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Clinician Views on Important Emergency Matters

Clinician Views on Important Emergency Matters

Emergency medicine (EM) physicians have a heightened duty to advocate for the interests of their patients. They provide care for the most vulnerable people, including those who are physically and mentally impaired as well as those who are uninsured. EM physicians in this role may find themselves in conflict with hospital administration. “Physicians need due process rights at hospitals in order to fulfill their duty to serve as patient advocates,” explains Robert M. McNamara, MD, FAAEM. A Complicated Issue The term “due process” means that a person will not lose rights without access to fair procedures. In the hospital setting, due process means clinicians will not lose their medical staff privileges without a fair hearing, according to Dr. McNamara. In 1998, a survey of EM physicians showed that many had been threatened with adverse actions when serving as advocates for quality of care or raising concerns about financial matters. Since that survey, the healthcare system has come under increasing strain, with ED volumes increasing significantly. At some institutions, admissions to hospitals through the ED can generate more profit than non-ED admissions, creating potential pressure on EM physicians to increase admissions.   Further complicating matters is that many EM physicians nationwide are employed by contract management groups (CMGs). These are for-profit business entities, and Dr. McNamara says the relationship between EM physicians and CMGs may cause financial pressures. “Some of these CMGs are publicly held and run by lay corporate officers who must answer to shareholders. This is in contrast to physicians, who have a primary ethical duty to patients. This can lead to potential conflicts regarding patient care.” Surveying...
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