The number of new residency programs exploding across the landscape of academic emergency medicine has created its fair share of drama lately, but we have never seen anything like the recent spectacle playing out at an old and established emergency medicine program, Summa Health, in Akron, OH. It's a juicy tale of perceived corporate bullying causing program directors across the nation to take sides in a perceived battle of “good versus evil.”
The subsequent fallout has generated enormous commentary in the EM blogosphere; most see this as corporate scheming to initiate an academic coup d'etat, while others liken it to a “messy divorce” in which the fault lies on both sides.
The story revolves around Summa Health System giving the contract for emergency medicine services (and running the EM residency) to a large contract management group, U.S. Acute Care Solutions (USACS). Allegations of unfair negotiation tactics and conflicts of interest have been posted by the previous program director and faculty, and this was followed by a robust rebuttal from the new program director. Conspiracy theorists are having a field day.
Regardless of where you sit, the business of medicine is changing fast. Medical corporations are in a mad dash to gobble up as many profitable hospitals as possible, and the need to channel as many paying customers to the doors of each hospital empire seems desperate. (“Corporations Rush In to Fill MD Shortage,” EMN 2017;39:1; http://bit.ly/2hXloWW.) Rumors run rampant in the hallways of the nation's hospitals as “Big Medicine” scopes out new acquisitions.
These activities did not extensively affect academic emergency medicine until recently. Sure, many programs over the years have been started or managed by private corporations like EmCare, TeamHealth, HCA, and USACS. My program was one of the first to be run by our small, democratic physician group back in 1995. Though many members of the academic community are leery of or downright object to these types of arrangements, forcing out faculty (particularly in the middle of interview season) has never been seen. Why is all of this happening?
Because this is an op-ed, I'll say it: It's about the money. I know this is not terribly insightful, but at least it's honest. Market economies rely on economic growth. Grow the economic pie, and everyone wins. But anyone who follows the news knows that current economic growth is very, very small. This forces the people interested in making money (e.g., CEOs, stockholders, and administrators) to cut costs to generate profit.
Without profit, investors shift money to industries that will bring better returns, and ultimately this makes borrowing money more expensive for hospitals. This in turn makes it more difficult to generate profits, and the people in charge of making money look for new ways to cut costs. (By the way, if this continues, cost-cutting will reach the salaries of emergency physicians.)
But money is just the tip of the proverbial iceberg. The concern for academicians and residents is quality education. High-quality training is more likely to produce great doctors and better medical care. At what point do maneuvers similar to those in Akron begin to erode the decades of work that built emergency medicine into one of the most popular and competitive specialties?
We took the scraps of medicine and made a feast in just 50 years. EM programs now enjoy the ability to choose from the very best medical school graduates in the country. But financial markets are not based on quality health care or education. They are based on greed. It might be great for some investors, but what will the cost to the infrastructure of academic emergency medicine be? Are we killing the goose that laid the golden egg?
Many in academics are looking to existing regulatory organizations such as the ACGME to police corporate behavior in building or acquiring emergency medicine residency programs. But is this realistic? With close to 200 programs, how can a relatively small organization in Chicago meet the exploding workload associated with the oversight of training nearly 2000 residents in our specialty alone?
This is even more daunting when you consider that all the new programs require a lot more supervision than established ones. Finding the right balance between free markets and appropriate regulation are the foundation of political rhetoric, and we can certainly expect to see a lot more of this in the future.