I joined my first democratic partnership, Emergency Medical Associates (EMA), out of residency in 2010. I quickly came to believe we were the best democratic emergency medicine partnership in the New York-New Jersey area and that I would spend the rest of my career as an EMA partner.
Then, in January of 2015, we sold our practice. I did not see how I could feel ownership and satisfaction in our sometimes brutal profession as a corporate employee, and I walked away from emergency medicine for a year.
Here's the story of how I found true partnership, lost it, and regained it.
Growing With a Physician Partnership
I didn't know much about democratic physician partnerships until I started searching for my first emergency medicine job after residency. It was a recruiter at EMA who explained the concept to me.
The idea of democratic groups is summed up in this line from American Academy of Emergency Medicine's vision statement:
I also liked what the recruiter said about shared decision-making, local autonomy, leadership opportunities, and really having a voice in my practice. It sounded too good to be true but also too good to pass up. So, I signed on.
The ideal practice situation in Emergency Medicine affords each physician an equitable ownership stake in the practice. Such ownership entails substantive responsibility to the practice beyond clinical services.
Because EMA has a two-year partnership track, I was prepared to spend some time paying my dues. I was wrong. Everyone treated me like a partner from day one. It was clear that even the newest guy in the room mattered in fulfilling the core mission of caring for patients, as well as building our company.
As promised, there were tons of opportunities to get involved. A few months after joining the company, I spent a day with our CEO on a lobbying trip to Albany. In less than two years, I was a co-associate ED director and serving on a company-wide quality improvement committee. In my first quality improvement committee meeting, two of the founding partners of EMA, as well as Mike Gerardi, then a future president of ACEP, came up to me to personally shake my hand and offer their help and mentorship whenever it might be needed. All three made good on that offer — spending hours guiding me on a quality committee project a year later.
I felt so lucky to have found EMA early in my career. I figured I'd retire from that group one day. Unfortunately, there were big changes on the horizon.
The Rise of Corporate Medicine
By 2014, even large independent groups were struggling to keep up with the changes in healthcare. The demands of payers and regulators multiplied. Hospitals were increasingly looking for physician groups that could offer vertical integration in the form of multiple integrated service lines. The architects of the ACA and ACOs made accelerated consolidation a goal.
The EMA board was concerned about its long-term ability to maintain its dividend levels to its partners and keep up with the changing regulatory and market demands. Interest rates were low, and interest in buying physician groups was high. They thought a sale might be our best option.
In late 2014, our board recommended we sell to a corporate management group. In January 2015, the partners voted to go forward with that sale. In all fairness, our new corporate parent did an excellent job keeping its promises. It incorporated EMA into a new corporate division and kept our physician leadership and support staff largely intact. It promoted key EMA leaders within the new division — and even to corporate senior management. So, in some ways, it seemed little had changed.
Still, to me, everything had changed. We partners had all just become hourly employees. Our bosses now included countless faceless shareholders, who did not share our Hippocratic Oath.
Finding a Home
With a heavy heart, I started exploring other practice options. Unfortunately, the forces that led to EMA's sale had also swallowed every viable democratic physician partnership in the Tri-State area.
I did find one cause for hope. A friend from residency was now practicing with a democratic physician partnership called Vituity. With 1,800 physicians, multiple practice lines, and a robust medical services organization, the group seemed to be adapting well to industry changes. It was the only group I'd seen that I believed could deliver on its democratic promises long-term. But the closest Vituity ED was about 200 miles from my home.
My family and I talked it over and decided relocation wasn't an option. Faced with the options of practicing emergency medicine with less than full ownership of my work or doing something else, I did something else. I joined an urgent care company that, while not offering partnership, was at least owned and run by physicians. It offered a lot less stress and a more normal-feeling work schedule than the ER ever could.
Then, on May 17 of this year, I received a message from a recruiter on Doximity advertising a great hourly at an ED in New Jersey. I wrote back to find out more, but I didn’t believe his response. The job he quoted was for Vituity!
Vituity had just announced the agreement to provide emergency medicine services at St. Mary’s General Hospital in Passaic, N.J., a day or two earlier. Partnership was an option for emergency physicians in the area again.
I definitely had a lot to think about. My urgent care job was a lot easier to balance with family life. And my last partnership, that I thought would last forever, sold very suddenly.
But Vituity wasn’t just surviving while all the other partnerships were being swallowed up, it was thriving. Vituity was growing in leaps and bounds, making vertical integration across the Acute Care Continuum and making adaptation to the changing marketplace a strength — not a liability. It learned how to make non-EM physicians our partners, so we could face the headwinds of the industry together. At 6 million patients annually, it could negotiate with insurers and compete like no other partnership.
When I considered what Vituity has accomplished and what partnership means to me, there was only one choice for me to make. I became a Vituity Partner and did my first shift at St. Mary’s in early August.
As I write this a month later, it's probably too soon to make sweeping judgments about my experience. But, I will say that I'm excited to come to work again. Every time I talk to my director and colleagues, I feel deeply that this is "our" group, and that we're in it together. I see the same excitement in physicians who joined Vituity from the previous group (a corporate management group), and I have already realized that their experiences and insight directly influence the management of our own practice. The energy is palpable, and our nursing and hospital partners feel it, too. I’ve had multiple members of the medical staff come to the ED and tell me how excited they are to have Vituity on board. There's a lot of energy in the air and excitement for the future.
Could Partnership Work for You?
I'm thrilled that physician partnership is an option once again in the New York-New Jersey area. I also realize that partnership isn't the perfect fit for everyone. So how do you know if it's right for you?
First, it's really the only model for physicians who feel that ownership of their clinical work is an absolute must. Maybe you came into medicine driven by a strong sense of mission. You're probably a passionate advocate for patients, colleagues, and quality. You like innovating and strategizing on how to take your department to the next level.
For others, it's subtler. Maybe there's tension between your values and your employer's that distracts you from what matters. Or maybe you see problems, but don't feel safe speaking up.
In either case, I highly urge you to give the democratic partnership model a try.
It's tremendously empowering. You’re motivated to go the extra mile, whether that means picking up a shift for a colleague in need or spearheading a new initiative. Best of all, you have the camaraderie that comes from sharing your personal mission with others.
This blog post was originally published at Perspectives on the Acute Care Continuum on September 21, 2016.