BY TOM BELANGER, MD, &
MITCHELL LOUIS JUDGE LI, MD
It would be an understatement to say emergency medicine is worried about corporate consolidation. The American Academy of Emergency Medicine and the American College of Emergency Physicians have written position statements, and many emergency physicians, prompted by Take Medicine Back, recently lent their voices in anonymous statements and virtual appearances to a Department of Justice and Federal Trade Commission request for information on merger enforcement. (AAEM. April 12, 2021; https://bit.ly/32ZbwTb; ACEP. April 18, 2022; https://bit.ly/3Oa6TeS; https://www.takemedicineback.org; Federal Trade Commission; https://bit.ly/3xIQCqm; ACEP. https://bit.ly/3y7s8J1.)
Market consolidation harms workers through regional monopsonies, but labor market power is also affected by information asymmetry, which is when employers, especially large ones, have more information about a labor market than employees. (U.S. Department of the Treasury. March 7, 2022; https://bit.ly/3y6KXfl.)
A less competitive labor market stifles wage growth and reduces the quality of the services delivered. Improving access to information, which reduces information asymmetry, is an important way to contest an increasingly consolidated market, improving conditions for workers and consumers who in this case are doctors and patients.
Anonymous App
We built an application that collects anonymous emergency medicine employer reviews and analyzes the results so that doctors have as much information as possible. (https://www.takemedicineback.org/emrating.)
The application is free to use, and all emergency physicians and residents can leave a review and read others' reviews. It is completely anonymous, does not track IP addresses, and cannot identify users, so reviewers are protected.
Reviewers can answer a series of questions about employment in emergency medicine and enter comments. Questions are specific to attendings and residents and they can search for employers or residencies or add their own if theirs has not been entered.
Users may review the results and filter by employer (or residency) or employer type (or residency employment model). A net promoter score is calculated when enough data are available. Basic sentiment analysis is used to turn comments, which are not visible, into a sentiment score to allow users to get a softer feel for an employer.
The information is then incorporated into a Google Data Studio report that allows users to view geographical information and sort and filter data based on features. A resident, for instance, could create a map of residencies operated by democratic groups, hospital employees, contract management groups, or any combination of the three.
Hold Employers Accountable
We can see some trends emerging from the 199 reviews available when these data were pulled on June 1. The vast majority of the reviewers so far are attendings—190 versus nine residents.
A few employment types dominate the reviews so far. (Graph 1.) Most reviews appear to be from four types of employers: contract management groups, democratic groups, hospital employees, and academic institutions. It is clear, even without performing a deep analysis of the various employer types, that contract management groups are regarded quite unfavorably compared with other employers. (Graph 2.)
This is, however, a rough summary of the data. The application itself gives a much more granular breakdown.
We would like to encourage all emergency physicians—residents and attendings—to review their employers. The more data we share, the greater chance we have of overcoming our informational disadvantage against an increasingly consolidated market.
Not only is it our duty to hold our employers accountable, but providing information for another emergency physician to use may someday change where they work, live, and maybe even the course of their lives. We all deserve access to the best information available when making such important decisions.
Dr. Belanger is the secretary of the American College of Emergency Physicians Locum Tenens section and an emergency physician in McKinney, TX. Read his past articles at http://bit.ly/EMN-numbERs. Dr. Li is the chief medical officer of the AAEM Locum Group, the founder of Thrive Direct Care, PLLC, and a founder of Take Medicine Back (https://takemedicineback.org).
Find graphs with data from the app in the August issue.
