Dr. Doolittle believes that family physicians and other primary care specialties practicing in rural EDs deserve more respect and collegiality from the field. He would like to see ACEP take a position on the legitimacy of primary care doctors running rural EDs. “At least let’s try to work together more collaboratively,” he said.
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ACEP Now: Jan 01His company, Integritas Providers of Carbondale, Ill., staffs 12 EDs in rural hospitals in the Midwest. Most of its physicians are experienced non-ABEM physicians from various training backgrounds.
“My wish is that emergency medicine residency programs would focus on offering more rural experiences, training the doctors of the future for a potential rural career, and recruiting medical students from rural communities,” Dr. Doolittle said. But, in the meantime, “we need more doctors tonight.”
Larry Beresford, an Oakland, Calif.-based freelance medical journalist, also writes for The Hospitalist and for EMS World.
References
- ACEP. New Indiana bill requires hospital EDs to have a physician onsite. Published May 10, 2023. Accessed December 4, 2024.
- Virginia’s Legislative Information System. House Bill No. 353. Published January 2024. Accessed December 4, 2024.
- Nelson SC, Hooker RS. Physician assistants and nurse practitioners in rural Washington emergency departments. J Physician Assist Educ. 2016;27(2):56-62.
- ACEP. Policy Statement. Guidelines regarding the role of physician assistants and nurse practitioners in the emergency department. Approved June 2023. Accessed December 4, 2024.
- Robeznieks A. Having a physician on site is best way to deliver emergency care. AMA Newswire. Published November 12, 2024. Accessed December 12, 2024.
- Chekijian SA, Elia TR, Horton JL, et al. A review of interprofessional variation in education: challenges and considerations in the growth of advanced practice providers in emergency medicine. AEM Educ Train. 2020;5(2):310469.
- U.S. Department of Health and Human Services. Office of Inspector General. The Emergency Medical Treatment and Labor Act (EMTALA). Last updated September 11, 2024. Accessed December 12, 2024.
- Beresford L. The EM residency program in Corpus Christi resuscitated. ACEP Now. 2024;43(1).
- Rosenberg M. Workforce of the Future. Report of the EM Physician Taskforce. Published March 9, 2021. Accessed December 3, 2024.
- Bennett CL, Clay CE, Espinola JA, et al. United States 2020 Emergency Medicine Resident Workforce Analysis. Ann Emerg Med. 2022; 80(1):3-11.
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2 Responses to “ACEP Takes Firm Stand on Physician Leadership”
January 7, 2025
Nate MinnickThere’s a catch for rural rotations for residents. The ACGME requires for EM:
“Faculty members supervising emergency medicine residents in an adult emergency department must either be ABEM/AOBEM board eligible or have current ABEM and/or AOBEM certification in emergency medicine.”
In the strictest sense, this limits programs from sending residents to sites that could possibly have FM physicians, since it would make scheduling more complicated.
Perhaps the ACEP Rural section can work with CORD to discuss with the ACGME. FM residents could to a rural rotation and work with EM or FM physicians.
January 12, 2025
Michael MenowskyI think this is a great first step for states and ACEP. I know Inwill catching a lot of backlash, but I believe Emergency Departments should be staffed by those trained to work there.
A 2 month of EM rotation during 3 yrs residency, I don’t think provides the knowledge or skills to provide quality, efficient and comprehensive Emergency Care. During residency I was required to do 3 months of Trauma Service, that does not make me a Trauma Surgeon.
With discussions of workforce shortages in EM and that being a factor in recent MATCH numbers, rural EM provides the opportunity for residents post graduation to expand into those areas.
I will leave you with this tale, I received a trauma patient that arrived as a transfer after a motor vehicle collision. The physicians I received the call from, told me he was a “family doctor” and did not know how to do a chest tube. He spotted the large pneumothorax on chest XRay. He stated he just wanted to get them out of the ED and asked if I would accept? Of course I did, the patient arrive in cardiac arrest, as soon as I did a thoracostomy, and 2 more rounds of CPR our team was able to resuscitate the patient. Trauma surgeon arrived and patient went to the OR for other injuries. My question, shouldn’t anyone working in an ED be capable of performing a chest tube, the ACGME requires that and many other to complete an EM residency?