Calling this relationship an "unspoken deal" belies the reality that the vast majority of the physicians working for large CMGs had no say in the matter. To suggest their end of the deal is fair ignores the fact that predating PE's involvement in EM the CMGs and many other groups which later sold out to PE were based on an exploitative model where the senior physician owners were already skimming off 20+%. This was known far and wide but ignored by ACEP (see articles from Hellstern, Simon, Bresler, et al in the 1980s). Maintenance of pay levels under a new master doesn't change the original sin of exploitation. PE has certainly stepped up the abuses as you mention by more readily replacing us with NPPs, forced supervision of same, metric burdens and protecting the contract at the cost of physician careers (see Ming Lin). The whole embrace of PE has tarnished EM in the eyes of Congress and the public. It was a Faustian bargain that benefited the few at the cost of many including our patients.
Calling this relationship an "unspoken deal" belies the reality that the vast majority of the physicians working for large CMGs had no say in the matter. To suggest their end of the deal is fair ignores the fact that predating PE's involvement in EM the CMGs and many other groups which later sold out to PE were based on an exploitative model where the senior physician owners were already skimming off 20+%. This was known far and wide but ignored by ACEP (see articles from Hellstern, Simon, Bresler, et al in the 1980s). Maintenance of pay levels under a new master doesn't change the original sin of exploitation. PE has certainly stepped up the abuses as you mention by more readily replacing us with NPPs, forced supervision of same, metric burdens and protecting the contract at the cost of physician careers (see Ming Lin). The whole embrace of PE has tarnished EM in the eyes of Congress and the public. It was a Faustian bargain that benefited the few at the cost of many including our patients.