The television drama "ER" portrays an urban emergency department hampered by budget cutbacks and managed-care restrictions. But the conditions in real-life emergency departments may be even worse, judging by comments from physicians who work in them.
A new study blames contract management firms, and managed healthcare companies in particular, for dissatisfaction among emergency physicians and a decline in emergency department quality of care. Lead author of the study is Scott Plantz, an emergency medicine physician at Mt. Sinai Hospital Medical Center in Chicago and vice president of the American Academy of Emergency Medicine. Plantz and five others worked on the study; four were emergency physicians.
The Association of Emergency Physicians estimates about one-third of the nation's emergency departments are run by contract management firms. Almost half of the 465 emergency physicians Plantz and the others surveyed said they have considered leaving the specialty because of unfair business practices, and about 75% said they felt financially exploited by the firms that manage their emergency departments. Another 23% said their jobs would be threatened if they were to voice "quality-of-care" concerns to the contract holder. The results of the survey were published in the American Journal of Emergency Medicine.
The survey concluded that the practice settings most often associated with perceived substandard care were those operated by multi-hospital contract companies. Moonlighting non-EM residents working in emergency departments were the practitioners most frequently associated with substandard care.
What the study may have highlighted even more clearly, however, was the general frustrations facing physicians these days.
For example, the study did not specifically define what comprises substandard care other than saying, "Contract companies . . . may have a financial incentive to hire non-board certified emergency physicians, including ones working in the field part-time, and continued expansion of these groups could detract from the quality of care provided."
In regard to the unsettling findings of the survey, the authors note that it relies solely on physician self-reporting; it provides no independent or objective confirmation of actual exploitative practices, termination, lack of due process or substandard care.
Emergency medicine physician John Timmons says contract management firms grew out of "the necessity to staff emergency departments 24 hours, seven days a week on site -- not at home, on call like other specialties -- at 5,000 different hospitals across the country." Timmons, who practices at Rush-Presbyterian-St. Luke's Medical Center in Chicago and is vice president of the Association of Emergency Physicians, predicts that the dominance of management firms will wane as physicians organize in private practices and contract with hospitals independent of management firms. "I think in 20 years we'll have very few contract groups," he says.