For decades, the concepts of democracy and democratic group practice have been held as the standard to strive for in emergency medicine. As democracy is akin to motherhood and apple pie, these concepts are accepted today, perhaps, just as they were decades ago. However, with the evolving landscape of health care, is it time to revisit these concepts? Is democracy a group structure or an ideal? Democracy can provide an opportunity to participate in group decisions and control one’s own destiny (to a certain extent), but democracy means that, on occasion, you may not get what you want if you are in the minority. Is democracy truly what emergency physicians want, or has fair and equitable treatment become the practical definition of “democracy”? In this three-part series, EM leaders from different walks of life will weigh in on the following questions. Read Part 2.
—Kevin M. Klauer, DO, EJD, FACEP
Ricardo Martinez, MD, FACEP, chief medical officer for North Highland Worldwide Consulting and assistant professor of emergency medicine at Emory University in Atlanta
Savoy Brummer, MD, FACEP, vice president of practice development at CEP America in Belleville, Illinois, and chair of the ACEP Democratic Group Section
Wesley Fields, MD, FACEP, past chair and the most senior member of the Board of Directors of CEP America in Emeryville, California
Nicholas J. Jouriles, MD, FACEP, president of General Emergency Medical Specialist Incorporated, a single-hospital group in Akron, Ohio
Lynn Massingale, MD, FACEP, executive chairman of TeamHealth in Knoxville, Tennessee
Dighton C. Packard, MD, FACEP, chief medical officer of EmCare in Dallas
RM: So let me go with our first question: what is the definition of “democracy”?
WF: Well, I think this is very perspective-driven, and I’ll start with one that I don’t necessarily subscribe to but I think is common with emergency medicine, in particular in a lot of residency programs, and probably supported by the American Academy of Emergency Medicine. Some folks in emergency medicine believe in an ideal or aspiration that’s based partly on the idea that emergency medicine can be practiced privately in the same sense you can have a private practice, such as dermatology or something else that’s not hospital-based, and that beyond that, all rights and privileges that can be assigned to other medical specialties need to be attributable and available for emergency physicians as well. I think that some folks believe that to be an attainable goal or a reality in our present world, but all of us have real-life experiences that demonstrate how tough it is to get close to that ideal.