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.