Your doctor should be your biggest advocate, doing what Ming Lin, an emergency medicine physician in Washington state, did at the peak of the Covid-19 surge in March: advocating for safer conditions in the emergency department where he worked, more testing for Covid-19, and better personal protective equipment and triage processes to keep patients and staff safe.
Instead he was fired. PeaceHealth, the health system that owned the hospital, said “his actions were disruptive, compromised collaboration […] and contributed to the creation of fear and anxiety.” Lin had no opportunity to defend himself and no legal protection because of who he worked for — which wasn’t the hospital or the health system.
Physicians employed by hospitals have the right to due process. That means if their medical privileges are terminated, they get a fair hearing and the right to appeal. And there is legal precedent that hospitals can’t compel physicians to waive those rights as a condition for being hired.
Those rights didn’t cover Lin because he was employed by TeamHealth, a multibillion-dollar contract management group (CMG) that supplies hospitals with physicians specializing in emergency medicine, anesthesiology, internal medicine, and many other specialties. And contract management groups aren’t legally bound to honor a physician’s due process rights.
In the same way that a school may hire a company to staff its lunchroom, a hospital may turn to a contract management group to provide it with physicians. These doctors are not employees of the hospital but rather are employees of the CMG.
Many hospitals across the country have outsourced their emergency department staffing to contract medical groups, with more than 30% of emergency physicians in the U.S. working for one of these groups. In some areas, emergency physicians have no choice but to work for a CMG — and in doing so waive their due process rights.
Lin’s story is not unique. There is a long history in medicine of physicians having few rights as employees. At NYU Langone, as Covid-19 swept through New York City, resident physicians advocated for hazard pay as their duties became harder and more dangerous. Their hospital publicly criticized them and questioned their compassion. Equally alarming, some physicians have stated they felt pressured to commit fraud by admitting patients regardless of their medical needs under the threat of losing their jobs.
Physicians working for contract medical groups who are put in untenable situations have little recourse — their contracts made them give up one of the most powerful tools they had for pushing back.
Fortunately, a bipartisan bill recently introduced in the House of Representatives by Rep. Roger Marshall (R-Kan.) and Raul Ruiz (D-Cal.) would close the CMG loophole. Both Marshall and Ruiz are physicians, and Ruiz is an emergency medicine physician. The bill, the ER Hero and Patient Safety Act (H.R. 6910) would require that all emergency physicians — regardless of who employs them — be given due process protections, and would also mandate that they cannot be terminated without due process.
This bill is a crucial step in making sure emergency medicine physicians have the protections they need to advocate for better workplaces and for better care. This is especially true as cases of Covid-19 are again on the rise in the U.S. Physicians need to be empowered to speak up for their patients, themselves, and their fellow health care workers when the health care system is under strain.
Emergency medicine physicians work in one of the most stressful environments that our health care system has to offer, and strive to provide the best care possible to every patient they meet. They should not have the added burden of worrying about whether they can lose their jobs without recourse.
Emergency medicine physicians advocate for their patients. When it comes to due process protection, Congress needs to advocate for them.
Gregory Jasani is an emergency medicine resident physician at the University of Maryland Medical Center in Baltimore. James Maloy is an emergency medicine physician and health policy fellow at George Washington University in Washington, D.C.
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Bravo! Absolutely key for EM physicians to be able to speak out on behalf of their patients. The need for due process is heightened in the ED where vulnerable patients are routinely encountered. Hospitals have used these CMGs to do their bidding in ways that are a danger to the public. Check out https://www.justice.gov/opa/pr/two-physician-groups-pay-over-33-million-resolve-claims-involving-hma-hospitals
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