Emergency medicine in the state of Utah, and especially along the Wasatch Front (Provo to Logan), had traditionally been provided by independent groups of emergency physicians covering one or two hospitals in long-term business and professional relationships. Dealings between emergency groups had generally been very cordial and collegial. High quality, ethical emergency medicine practiced by physicians who remained strongly independent had been the norm in Utah hospitals since the birth of the specialty.

As healthcare changed radically in the 1990's, it became apparent that small independent groups of emergency physicians were becoming increasingly vulnerable. Pressure could be brought to bear by hospital ownership organizations, by insurance carriers, by large, predatory multi-state contract holding groups and others. Practicing high-quality and ethical emergency medicine was no longer a guarantee that a contract would be safe and that compensation would remain fair.

Certain emergency physicians who had spent their entire careers in Utah came to realize in retrospect that they had been blessed to practice in an almost ideal medical and professional environment. Excellent patient care had always been the yardstick, good relations with hospital administrators was the norm, and essentially all decisions affecting the medical and business aspects of their practice were made by the physicians involved, not dictated by outside managers. It was becoming increasingly obvious that if this professional environment were to continue, changes would need to be made. Emergency physician groups in Utah would need to get bigger in order to get stronger and retain their autonomy.

The first attempt at exploring a merger of Utah emergency physician groups began in the mid 1990's, when James Allred, MD, took the initiative. He contacted key emergency physicians along the Wasatch Front, and organized meetings with individuals representing many of the hospital emergency departments in the Salt Lake and Ogden areas. These doctors hired an outside facilitator to help develop a business structure that would be conducive to a merger, and an extensive business plan was written. For a variety of reasons this initial effort failed, but the seed had been planted.

In the fall of 1998, meetings resumed to see if a simpler, more streamlined structure could be developed which would still reasonably meet everyone's needs. The guiding principles were to create an entity that would make it easier to improve patient care, allow the best integration of business and administrative functions, and still retain maximum independence at each hospital site. Although many groups were invited to attend, the emergency physicians who ultimately committed themselves to finding the best merger solutions were affiliated with CarePlus Physicians, Western Emergency Physicians (WEP), Utah Emergency Specialists (UES), and Total Emergency and Ambulatory Medicine (TEAM).

Representatives from these groups met at least twice a month for more than a year discussing details, debating philosophies, meeting with legal and financial advisors, and making the hundreds of sometimes difficult decisions that were required to complete the goal. Terri DeJohn, MD, acted as chair of the organization committee, and provided outstanding leadership. By the fall of 1999, after a great deal of work, all parties signed a basic operating agreement and Emergency Physician's Integrated Care became a reality.

The goal of those who set out to form EPIC was to create a business and professional structure that would continue far into the future, based on the concepts of excellent clinical medicine and fair, democratic dealings among equal partners. The idea was not to form a business structure that would be "sold" at a later date to an outside management group, providing a financial windfall for current partners while seriously hindering those physicians left behind. Our intent was to form a organization which would offer the newest emergency medicine residency graduate, and those doctors who will enter our specialty in the future, the same independent opportunities, challenges and rewards that had been available to the earlier generation.

EPIC is a work in progress. Many obstacles have been negotiated, and many more are yet to be addressed. Difficulties and challenges remain. Working together, as equal partners in an atmosphere of mutual respect and trust, we fully intend to achieve our goal of a medically excellent, financially stable and thoroughly integrated democratic group of independent emergency physicians.