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ACEP Now: Vol 33 – No 08 – August 2014The case for maintaining strict membership requirements for ACEP
The discussion on opening up ACEP membership to non–emergency medicine boarded physicians is not a new one, but it is one that is important to continue. When considering this issue, I feel it’s important to question why a non–emergency medicine boarded physician would want the ACEP affiliation in the first place. The answer is simple: the affiliation means something now more than ever.
When our specialty was in its infancy, there were no “emergency medicine” physicians. There were certainly people who worked in the emergency environment, however, who had the wisdom to recognize the need for something better. Those pioneers saw the need for specific emergency medicine training, and over time, the emergency room became the emergency department, and the specialty was born. Since that time, there has been a marked evolution of what is expected from the emergency department and of those who provide emergency care. We are now the gatekeepers to the hospital and the providers of the bulk of ambulatory care in this country. Certainly, this is a far cry from the emergency room of old.
Our founders had to “learn on the job,” as new doctors in emergency department roles, without the benefit of formal emergency medicine training, are still doing the same thing. Although this is still an unfortunate reality, I do not feel it is in the best interest of the College to support this method of meeting our patients’ needs by endorsing the individuals who did not train in emergency medicine. Emergency medicine training prepares us to work up complaints in a different manner. The ordering of our differential diagnosis is different. Our skill set for approaching problems is different. These differences matter—period. Just because physician shortages force us to accept non–emergency-trained physicians in emergency department roles does not mean that we should fail to recognize that emergency medicine is best practiced by emergency-trained physicians and that those who work in the emergency environment who lack our specialty training are markedly dissimilar from us. On-the-job training is no longer appropriate just as simply passing written and oral exams is insufficient to demonstrate knowledge. To state that ACEP needs to incorporate non–residency-trained physicians into emergency medicine discounts the effort, knowledge, and dedication of emergency medicine–trained residents. It also sets a dangerous standard for the care of our patients.
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3 Responses to “Maintain Emergency Medicine Certification as Requirement for ACEP Membership”
August 17, 2014
edboudreauIt would be helpful to recognize that ACEP is not solely a political organization advocating for those who are being trained by the current model. I believe it short sighted to assert that learning can only occur one way. Training is not the only way to create a mindset and approach to quality. I believe ACEP should be advocating for the physician on the front line at the critical access hospital who was trained as a family physician but felt the pull to do Emergency Medicine. Does ACEP become stronger by excluding that physician from membership or dialogue.To suggest that Emergency Medicine can not be learned any way but the way I learned it is dangerous for our patients and our college. I suggest that those advocating an isolation position walk in the shoes of those they wish to exclude. Probably can’t be done in the halls of a big city academic institution.
Ed Boudreau,DO, FACEP, FAAEM
August 17, 2014
benzonitSorry, Dr.Radtke, but I have to vote for the big tent approach. I come to this position not by reading the words but by watching the actions of leadership.
I am one of those 30 year veterans of the early days. I boarded many years ago and have maintained my knowledge base. I am proud of our specialty and contribute to it in time, talent and treasure.
I noticed over a decade ago that non EM boarded physicians were claiming to be EM boarded by declaring EM as their specialty. (These same non EM boarded physicians deliver babies but do not claim OB/Gyn specialty.) These claims reside on State and Federal sites, including members of FSMB and CMS. ABMS is aware.
The claiming of boarding falsely has implications far beyond our specialty, of course. This is especially dangerous as the site hosting these claims are licensing and governmental. Communication with some of these boards has resulted in nothing, as our official bodies do not object.
Our ACEP has refused to take up the defense of our “trademark.” In this setting, how can we hold both positions? Anyone can claim to be EM boarded, using a governmental site. But our college would refuse membership to the same physicians who claim boards they don’t have.
The cognitive dissonance boggles the mind.
Thomas Benzoni, DO, AOBEM, FACEP
Sioux City, IA US
August 25, 2014
Anoop KumarWhat’s missing in this conversation is the topic of what the core skill is in emergency medicine. Consummate emergency physicians are masters of management as a whole, not just differential diagnosis or doing procedures. Leadership and management define the core of EM, but our residency programs and professional societies have so far not embraced this philosophy. Because we haven’t done so, we are a fractured specialty. We argue over who really is an EP and who deserves to be boarded without being clear on who we are to begin with.
If we embrace this philosophy and act on it, we will take our specialty to new heights as leaders in healthcare. It is something we sorely need in today’s healthcare climate.
I commented extensively on this is an article written last year:
http://www.kevinmd.com/blog/2013/09/leadership-management-define-core-emergency-medicine.html
Cheers,
Anoop Kumar, MD