What do you think?
Rate this book
The Rape of Emergency Medicine
Book by Keaney, James
288 pages, Paperback
First published February 1, 1992
7 people are currently reading
80 people want to read
Ratings & Reviews
Friends & Following
Create a free account to discover what your friends think of this book!
Community Reviews
Displaying 1 - 5 of 5 reviews
November 16, 2023
DNF; didn’t really latch onto what he was saying. Informative, sure, but terribly written
August 10, 2022
Absolute must-read for anyone thinking of going into Emergency Medicine, any new trainee PA or NP, or anyone going into an over-corporatized, commoditized specialty like Hospitalist Medicine. It's best feature is that it has enough humor and is fast-paced enough to keep it from being depressing.
Keaney's book is a tell-all exposé about the formation and amalgamation of ER staffing companies and their ludicrous 40% take of medical care given in emergency rooms, starting in the 1970s. It was released in the early 90s under the pseudonym The Phoenix in order to avoid tremendous political and legal backlash, as the companies, professional organizations, and people described, though given the grace of pseudonyms, are indeed real and easily identifiable.
The story follows a few archetypal ER docs, hospital administrators, staffing company founders, and their supporting cast, and explains how we got from hospitals needing ER coverage to the proliferation of pricegouging underhanded staffing middleman companies. It's paced and deliberate and explains stepwise how these leaches came to exist, spread, and dominate my profession despite bringing nothing to the table and taking such a large cut of the money meant to pay the hospitals and doctors actually caring for patients. I've worked for these companies for years, but still learned more than a few things about how they tick.
My only complaint is that it needs an update. Another 8-10 chapters of harsh reality to continue the history from the 1990s through 2020. Pity, but now that Dr Keaney's real name is on it, he can't possibly write one. Nor can it be published without a pseudonym.
The book stops when the founders of these companies became so rich that they started working together to entrench their golden geese, becoming philanthropists and giving each other honors for their roles in advancing the specialty.
What's happened since then, to my quick limited knowledge, includes: the wholescale corporatization of these staffing companies, now sold to private investment firms; further entrenchment of the parasitic companies in state and federal law as "medical care homes;" the elevation of the hospital administration game from "O-J-Ters" to elite capitalists in the 2010s; the use of PAs and NPs in search of finding a cheaper, more naïve Dr Monk; the spread of staffing companies to hospitalist medicine, teleradiology, emergency psychiatry, teleneurology; the agglomeration of hospital into super-chains like HCA, essentially making hospitals themselves like the doctors in the book - commoditized, carelessly-handled, workhorses for corporate profiteering; downstream effects of ACA, EMTALA, and HIPPAA; the proliferation of standalone ERs; the gaming of CMS and sale of small hospitals; I could go on but this is getting tedious and demoralizing the way the book never was.
If you are in training to become an NP or PA, read this book. If you're thinking about a career as a hospitalist, politician, or especially ER doctor, read this book. It's fast, fun, and very informative.
Keaney's book is a tell-all exposé about the formation and amalgamation of ER staffing companies and their ludicrous 40% take of medical care given in emergency rooms, starting in the 1970s. It was released in the early 90s under the pseudonym The Phoenix in order to avoid tremendous political and legal backlash, as the companies, professional organizations, and people described, though given the grace of pseudonyms, are indeed real and easily identifiable.
The story follows a few archetypal ER docs, hospital administrators, staffing company founders, and their supporting cast, and explains how we got from hospitals needing ER coverage to the proliferation of pricegouging underhanded staffing middleman companies. It's paced and deliberate and explains stepwise how these leaches came to exist, spread, and dominate my profession despite bringing nothing to the table and taking such a large cut of the money meant to pay the hospitals and doctors actually caring for patients. I've worked for these companies for years, but still learned more than a few things about how they tick.
My only complaint is that it needs an update. Another 8-10 chapters of harsh reality to continue the history from the 1990s through 2020. Pity, but now that Dr Keaney's real name is on it, he can't possibly write one. Nor can it be published without a pseudonym.
The book stops when the founders of these companies became so rich that they started working together to entrench their golden geese, becoming philanthropists and giving each other honors for their roles in advancing the specialty.
What's happened since then, to my quick limited knowledge, includes: the wholescale corporatization of these staffing companies, now sold to private investment firms; further entrenchment of the parasitic companies in state and federal law as "medical care homes;" the elevation of the hospital administration game from "O-J-Ters" to elite capitalists in the 2010s; the use of PAs and NPs in search of finding a cheaper, more naïve Dr Monk; the spread of staffing companies to hospitalist medicine, teleradiology, emergency psychiatry, teleneurology; the agglomeration of hospital into super-chains like HCA, essentially making hospitals themselves like the doctors in the book - commoditized, carelessly-handled, workhorses for corporate profiteering; downstream effects of ACA, EMTALA, and HIPPAA; the proliferation of standalone ERs; the gaming of CMS and sale of small hospitals; I could go on but this is getting tedious and demoralizing the way the book never was.
If you are in training to become an NP or PA, read this book. If you're thinking about a career as a hospitalist, politician, or especially ER doctor, read this book. It's fast, fun, and very informative.
August 13, 2022
Aims to be somewhere between "The Big Short" and "The House of God"... Moderate success in that regard.
Not really well written but somehow still entertaining and illuminating on one of the bigger controversies in North American medicine.
Recommended for all aspiring and current EM docs working in the US.
Not really well written but somehow still entertaining and illuminating on one of the bigger controversies in North American medicine.
Recommended for all aspiring and current EM docs working in the US.
January 12, 2023
The books does offer an interesting history of the state of emergency medicine in the 1990's but the author often goes on tangents that he doesn't connect very well; and, unfortunately, the book suffers from men writing about women syndrome with a touch of white people writing about minorities-itis
April 6, 2023
Amazingly still apropos here in 2023.
Displaying 1 - 5 of 5 reviews