Disposable Doctors: Imprudent NY Jurists Side Against Patient Interest

Posted: October 5, 2010 by Doc in Emergency Medicine, ER Docs
Tags: , , ,

“Affirmed”!

and with that, the NY Appellate Court, seemingly sealed the dismissal of ABPS’s suit against NY-DOH, forcing a possible showdown before the U.S. Supreme Court.

The Appellate Court, gave short shrift to the strong arguments made by ABPS’s lawyer, Mr. Michael Sussman, easily finding for NY State, without reasoning or gravitas.  

Not that the Court needed a reason. You see, actions by this or any state, wherein the regulation(s) involve health education and welfare and not race, gender or nationality, gets subject to a legal analysis called, “rational basis”. And DW wants you to know that “rational” is used loosely, we mean really loosely, we mean even, irrationally.

Here is what occurred;

(1) New York has a physician website that lists doctors as emergency medicine board certified IF they did a residency in emergency medicine,  no problem there,

(2) an organization called ABEM [The American Board of Emergency Medicine, owned by the American Medical Association] lobbied New York to list MDs with its certification as board certified, whether or not they had done a residency in emergency medicine.

(3) the ABPS [American Board of Physician Specialties, certifies experienced ER doctors who have done residencies such as surgery, family practice and internal medicine AND have at least 5 years experience in emergency medicine practice, not owned by the AMA, having a patient first position] sued  because except for the emergency medicine residency requirement, their ER doctors meet and exceed the criteria, permitting the ABEM non ER residency trained to be able to advertise themselves as board certified.

(4) ABPS contended that if the ABEM/AMA doctor did not do a residency s/he should not be listed on the State’s website following the rule. But that if such a doctor certified by its competitor could be listed, then ABPS doctors should be listed as well.

(5) It is even simpler, ABPS said there should be a site where all ER docs should be listed, and in fact the State could list the certifying board, and whether or not an emergency medicine residency was done. ABPS believes that the best ER docs are residency trained in a relevant specialty and experienced with more than five years practice and does not accept the AMA tenet that three (3) years of emergency medicine is enough. Some hospitals agree and have even added another 4th year. However, that still does not trump greater than 5 years of experience.

 A simple and rational argument; if the rule says, you have to be emergency medicine trained to be board certified in new york, ABPS argued, then why are non emergency trained ER docs listed as certified. Was it simply because they had grandfathered certification by the AMA?

All that seems simple enough. And yet, the courts in New York, ruled against the ABPS    essentially aiding and abetting the business of the AMA/ABEM, on the basis that New York’s action was “rational”- The sort of irrational technicality that only lawyers and judges can understand. the sort of irrationality that allows criminals to get away with their crime(s).

DW asks, when did New York get into the business of aiding and abetting bad actors who seek to destroy competitor organizations with complete disregard for patient welfare issues, such as adequate access to Emergency Care?

DW has learned that there are hospitals in upstate New York, that don’t have and cannot recruit any ER doctors. Moreover, superior ABPS ER physicians are excluded from the Emergency Medicine workforce because of the AMA’s predatory action; now assisted by the state.  

DW wonders who the Court would prefer seeing if they had an emergency: a physician trained in a relevant specialty e.g. surgery, medicine, family practice, anesthesiology, pediatrics, with at least 5 years experience as an ER attending such as the ABPS certified physicians; OR, a physician who only completed a three (3) year residency in emergency medicine but was certified by the ABEM/AMA. If the court is confused, ask the patients in Upstate New York, or indeed throughout the state.

PATIENTS PREFER EXPERIENCED AND EXPERT PHYSICIANS, THAT’S JUST COMMON SENSE. 
Unfortunately, as we all know “common sense” isn’t so common, and as it turns out, in NY state, “rational” isn’t rational either.
INCIDENTALLY, A RECENT NATIONAL STUDY HAS SHOWN THAT EM RESIDENCY TRAINING DOES NOT IMPROVE QUALITY OF CARE.  (see EM Residency Training and Quality Measures)

What were the judges thinking? CLEARLY, THEY WEREN’T THINKING FOR THEMSELVES BUT MERELY CHOSE TO LISTEN TO AMA/ABEM TO THE DETRIMENT OF THE PEOPLE OF NEW YORK.

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Comments
  1. boardcertified says:

    http://www.aaem.org/boardcertification/quality.php

    The link above gives a more complete picture of the literature on the relationship between board certification and quality of care. The court made the right decision for a variety of reasons, some legal and some medical.

  2. Dr. LB says:

    There is an important recent study from Johns Hopkins which shows no OBJECTIVE difference in terms of quality care between Emergency Medicine Residency Trained Emergency Physicians and non-Emergency Medicine Residency Trained Emergency Physicians.

    Link to Abstract …http://www.ncbi.nlm.nih.gov/pubmed/20716690

  3. Beckham says:

    Monday, October 11, 2010
    Practice Track Needed Till EP Shortage Ends
    Editor:
    I am a board certified diplomate of the American Board of Physicians Specialties (ABPS). I have practiced emergency medicine for the past 20 years. I have never seen this type of idiocy in any profession other than medicine. (EMN 2010;32[9]:1.) We fight each other as if we are foreign countries. We have the fight of our lives trying to save our way of life as it is with all the Medicare cuts and insurance companies targeting us by cutting our salaries and reimbursements for their own profits.

    I don’t think the American College of Emergency Physicians and all the powers-that-be have the patients’ best interests at heart. These people are self-serving and self-absorbed. Their interest is to keep salaries very high for residency trained emergency physicians. These residency trained physicians will never go to underserved areas where they are needed; they will remain around the cultural centers, commanding higher salaries and enjoying the amenities of city living. The underserved areas will continue to suffer, and have a lack of or diminished physician services.

    The newly residency trained doctor will not want to work the long laborious night shifts or odd hours, and most likely will not want to work more than the usual work week when the hospital is in a pinch. The hospital will find itself still turning to even more expensive locums coverage. This is what ACEP and its companions want because who will most likely be the locums owner and provider? Probably the same residency trained doctors group or some similar type of arrangement.

    These are some of the reasons that ACEP and its companions want to rule out ABPS, family, and internal medicine doctors from working in emergency departments. I don’t think it has a lot to do with training or the ability to work an emergency department at all. I don’t think you can tell a hospital administrator with confidence that a doctor just out of residency is more capable of working in an emergency department than a 20-year veteran emergency physician who has worked more than 4,000 hours a year for 20 years in an emergency department.

    I have nothing against residency training. If a practitioner knows when he finishes medical school that emergency medicine is the field that he wants to pursue, then go into an emergency medicine residency. But, like most things in life, nothing is perfect. We finish medical school, chose our paths, and for whatever reasons decide that something else may be more attractive than what we chose. So maybe we find one of those small hospitals that will allow doctors residency trained in something other than emergency medicine to work in the emergency department because of need and because they cannot find a board certified residency trained emergency physician at any price who wants to come to Timbuktu to practice mistake-free medicine because we all know residency trained doctors never get sued and never make mistakes.

    No one in emergency medicine wants a practice track, but it is still needed, and as long as there are not enough residency trained physicians to cover our emergency departments, some hospitals will have to use internists or family practitioners to cover their departments. The way to ensure that these physicians have the knowledge of emergency medicine is to offer them certification. If a family practitioner or internist wants to work in the emergency department, ABPS or some other entity should offer testing before the doctor ever works in the emergency department. Maybe an airway clinic or some type of anesthesia course also should be offered prior to the physician working in the emergency department. This would better serve the public and better ensure patient safety than fighting over certification, which only boils down to a fight over money.

    My message to ACEP is this: When you can tell me that state regulations will allow your residency trained doctors to drop their malpractice insurance because they are so perfect, I will believe that only residency trained doctors should be in emergency departments. We all have to carry malpractice, which means that the public doesn’t believe in any of us, so to better protect them and ourselves, why don’t we unite and develop solutions that include all of us? There is enough room at the table; visits keep going up, and people keep coming. Let’s quit acting like wolves and pigs, and act like humans who can talk and work things out, and come up with solutions instead these turf battles.

    John Stanton, DO
    Horsham, PA

  4. This topic should be of great importance to anyone that can afford health care and even those that cannot because your health is priceless. Read on to learn more.I truly appreciate the content of your blog… Thanks

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