• Howard Blumstein, Robert M McNamara, Kevin Beier, and Larry D Weiss.
• Department of Emergency Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania 19140, USA.
• J Emerg Med. 2013 Jul 1;45(1):111-6.e3.

BackgroundA 1998 survey of emergency physicians indicated that many were threatened with adverse actions when advocating regarding the quality of care or raising concerns about financial issues.Study ObjectivesTo assess the current state of these issues.MethodsAn anonymous electronic survey of emergency physicians was conducted using the American Medical Association's database.ResultsOf the 1035 emergency physicians who received the survey, 389 (37.6%) answered the questions. Over half had been in practice for 16 or more years and 86% were board certified. Of those who knew the answer to the question, 62% (197 of 317) reported that their employer could terminate them without full due process and 76% (216 of 284) reported that the hospital administration could order their removal from the clinical schedule. Nearly 20% reported a possible or real threat to their employment if they raised quality-of-care concerns. Financial pressures related to admission, discharge, and transfer of patients were also noted by a number of respondents. Physicians who worked for contract management companies reported a higher incidence of impaired practice rights.ConclusionPracticing emergency physicians continue to report substantial concerns regarding their ability to speak up about the quality of care and pressure regarding financial matters related to patient care.Copyright © 2013 Elsevier Inc. All rights reserved.

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