“Entrepreneurial” physicians seen as threat

“Entrepreneurial” physicians seen as threat

CORRESPONDENCE 2. Nou E: A clinical comparison of subcutaneous doses of terbutaline and adrenaline in bronchial asthma. Scand J Respir Dis 52:192198,...

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2. Nou E: A clinical comparison of subcutaneous doses of terbutaline and adrenaline in bronchial asthma. Scand J Respir Dis 52:192198, 197i. 3. Glass P, Dulfano MJ: Evaluation of a new f~2 adrenergic receptor stimulant, terbutaline,in bronchial asthma. 1. Subcutaneous comparison with epinephrine.. Curr Ther Res !5:141-149, 1973. 4. Schwartz HI, Trautlein JJ, Goldstein AR: Acute effects of terbutalme and epinephrine on asthma. J Allergy Clin Immunol 58:516522, 1976.

Vincent P. Gotz Robert D. Brandstetter, MD Dexter D. Mar, PharmD University of Florida College of Pharmacy Gainesville 1. Brandstetter RD, Gotz VP, Mar DD: Optimal dosing of epinephrine in acute asthma. Am J Hosp Pharm 37:1326-1329, 1980.

"Entrepreneurial" Physicians Seen As Threat To the Editor: I am discontinuing m y membership in the American College of Emergency Physicians. [ have been a member of ACEP since 1976, am a graduate of an emergency medicine residency, and am a diplomate of the American Board of Emergency Medicine. I will speak frankly: It is m y belief that ACEP is too tolerant of, if not dominated by, the entrepreneurial "multihospital" physicians who hold contracts, sometimes from hundreds of miles away, and employ their fellow physicians on a salary basis. As these medical empires expand, graduates of emergency medicine residencies are finding their opportunities as feefor-service practitioners to be severely curtailed. Furthermore, I personally feel that these entrepreneurs are as much of a threat, if not more, to me and m y colleagues and our single-hospital contract as are the twin threats of hospital takeover and socialized medicine. It seems that among American specialties, emergency medicine has the only College which still gives honor and moral support to the entrepreneurs, while simultaneously paying lip-service to traditional fee-for-service private practice. The American College of Radiology had a similar problem some years ago, and confronted it with a proviso in its Code of Ethics: "In the practice of medicine, physicians should limit the source of their professional income to medical services actually rendered by them, or under their supervision, to their patients." Many of us emergency physi-


cians feel that ACEP should have taken a similar stand long ago. A few years ago one of m y colleagues wrote a letter deploring the same problem to a high ACEP official. The official's reply was one of hostile antagonism. With such a response to the issues, i believe that ACEP will find more of its members casting their votes with their memberships. My respect goes to those dedicated ACEP members who have worked to advance our specialty, but I think they must finally take a stand on this issue. The wolves are loose among the sheep. Those of u s who believe in traditional fee-for-service, community-based medicine had better think very carefully about what it could mean to our autonomy and independence to have profit-dominated businessmen take over the delivery of emergency car e. I believe that it would make very little difference to most of us tO be placed on a salary by the government bureaucrat based in Sacramento or Washington, DC, or to be placed on the same salary by an entrepreneur based i n Los Angeles, Chicago, or Dallas.

Paul C. Randau, MD Manhattan Beach, Californi a /Editor's note: We encourage readers with opinions on this and other issues to share their viewpoints with the reader-


Annals of Emergency Medicine

11:6 June 1982