For decades, the concepts of democracy and democratic group practice have been held as the standard to strive for in emergency medicine, but with the evolving landscape of health care, is it time to revisit these concepts? What role will democratic groups have in the future of emergency medicine? In Part 3 of this three-part series, EM leaders from different walks of life weigh in on the following questions. Be sure to read Part 1 and Part 2.

—Kevin M. Klauer, DO, EJD, FACEP

Moderator

Ricardo Martinez, MD, FACEP, chief medical officer for North Highland Worldwide Consulting and assistant professor of emergency medicine at Emory University in Atlanta.

Participants

Savoy Brummer, MD, FACEP, vice president of practice development at CEP America in Belleville, Illinois, and chair of the ACEP Democratic Group Section
Wesley Fields, MD, FACEP, past chair and the most senior member of the Board of Directors of CEP America in Emeryville, California
Nicholas J. Jouriles, MD, FACEP, president of General Emergency Medical Specialist Incorporated, a single-hospital group in Akron, Ohio

Lynn Massingale, MD, FACEP, executive chairman of TeamHealth in Knoxville, Tennessee
Dighton C. Packard, MD, FACEP, chief medical officer of EmCare in Dallas

RM: Is the democratic model that we have articulated in the past going to be the most successful structure in the future, or do we all have to begin to give up a little something to get something bigger?

DP: The silence probably speaks for itself. I’m not sure that it’s a matter of democratic versus nondemocratic. Regardless of whether you’re democratic or nondemocratic, I think a larger group actually gives you the opportunity to take some risk, to try different models. I don’t know if they’re all going to win or all going to lose, but if you’re large enough, you can take a risk and you can try different things and then, hopefully, spread that success across your system. If the democratic group has the willingness to invest in itself, to take those risks, then I think they can be as successful as a nondemocratic group.