RM: You raise a good point. Is it really about specific things, or is it really about the definition of “democracy”? I can tell you, when I ran the National Highway Traffic Safety Administration, I often told my staff that they were confusing our organization with a democracy. Somebody had to be in charge, and we had to have certain roles and responsibilities well-defined in order for us to execute as a team. We’re taught in medicine that it’s about independence and autonomy, but we see in the landscape a big move toward organizational change that’s creating much greater focus on teams. With teams, you have to give a little bit of something to become part of something bigger. That’s why this is a good time to help define what the characteristics of democracy are versus our next question: is it something specific, or is it really more of an ideal? I’ve heard the group talk about having a voice at the table, being able to participate, that sort of thing. So do we think (I’ll go to the third question) there’s some confusion, bouncing off of Dighton’s comment, of exactly what democracy should be about? I’ve heard it’s changing.
Explore This IssueACEP Now: Vol 34 – No 10 – October 2015
SB: As it relates to a democracy, even in our national governance, there are different, obvious forms, and here in the United States, we are the gold standard of a democratic system, but not everyone in our country votes on every issue every time. The ability for an organization, or for a nation, to proceed with effective governance is many times in the form of a representative democracy. There’s nowhere in ACEP that describes a democratic organization or even the basis of democracy within a group as a one-site location. When we talk about getting confused, clearly there is confusion, and many times that type of confusion is present because there are groups that are trying to confuse the term for their own purposes. It has been very, very clearly stated, by both AAEM and ACEP, what the tenants of a democratic group are about.
My doctors feel that they’re being treated fairly both by my group and by the hospital. To some extent, I see that as part of my job to make sure that happens. —Dighton C. Packard, MD, FACEP
WF: I’m pretty sure ACEP can validate this for me, but I think that most of us that deal with hospitals and hospital-based systems see that there’s a pretty strong trend in recent years that there are more emergency physicians directly employed, either by hospitals or related entities, than there are people practicing in democratic groups of any size. It’s obviously not what we’re talking about, but I think how important this is or how relevant this is depends on how common or prevalent this practice model is. My sense is that it’s a little bit of an endangered species for the reasons that Dighton suggested, and I think folks that read ACEP Now probably need to know what the facts are.