediate contextual benefit only. To elevate quality and service standards based on our expertise and has been modulated as downregulated to keep working as a commercial issue more than to reinfore their vocation to heal, save and efficiently attend persons in risk.
Politics has done too much damage. Has corrupted the soul of most of professionals and the voice is now unpassionate and delicate and fearful uncapable of get us off the trouble path to redirect the goals to the true vision on common wellness.
Respectful bow and thankful support voice from Colombia.
Eliecer Cohen
(Still an International ACEP member).
I have few words (an unusual position for me) as I count you among those I look to for mentorship and direction in my career (and life). As the President-Elect of the Illinois Chapter (a position you once held), I can only say that while your decision saddens me, I appreciate the Jeffersonian sentiment that you can not simultaneously be part of the problem and part of the solution. I hope, however, that like Jefferson, your decision brings about change, that you re-engage to help that occur, and that you remain engaged if it does. I think that most of your concern boil down to one: what role does the staff of a member organization have? All of the issues you raise, from the in-house council’s actions to censorship (which I also experienced around COVID – from the opposite camp) on the e-list, are actions of the staff, not the member leadership. I hope your message is heard, loudly and clearly, by the member leaders who oversee those staff.
In the meanwhile, you will be missed.
Bravo for your courage. I was recently forced out of a 25 year career, for even questioning the effectiveness of the vaccine after being vaccinated. I’ll be signing up for AAEM.
Just now seeing this, and I like many others who were highly involved in the reconstituted ACEP Medical Legal committee (and also in my case the WellBeing committee, these issues being closely intertwined) —I was the first Board Liaison while serving as Council Speaker)– am very sorry to hear that your consistently well informed and always thoughtfully legally reasoned voice was silenced, and you chose no longer to be ignored or denigrated (as did I).
What happened in ACEP from my perspective is that it became wealthy. Then it became overly protective of that wealth, to the detriment of the very members who had created that wealth through faithful membership and countless hours of selfless service. It then hired Counsel that was inexperienced and/or clueless, and also apparently litigation averse, to the extent that ACEP’s own internal rules (about following the Direction of Council) were broken by naive leaders, misled by staff about the magnitude of potential risks.
Essentially, IMHO, organizational cowardice trumped organizational courage in service to members.
Your voice and selfless service will be sorely missed, except by those who believe that their continued lucrative employment depends on continuing to advance this protectionist agenda.
Just now seeing this, and am like many others involved in the second ACEP Medical Legal committee (I was the first Board Liaison while serving as Council Vice Speaker)—–very sorry to hear that your consistently well informed and always carefully legally reasoned voice was silenced, and you chose no longer to be ignored, your efforts canceled, or your viewpoint denigrated (as did I).
What happened in ACEP from my perspective is that it became wealthy. Then it became overly protective of that wealth, to the detriment of the very members who had created the wealth through faithful membership and countless hours of selfless service to a very deserving group of colleagues. It then hired Counsel that was inexperienced and/or clueless (and therefore not surprisingly, inordinately litigation averse). Under this staff, ACEP’s own By-Laws (for example, following the Direction of Council) were broken by naive leaders, misled by such staff about the magnitude of potential risks.
Essentially therefore, IMHO, organizational cowardice trumped organizational courage in service to members.
Your voice and selfless service will be sorely missed, except by those who believe that their increasingly lucrative employment depends on continuing to advance this protectionist agenda.
Well written. My feelings as well. With much sadness, I also decided not to renew after 33 years.