When I started practice a little more than a decade ago, I got on staff at our suburban community hospital. With my shiny new diploma fresh out of training, I was probably more than a little condescending, having been taught at the big city academic medical center (BCAMC) where I trained, that REAL cutting edge medicine could only be practiced at BCAMCs.
Fortunately, I was knocked off my ivory tower , brought down to earth, and saved on what would turn out to be many, many occasions, by my favorite ER docs. These guys had battle experience, having worked in big city hospital ERs, they knew the patients, they had smarts, and heaps of common sense. Aside from taking care of a never-ending stream of patients, they also had to constantly beg for admission beds, cajole cranky consultants to come in, and sweet-talk the lab or radiology to speed up that blood test or CT scan. When I got that 2AM call from a wheezy asthmatic, all I had to do was send them to the ER and I could rest easy that my patient would be well cared for until I got there. We were a team, and I never even thought what it would be like without them to rely upon.
So, I was stunned when I heard that these wonderful doctors, who had served our community well for more than 10 years were being fired! Why? you may ask, and I asked the same question. The reason given was that they had not done a residency in Emergency Medicine and did not have ABEM certification! Now, please note that the ER docs in question had done residencies in Internal Medicine and Surgery and had board certifications in these specialties and/or were certified by the ABPS, and more importantly, WERE EXCELLENT ER PHYSICIANS AND HAD DONE AN OUTSTANDING JOB FOR MORE THAN 10 YEARS! Why would the hospital be one day happy with their services, then next day suddenly dispose of them like used Kleenex? Well, apparently the hospital CEO decided (without consulting the medical staff) that he would like to “improve” the ER by contracting with an outside company that would bring in their own doctors, none of whom we knew or ever met, but were ER residency trained and ABEM certified, and they did not hire non-ER trained ER physicians, thus our old ER docs were OUT. It is heart breaking and shameful that after devoting a significant portion of their lives and careers to this hospital and community, our ER docs were dismissed, (as if talented experienced physicians are so easily replaceable), through no fault of their own.
Apparently, this episode is not so uncommon nowadays. Nassau University Hospital planned to fire all of its ER doctors in 2005 and only backed down under pressure from the union. ER doctors in New Mexico and New York have also gotten the same shoddy treatment. I don’t understand this mad rush to replace good ER doctors when there is a supposed shortage of ER physicians and a full 38% of ER physicians in this country are NOT ER residency trained and ABEM certified, approximately 13,000 physicians.
What I also find distressing is that no one is speaking up for my friends. Not the AMA, and ACEP, which is supposed to advocate for ALL ER doctors (not just the ER trained, ABEM certified) has been far from helpful, in spite of their policy which states:
“A qualified emergency physician is defined as one who possesses the training and experience in
emergency medicine sufficient to evaluate and initially manage and treat all patients who seek emergency care. ACEP believes that the ED medical director should be responsible for assessing and making recommendations to the hospital’s credentialing body related to the qualifications of emergency physicians with respect to the clinical privileges granted to them. Such qualifications may include
- -professional credentials such as board certification;
- -objective measurement of care provided;
- -prior training;
- -and evidence of continuing medical education.
Although board certification in emergency medicine is an excellent benchmark that should be considered when delineating clinical privileges,
no single criterion should provide the sole basis for decisions regarding an individual’s emergency medicine practice.” (Approved 1985; Revised 1991; Revised 1995; Reaffirmed 1999; Revised 2004)
Some organizations, such as the EMRA and the AAEM even actively campaign against their non-ER residency trained colleagues. Is this what we’ve come to? No wonder the malpractice lawyers and insurance companies have no problem picking us off. Instead of getting our act together and supporting one another, we are too busy stabbing each other in the back.
To the hospital staff’s credit, petitions were circulated, special meetings were held, and outraged letters to the administration and the press were written, there was much wailing and moaning, but to no avail. My friends are gone, and as one of the other doctors said, “The ER is a strange and cold place” without them. ER care since they left is more fragmented and confused, because the new guys are still on a learning curve and they don’t know the patients or the other docs.
All this has left those of us remaining disgusted and demoralized, but we will recover, and life will go on. Excuse me while I go throw up now.