Practice Track Needed Till EP Shortage Ends
I am a board certified diplomate of the American Board of Physicians Specialties (ABPS). I have practiced emergency medicine for the past 20 years. I have never seen this type of idiocy in any profession other than medicine. (EMN 2010;32:1.) We fight each other as if we are foreign countries. We have the fight of our lives trying to save our way of life as it is with all the Medicare cuts and insurance companies targeting us by cutting our salaries and reimbursements for their own profits.
I don’t think the American College of Emergency Physicians and all the powers-that-be have the patients’ best interests at heart. These people are self-serving and self-absorbed. Their interest is to keep salaries very high for residency trained emergency physicians. These residency trained physicians will never go to underserved areas where they are needed; they will remain around the cultural centers, commanding higher salaries and enjoying the amenities of city living. The underserved areas will continue to suffer, and have a lack of or diminished physician services.
The newly residency trained doctor will not want to work the long laborious night shifts or odd hours, and most likely will not want to work more than the usual work week when the hospital is in a pinch. The hospital will find itself still turning to even more expensive locums coverage. This is what ACEP and its companions want because who will most likely be the locums owner and provider? Probably the same residency trained doctors group or some similar type of arrangement.
These are some of the reasons that ACEP and its companions want to rule out ABPS, family, and internal medicine doctors from working in emergency departments. I don’t think it has a lot to do with training or the ability to work an emergency department at all. I don’t think you can tell a hospital administrator with confidence that a doctor just out of residency is more capable of working in an emergency department than a 20-year veteran emergency physician who has worked more than 4,000 hours a year for 20 years in an emergency department.
I have nothing against residency training. If a practitioner knows when he finishes medical school that emergency medicine is the field that he wants to pursue, then go into an emergency medicine residency. But, like most things in life, nothing is perfect. We finish medical school, chose our paths, and for whatever reasons decide that something else may be more attractive than what we chose. So maybe we find one of those small hospitals that will allow doctors residency trained in something other than emergency medicine to work in the emergency department because of need and because they cannot find a board certified residency trained emergency physician at any price who wants to come to Timbuktu to practice mistake-free medicine because we all know residency trained doctors never get sued and never make mistakes.
No one in emergency medicine wants a practice track, but it is still needed, and as long as there are not enough residency trained physicians to cover our emergency departments, some hospitals will have to use internists or family practitioners to cover their departments. The way to ensure that these physicians have the knowledge of emergency medicine is to offer them certification. If a family practitioner or internist wants to work in the emergency department, ABPS or some other entity should offer testing before the doctor ever works in the emergency department. Maybe an airway clinic or some type of anesthesia course also should be offered prior to the physician working in the emergency department. This would better serve the public and better ensure patient safety than fighting over certification, which only boils down to a fight over money.
My message to ACEP is this: When you can tell me that state regulations will allow your residency trained doctors to drop their malpractice insurance because they are so perfect, I will believe that only residency trained doctors should be in emergency departments. We all have to carry malpractice, which means that the public doesn’t believe in any of us, so to better protect them and ourselves, why don’t we unite and develop solutions that include all of us? There is enough room at the table; visits keep going up, and people keep coming. Let’s quit acting like wolves and pigs, and act like humans who can talk and work things out, and come up with solutions instead these turf battles.
John Stanton, DO
“I have never seen this type of idiocy in any profession other than medicine.”
Thank you for your letter, Dr. Stanton. I would venture to add that not only has “this type of idiocy” not been seen in any other profession except medicine, but the level of abuse and vituperation hurled mainly by AAEM (see Dr. Scaletta’s Nasty Comments) over the decades since ABEM prematurely and mistakenly closed its practice track, even in medicine, can only be found in the specialty of Emergency Medicine, much to its eternal shame.
“Turf wars” occur between specialties on a regular basis. Even now, radiologists and emergency physicians battle over who is qualified to do ultrasounds in the ER; plastic surgeons, ENTs, and ophthalmologists argue over who is best qualified to do eye lifts; Dermatologists and cosmetic surgeons maintain that they should be the only ones who should do botox and restylane injections, the list is endless.
However, most of these other “turf wars” have been conducted in semi-civilized, collegial discourse between specialty groups without resorting to demeaning, occasionally libelous speech which has been the hallmark of the rhetoric of AAEM and its minions.
And instead of healing the rift and seeking solutions for ALL ER physicians, not just the ABEM certified, ACEP has exacerbated the divide by siding with AAEM, making non-EM residency trained physicians like Dr. Stanton even more disenfranchised. This is a failure of leadership and policy that can only be described as tragic.
Fortunately, the American Academy of Family Physicians has stepped into the void left by ACEP and has been more proactive in advocating for the significant number of its members who do practice Emergency Medicine. They also have enough foresight to offer solutions to the EP shortage in the rural areas by sanctioning EM fellowships, which of course, the EM leadership is fighting tooth and nail. (see: EM Fellowships for FPs: Bane or Boon?)
Let us hope that the bullying tactics of AAEM and ACEP do not win the day. The only way to combat this would be to support ABPS and AAFP in its efforts, such as during the Texas Medical Board meeting.