ACEP Now: Should ER docs unionize to get better working conditions?

Dr. Shah: That’s a complicated question. I attended the ACEP panel on this last year, and they talked about the pros and the cons. It may not be for everybody. Some groups and practices have explored the option, understand what they’re getting into and have concluded that that they’re going to work together to get better outcomes under a unionized model. It has clearly made sense for those groups. It’s not a decision to be taken lightly.

ACEP Now: What are you hoping to accomplish at the federal level that you couldn’t at the state level?

Dr. Shah: The big thing at the federal level is that Medicare and Medicaid are controlled up there at the federal level, right? And a lot of health care financing is done at the federal level that isn’t done at the state level. That’s really it. We did have some control over the state Medicaid system at the state legislature level, which was good. But you’re trying to get everybody covered and lower the costs. I mean that’s really it, and it’s a much bigger problem. CMS controls a lot of the rules for how things are financed, and therefore that’s where you have to go if you want to make changes.