I’d like to thank everyone who graciously emailed and expanded my education on this issue (see previous post, “Disposable Docs”) In that post, I asked the question, “Is there no remedy for the situation of my ER friends? Are they and others like them (competent, experienced, non ER trained docs) supposed to just sit on their hands while the powers-that-be decide their fates?”
Apprently not, I’m happy to report that something is being done!
First, a short history lesson for those like me, who are unfamiliar with the ER boards controversy:
-The specialty of Emergency Medicine was first recognized by the American Board of Medical Specialties in 1979. Before this, the Emergency Department was manned by a variety of physicians trained in various fields such as Internal Medicine, Surgery, Family Medicine, and Pediatrics.
- Certification or recognition of expertise in the specialty of Emergency Medicine was achieved by passing a certification exam given by the American Board of Emergency Medicine (ABEM).
The ABEM exam was first offered in 1980. From 1980 to 1988, there were two ways for physicians to qualify for the examination. One could either complete a residency in emergency medicine, or satisfy the requirements of a “practice track” pathway. The prerequisites of this option were 7,000 hours and 60 months of emergency department practice experience, with a specified number of CME credits in emergency medicine.
-In 1988, this alternative pathway or the “practice track” was terminated, sparking considerable controversy and dissension. Some felt that this closure was arbitrary and premature. This act essentially divided emergency room physicians into those who are ABEM certified, whether they had gone through EM residency training or not, and those who are not ABEM certified. Right now, 38% or approximately 13,000 ER doctors in the US are not ABEM certified, and it is estimated that there will not be enough EM residency trained, ABEM certified ER docs for at least the next 10 years according to the Institute of Medicine.
- Lack of recognized EM certification has serious consequences for these physicians in terms of significantly lower compensation and disappearing job opportunities. Limitations on the supply of available ER physicians also has significant consequences on the US Emergency Health Care system, concerns which have been addressed in the IOM report and by the American Academy of Family Physicians.
- The non-ABEM certified ER physicians have fought back. Instead of seeking ABEM certification, which is closed to them, they have acquired certification through the American Board of Physician Specialties examination(ABPS), the third largest multispecialty physician certifying body in the country. This alternative ER certification, called BCEM (Board of Certification in Emergency Medicine) is recognized in Florida, Utah, and Oklahoma, and has been vigorously opposed by groups representing the ABEM certified docs such as AAEM.
In December 2006, the ABPS filed a complaint against the New York Department of Health and Department of Education claiming arbitrary denial of recognition as a legitimate certifying body in New York State.
If they win, hopefully this will be an avenue for non-ER trained, non-ABEM certified ER physicians to continue their livelihood and careers, at least in New York, Florida, Oklahoma, and Utah.
What about the other 47 states? Maybe this will wake up the non-ABEM ER physicians to finally do something before it’s too late.
*NEWSFLASH* Feb 14, 2007
There is currently a bill pending in Florida which states the following:
A physician licensed under this
chapter may not hold himself or herself out as a
board-certified specialist unless the physician has received
formal recognition as a specialist from a specialty board of
the American Board of Medical Specialties or other recognizing
agency approved by the board which requires completion of an
approved residency or fellowship training program from the
Accreditation Council for Graduate Medical Education in the
specialty of certification.
If this bill (which is being pushed by ACEP) passes, it means that ONLY physicians who underwent residency/ fellowship training in a specialty can say that they are board-certified in that specialty. This leaves out all the emergency room doctors who did not do emergency medicine residency, whether they are ABEM or BCEM certified including all the doctors who were “grandfathered” in through the practice track. It also leaves out all the physicians who are certified by the American Board of Preventive Medicine, the American Board of Pain Medicine, and the American Board of Facial Plastic Reconstructive Surgery all of whom allow non-specialty trained physicians to be certified.
What the heck is ACEP doing and why isn’t anyone doing anything about it? Don’t they get that there is strength in numbers? If they were to welcome the 13,000 non-ABEM non-EM trained ER docs instead of fighting these turf wars all over the country, they would actually be able to improve the emergency care in this country (see IOM report).