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Emergency medicine is by necessity a group practice, since coverage of any emergency department (ED) of any size requires multiple physicians. The evolution of emergency medicine into a mature specialty has created numerous models of emergency medicine group practice, including physicians employed by or contracted with the hospital, democratic physician groups ranging from single hospitals to multiple sites, sole proprietorships, regional or local groups, and large, multihospital national groups. The type of ED group at an individual hospital varies widely, often because of factors such as the history of the ED at that institution, geographic factors, preferences of the chief executive officer, board, or medical staff, and availability of emergency physician resources within a given geographic area.

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Although it is clear that emergency medicine requires some sort of group structure, the taxonomy of emergency medicine groups has been inconsistently defined and inadequately articulated.1

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Nonetheless, it is common for emergency physicians to have deeply-held views on the best structure ranging from small “democratic groups” to physician groups providing services in multiple states and in specialties far beyond emergency medicine2,3 (Box 88-1).

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Box 88-1 Primary Types of Emergency Medicine Group Structures
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Quality in Emergency Medicine

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Woven into this group structure concept is the notion of emergency medicine as not only an art and a science, but also a business.4 Without question, the primary goal of emergency medicine and the physicians who practice it should always be quality patient care (Box 88-2). Nonetheless the quality patient care itself has multiple definitions and is ever-changing—a moving target. In the past, it was presumed that making the right diagnosis and providing the right treatment constituted “quality.” However, emerging concepts in the healthcare environment5,6 have made it clear that the definition of quality also involves a careful understanding of, and effective and satisfactory response to, the multiple and diverse customers involved in the delivery of healthcare.

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Box 88-2 Vision Statements Should Focus on the Needs and Expectations of the Patients Served

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