Disposable Doctors: Imprudent NY Jurists Side Against Patient Interest

“Affirmed”!

and with that, the NY Appellate Court, seemingly sealed the dismissal of ABPS’s suit against NY-DOH, forcing a possible showdown before the U.S. Supreme Court.

The Appellate Court, gave short shrift to the strong arguments made by ABPS’s lawyer, Mr. Michael Sussman, easily finding for NY State, without reasoning or gravitas.  

Not that the Court needed a reason. You see, actions by this or any state, wherein the regulation(s) involve health education and welfare and not race, gender or nationality, gets subject to a legal analysis called, “rational basis”. And DW wants you to know that “rational” is used loosely, we mean really loosely, we mean even, irrationally.

Here is what occurred;

(1) New York has a physician website that lists doctors as emergency medicine board certified IF they did a residency in emergency medicine,  no problem there,

(2) an organization called ABEM [The American Board of Emergency Medicine, owned by the American Medical Association] lobbied New York to list MDs with its certification as board certified, whether or not they had done a residency in emergency medicine.

(3) the ABPS [American Board of Physician Specialties, certifies experienced ER doctors who have done residencies such as surgery, family practice and internal medicine AND have at least 5 years experience in emergency medicine practice, not owned by the AMA, having a patient first position] sued  because except for the emergency medicine residency requirement, their ER doctors meet and exceed the criteria, permitting the ABEM non ER residency trained to be able to advertise themselves as board certified.

(4) ABPS contended that if the ABEM/AMA doctor did not do a residency s/he should not be listed on the State’s website following the rule. But that if such a doctor certified by its competitor could be listed, then ABPS doctors should be listed as well.

(5) It is even simpler, ABPS said there should be a site where all ER docs should be listed, and in fact the State could list the certifying board, and whether or not an emergency medicine residency was done. ABPS believes that the best ER docs are residency trained in a relevant specialty and experienced with more than five years practice and does not accept the AMA tenet that three (3) years of emergency medicine is enough. Some hospitals agree and have even added another 4th year. However, that still does not trump greater than 5 years of experience.

 A simple and rational argument; if the rule says, you have to be emergency medicine trained to be board certified in new york, ABPS argued, then why are non emergency trained ER docs listed as certified. Was it simply because they had grandfathered certification by the AMA?

All that seems simple enough. And yet, the courts in New York, ruled against the ABPS    essentially aiding and abetting the business of the AMA/ABEM, on the basis that New York’s action was “rational”- The sort of irrational technicality that only lawyers and judges can understand. the sort of irrationality that allows criminals to get away with their crime(s).

DW asks, when did New York get into the business of aiding and abetting bad actors who seek to destroy competitor organizations with complete disregard for patient welfare issues, such as adequate access to Emergency Care?

DW has learned that there are hospitals in upstate New York, that don’t have and cannot recruit any ER doctors. Moreover, superior ABPS ER physicians are excluded from the Emergency Medicine workforce because of the AMA’s predatory action; now assisted by the state.  

DW wonders who the Court would prefer seeing if they had an emergency: a physician trained in a relevant specialty e.g. surgery, medicine, family practice, anesthesiology, pediatrics, with at least 5 years experience as an ER attending such as the ABPS certified physicians; OR, a physician who only completed a three (3) year residency in emergency medicine but was certified by the ABEM/AMA. If the court is confused, ask the patients in Upstate New York, or indeed throughout the state.

PATIENTS PREFER EXPERIENCED AND EXPERT PHYSICIANS, THAT’S JUST COMMON SENSE. 
Unfortunately, as we all know “common sense” isn’t so common, and as it turns out, in NY state, “rational” isn’t rational either.
INCIDENTALLY, A RECENT NATIONAL STUDY HAS SHOWN THAT EM RESIDENCY TRAINING DOES NOT IMPROVE QUALITY OF CARE.  (see EM Residency Training and Quality Measures)

What were the judges thinking? CLEARLY, THEY WEREN’T THINKING FOR THEMSELVES BUT MERELY CHOSE TO LISTEN TO AMA/ABEM TO THE DETRIMENT OF THE PEOPLE OF NEW YORK.

ABMS RESORTS TO STATE BOARD TAMPERING TO BLOCK ABPS PART 2

As promised, this site received and now posts the letter ( ABMS letter to SenCoffee) from Kevin Weiss MD, CEO of ABMS, opposing the Oklahoma Medical Boards final approval for ABPS diplomats to advertise their board certification. On November 18, 2009 a public hearing to recognize the ABPS as another pathway to ‘Board Certification’ for the purpose of physicians advertising their credentials to the public was granted.

 

The problem with Dr. Weiss’s letter was (1)  it was sent AFTER approval was granted by the Oklahoma Medical Board, AND  (2) after receiving the letter it seems that Senator Coffee contacted influential board member(s) per Dr. Kevin Weiss’s influence, and as a result, the Board overturned their properly considered approval of ABPS  and (3) Dr. Weiss’s ABMS’ letter is filled with propaganda and mischaracterizations, which Senator Coffee obviously did not take the time to check out. 

 

This conduct is, at the very least unethical, and possibly actionable, on multiple levels and a response from the Oklahoma Medical Board, Senator Glenn Coffee and ABMS and ABPS to clarify this issue would be much appreciated.

 

 

Board tampering and misconduct are alleged to have occurred during this period by virtue of interference with the medical board’s decision by parties who are not members of the board.

  LINK:

ABMS letter to SenCoffee

ABMS Resorts to State Board Tampering Part 1

Supply of board-certified emergency physicians unlikely to meet projected needs across the U.S.

from: Mass Gen Hospital Press Release:

MGH-led study supports the need for alternate staffing strategies

17/Dec/2008

BOSTON – The number of physicians with board certification in emergency medicine is unlikely to meet the staffing needs of U.S. emergency departments in the foreseeable future, if ever; according to a study from a research team based at Massachusetts General Hospital (MGH). In the December issue of Academic Emergency Medicine, the investigators report finding that staffing every emergency department with board-certified emergency physicians does not appear to be feasible, given their projections for the field.

“Thousands of emergency departments are not currently staffed by physicians with this type of training,” explains Carlos Camargo, MD, DrPH, of the MGH Department of Emergency Medicine, who led the study. “We questioned whether staffing every department with residency-trained, board-certified emergency physicians – which some individuals have advocated for decades – was a realistic goal. So we set out to estimate emergency physician workforce needs, taking into account the diversity of hospitals across the country and projections about the future physician supply and demand.”

The researchers analyzed data from the 2005 National Emergency Department Inventories–USA database to determine the number of emergency departments in the country and their patient volumes. Based on the approximately 22,000 board-certified emergency physicians in practice and the 1,350 who became newly certified during 2005, the team developed three scenarios for physician supply, all of which assumed the same number of new board-certified physicians each year. The best-case scenario, which was intentionally unrealistic, assumed that no board-certified emergency physician died or retired; the worst case assumed an annual attrition rate of 12 percent; and the intermediate scenario assumed 2.5 percent attrition each year.

Having at least one board-certified emergency physician present in all U.S. hospital emergency departments at all times would require 40,000 physicians with such training, indicating that only 55 percent of 2005 demand was being met. Under the intermediate-scenario projection, it would not be possible to meet the goal until 2038, and under the worst-case scenario, the goal could never be met.
*** Even if no board-certified emergency physician ever died or retired, 100 percent staffing of all emergency departments with board-certified emergency physicians would not happen for more than a decade. ***

“The mismatch between the supply and demand for residency-trained, board-certified emergency physicians is a longstanding problem,” Camargo says. “The need for emergency services is large and growing; and even if existing programs graduated more physicians, there is little reason to think more of those graduates would move to the rural areas that are particularly short on physicians with this specialized training. We probably should explore alternatives, such as giving the family physicians who currently staff many U.S. emergency departments extra training in key emergency procedures. We might also increase our reliance on nurse practitioners and physicians assistants, who can help emergency physicians of any training background better handle the continually rising number of patients.” Camargo is an associate professor of Emergency Medicine at Harvard Medical School.

Co-authors of the Academic Emergency Medicine report are Janice Espinola, MPH; Ashley Sullivan, MS, MPH, and John Pearson, MGH Department of Emergency Medicine; Adit Ginde, MD, MPH, University of Colorado Denver School of Medicine; and Ayellete Singer, MA, and Adam Singer, MD, Stony Brook University Medical Center, New York.

Note:
THANK YOU! Now, who will step up and do something about it? It is obvious that the leadership of EM organizations are too preoccupied with protecting their turf, to care whether good emergency care is actually being delivered to the US population. Board certification, which has been used as a “merit badge” of quality, is instead being used to exclude other competent medical professionals from working in Emergency Departments regardless of the detrimental effects on communities.
It would seem that other agencies, perhaps the government (Health and Human Services?) or even the courts will have to come in and act, and their solutions will probably be something that the EM residency trained/ “board certified” docs will not like. But you know what? It will be their own fault for not seeing the big picture. -DW

Comment:
There are numerous physicians likely more skilled than those having completed a residency in emergency medicine, that could be absorbed in the ER workforce and fulfill the nations needs virtually instantaneously. Those docs are methodically being eliminated by restraints on trade that quite frankly echo the charges in ANTITRUST made by Daniel v. ABEM. Imagine, the powers that be would rather have a P.A. or a N.P. [nothing against the care provided by these practitioners] supervised by one residency trained ER physician, than have an experienced, higly trained ER physician certified by AAPS, who in some instances, trained the ER residency trained physician. Thus, this ER “residency” has become manna. But not so fast. The need for this residency was not called for unanimously, far from it. I heard it once said that life imitates art and that the TV show ER probably had more to do with legitimizing ER medicine than any politial sleight of hand that brought it about.

It has become obvious to me that this “ER residency” has been fought for tooth and nail and has become a holy grail so to speak. At the heart of things, the demigods in ER medicine sold the nation, or at least got it passed when no one was looking or even cared, on the need for a “residency” in ER medicine. Note that many specialties disagreed with such a need and opposed the creation of ER medicine as a separate specialty. Initially it was suggested it be a fellowship of general surgery, internal medicine or family practice. As such, training costs would be minimized and manpower issues would be less severe or there would be none. Saved money would be spent on improving 911 care so to speak so that out of hospital care would be improved and not as dismal as some reports now charge.

ER is not like general surgery where one would have to learn operations. So even cross training would not be a problem. Thus, if there was a national emergency there are many physicians that could walk into an emergency room and independently and successfully care for patients. Not so in surgery.

Yet still, the demigods, by attrition, or because of oppositon apathy, won the battle to create what was felt by important medical authorities to be, a relatively insignificant residency. And then the first thing they did was arbitrarily close their practice track eliminating thousands of excellent ER physicians/colleagues from the workforce, resulting in Daniel V. ABEM. I should say, Daniel v. ABEM 1, since the way the ER workforce is controlled by all the outsourced ER service providers [another issue], we will soon see much more litigation, and Daniel v. ABEM 2. We are already poised for a dramatic court case in AAPS V. NYSDOH, wherin AAPS is very likely to win under the legal standard that the NYSDOH lacked rational basis. You may know that under the legal theory of rational basis, States can legislate that a caveman may practice emergency medicine and win, but not so in this current AAPS case.

In AAPS V. NYSDOH case, really a natural outflow of Daniel 1, the opposers to the broader, more inclusive practice of emergency medicine, of course i mean, ABEM, ACEP, AAEM, AMA, ETC…have gone as far as to put their own grandfathered physicians on the line. Because in this case, the grandfathered physicians would have to be removed from the State’s website and unable to call themselves Board Certified in New York State. OR, they permit BCEM certified physicians to be listed on the website.

Dr. Collman in a recent rant on your site, is perfectly right. It is about patient care. And you are right in part, it isn’t a turf war, it is an attempt at monopolizing a market.

The United States would see dramatic reduction in costs, and I am certain an increase in quality of care if they open up the ER market and expand not shrink the workforce. This issue will need to be removed from the hands of physicians, especially those with strong self interest in eliminating equally qualified physicians. Let’s face it, ER medicine is such that just because a physician trained in ER medicine doesn’t make him better than a physician with practice experience that did not. The “residency” should not have gone forward.

Richard Davis ESQ.
Litigation Logistics

Links:
Disposable Doctors 1
Disposable Doctors 2
American Board of Physician Specialties
PUMA MD
US Alliance of Emergency Medicine
Fighting to Level the Playing Field for AAPS docs in NY
News from AAPS vs. NY-DOH
Florida ACEP: “Only EM Residency Trained Docs Should Work in ERs”
Response to Florida ACEP

E.R. Patients Often Left Confused After Visits

By LAURIE TARKAN
Published: September 15, 2008
in the New York Times

A vast majority of emergency room patients are discharged without understanding the treatment they received or how to care for themselves once they get home, researchers say. And that can lead to medication errors and serious complications that can send them right back to the hospital.

Patient Comprehension of Emergency Department Care and Instructions: Are Patients Aware of When They Do Not Understand? (Annals of Emergency Medicine)
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In a new study, researchers followed 140 English-speaking patients discharged from emergency departments in two Michigan hospitals and measured their understanding in four areas — their diagnosis, their E.R. treatment, instructions for their at-home care and warning signs of when to return to the hospital.
The study, published online in July by the Annals of Emergency Medicine, found that 78 percent of patients did not understand at least one area and about half did not understand two or more areas. The greatest confusion surrounded home care — instructions about things like medications, rest, wound care and when to have a follow-up visit with a doctor.

“We’re finding that people are just not prepared for self-care, and that’s what is bringing them back,” said Dr. Eric Coleman, director of the Care Transitions Program at the University of Colorado, who was not involved in the study.

The researchers described a woman in her 20s who went to the emergency room with abdominal pain. After extensive testing, doctors there diagnosed pelvic inflammatory disease, a sexually transmitted infection.

But when interviewed by a researcher, the woman said that she was not aware of any diagnosis, that she did not realize she had been sent home with an antibiotic (she took only the pain medication she was given), and that she did not know she should abstain from sex, tell her partner or have follow-up care.

“The risk is that she could become more seriously ill,” said one of the authors, Dr. Kirsten G. Engel, a clinical instructor at Northwestern University. “It’s a significant risk to her fertility, and she could pass it to her partner.”

Dr. Paul M. Schyve, senior vice president of the Joint Commission, the main organization that accredits hospitals, said: “This study showed that this is much more common than you think. It’s not the rare patient.”

Similar results have been found for patients leaving hospitals, not just emergency rooms. And experts say they help explain why about 18 percent of Medicare patients discharged from a hospital are readmitted within 30 days.

Doctors and patients say that with hospitals pressed to see more patients faster, patients get less attention. “When I start my shift, I know what I’d like to accomplish, but by the end of the shift, my main concern is that nobody dies, and the other things become less important,” said Dr. Michael S. Radeos, research director in the department of emergency medicine at New York Hospital Medical Center of Queens.

Jaleh Teymourian Brahms of Millburn, N.J., ended up in the emergency room after falling face down on a street in Manhattan. “I had pavement embedded in my face and two chipped front teeth,” she said.

After being examined for broken bones (there were none), she waited four hours before she was discharged, with bits of pavement still embedded in her face. Ms. Teymourian Brahms said she received no instructions about how to care for her face. Her dentist had to pick the tar and gravel out with a dental tool, then instructed her on how to clean her face and to keep it moist with an antibacterial ointment.

“I risked a nasty infection had I not seen him,” she said.

Everything is exaggerated in the emergency department. Doctors are harried, they have little time to go over complicated information and they do not know the patients. Most patients are anxious, upset and not likely to be thinking clearly.

“These factors do not make for the best environment for someone to absorb information,” Dr. Engel said.

The problem is particularly acute when it comes to drugs. A patient-education program used in 130 health delivery systems across the country found that about 40 percent of patients 65 or older have a medication error after they leave the hospital. A 2006 report by the Institute of Medicine found that doctors and nurses were contributing to these errors by not providing information in an effective way.

“The physician’s ability to predict whether a patient understands isn’t as good as can be,” said Dr. Rade B. Vukmir, an emergency physician at the University of Pittsburgh and spokesman for the American College of Emergency Physicians.

In the past, patients who did not follow discharge instructions were often labeled noncompliant. “Now, it’s being called health illiteracy,” Dr. Coleman said, adding that as many as half of all patients are considered to lack the ability to process and understand basic health information that they need to make decisions.

But the patient is only part of the equation, he continued; doctors are notoriously inept at communicating to patients.

The new study found that people were not aware of what they did not understand, suggesting that simply asking a patient if he understands is not enough.

“We’re good at saying, ‘Here’s the information, any questions?,’ ” Dr. Coleman said, “and the person nods his head, but they don’t get it.”

Older patients are particularly vulnerable. “They have the kinds of communication barriers we might expect, with vision and hearing problems,” said Dr. Susan N. Hastings, an instructor in geriatrics at Duke. The hectic environment of the emergency department can be particularly stressful for them.

Until recently, poor communication was largely ignored by hospitals. “Just a few years ago, there were subtle incentives for hospitals to not get involved in this area, because of financial gains when people come back,” Dr. Coleman said.

But hospitals are now being forced to face their communication inadequacies. “We’ve raised the bar of what’s expected of hospitals,” said Dr. Schyve, of the Joint Commission. At the same time, the Medicare Payment Advisory Commission, a government agency that advises Congress on Medicare issues, has recommended a policy change that would reduce payments to hospital with excessive readmission rates. It has also asked Medicare to allow hospitals to reward physicians who help lower readmission rates.

Experts in doctor-patient communication recommend a “teach back” approach, in which the patient, preferably accompanied by a relative, friend or caregiver, has to repeat the instructions back to the doctor.

“No matter what you put in writing, what diagrams you have, you really can’t be confident that patients understand what they should be doing unless you have them repeat it back to you,” Dr. Schyve said.

Dr. Vukmir, of the emergency physicians’ group, recommends a “dual discharge” approach: the physician talks to the patient about the results, treatment plan and follow-up care. Then a nurse follows up with computerized discharge instructions.

But Dr. Coleman believes this is not enough. “A third of people over 55 have impaired executive cognitive function,” he said, adding that such patients might understand their medications and know when to take them, but fail to follow through.

He recommends that hospitals coach patients on self-management skills before discharge. Patients need to ask questions, he said. Hospitals should make follow-up calls and visits to patients, a costly endeavor but potentially less expensive than getting reduced Medicare payments if readmission rates are high.

“Hospitals need to have some accountability for the no-care zone, the period between when you leave the emergency department or hospital and when you get into your primary care setting,” Dr. Coleman said. “They should be available for 72 hours.”

Florida ACEP: “Only EM Trained Docs Should Be Working in ERs”

(I am posting this “editorial” from the Floria ACEP EM Pulse mainly because when other physicians tried to respond to this piece in writing, they were informed that their letters would not be published. Therefore, in the interest of free speech and debate, I am offering this space as a forum to discuss the issues. Note: I put the phrases I found interesting in boldface, everything else is Dr. Graber’s.)

from EMpulse September / October 2007
THE EDITOR’S EMERGENCIES
Like it Or Not, The Future is Emergency Medicine Residency Training
by Mylissa Graber, MD, FACEP editor@fcep.org
VP, Florida College of Emergency Physicians

I find it so sad that there are still people that think that someone does not need to be residency trained in emergency medicine in order to begin a career in emergency medicine in today’s day and age. Not only do some physicians think that way, but they actively pursue
legislation to always keep that door open and belittle what all of us have worked so hard to develop: a quality,well-trained emergency medicine specialist, who has been rigorously drilled and tested on a specific skill set that makes them capable of working extremely effectively
in any emergency department, and ready for any emergency situation. Not only do these others continue to fight this, but they do it with half truths about what we are doing and what we are trying to accomplish.

As you all should know, this past year we submitted a bill in the state of Florida to require specialty-specific residency training in order to be recognized as Board Certified in the state of Florida on a go-forward basis,meaning that anyone who has already been recognized
as board certified would still be so, but that from this point on we will close the door to those training in other fields to pursue an emergency medicine career. ABEM closed its doors 20 years ago. ACEP closed its doors eight years ago, and still, even with that, we decided in
Florida that anyone recognized up to now, 2007 or when resubmitted next year in 2008, could still be recognized, but not past that. The bill specifically states that the Florida Board of Medicine could only recognize organizations that require emergency medicine residency training
to enter the specialty as of this year, which means that all AAPS would really have to do to be recognized and end this entire ridiculous continued struggle, would be to shut the door for new diplomats to only those who have completed an accredited emergency medicine residency
program. But instead of doing that, they choose to spend thousands and thousands of dollars to “defeat us” and to continue to push state-by-state to forever keep the door open to non-residency-trained physicians entering emergency medicine. Why?

Two sessions ago we attempted to submit this bill, and I met personally with certain key legislators who could pass the bill through, including one who had sponsored the AAPS bill that failed a few years before. Interestingly, when he heard what we were trying to do,
he agreed completely and said he would support us on this. We met with him several times after and he still gave his support. Then a lobbyist for the “other side,” who apparently had been away, and who had some sort of connection to this legislator, resurfaced and the next
thing we knew, the legislator withdrew his support and we were blocked from filing the bill. Why?
Recently I was talking to a colleague I used to work with, who unbeknownst to me is BCEM certified, not ABEM certified. I knew that he was not EM trained by his practice style, but assumed he had grandfathered in to ABEM and he had never told me otherwise until
recently. I had called him about something else and he told me how he heard about the bill I was pushing and that he had received correspondence from AAPS stating that they needed to fight this bill, because it would result in the loss of his job and the end of his career, etc. He
told me he donated several thousand dollars to help them fight this “cause.” Of course, I had a lot to say about that and was furious, especially because this was blatantly
false and I was upset that as a personal friend he never came to me to inquire about what was really going on. I explained to him that the bill we submitted was not retroactive and that anyone recognized or already practicing would be able to continue to do so, that this is only
about board certification and not employment, and that this was about the future workforce of emergency medicine, not the present, and that no one entering emergency medicine today should be residency trained in anything other than emergency medicine. His response: “Oh,
well I agree with you about that. That’s not what they said. Hmm, I will need to talk to them.” I told him he gave a huge amount of money – I wish we could foster that kind of contribution for any of our other issues -against something he didn’t even agree with, because he
was given false information. He told me he was going to follow up with them, but I haven’t heard anything since. So let’s look into this for a moment. Why would an organization rally up such support from their members based on inaccurate information? And why is it that they
require specialty specific residency training for almost every other specialty except emergency medicine? What is it that is driving them so? Well, a few years ago I visited their website and found out some interesting information.

The vast majority of the new diplomats, who sit for their boards, sit for the emergency medicine boards. It would seem that we may be their “cash cow” and we could easily surmise that if they close their doors to only EM residency-trained physicians, they may be losing significant money, so they potentially have a lot at stake financially. Sad, isn’t it, that it may not be about quality after all? Interestingly, I visited the site again, and you can no longer access this information. I guess they were afraid we might catch on. There is also another website bragging about their success at “defeating” the bill that we sponsored and announcing that they are suing the New York Board of Medicine, that thanks to that they can
continue to be recognized and it states on there that this will “open the door for non-ER trained, non-ABEM certified ER physicians to continue their careers and maintain
their livelihood.”

I still do not understand what they are talking about.The physicians who have been so vocal and intricately involved in their activism and responsible for getting the Florida Board of Medicine to recognize them are far from unemployed. In fact, some of them are leaders of the
community and even directors of the ERs, own groups, etc. One I know of who is very vocal is retired, not even practicing anymore. I’m sorry that 20 years ago they missed the deadline for sitting for the ABEM boards or chose not to because they didn’t think it would matter, but there had to be a cut-off somewhere, and the natural attrition of these physicians needs to take place. The doctor who I know is in absolutely no danger of losing his job.

There are non-EM-trained physicians all over the state that are working in emergency departments and have been for 10, 20, 30 years who have very secure jobs, but
emergency medicine has become very complex, so it is inappropriate for physicians currently training in other specialties to use these alternate routes to enter emergency
medicine and call themselves board certified emergency physicians without doing the appropriate emergency medicine training. The learn-on-the-job approach
with no formal supervision or training is not only antiquated, but in today’s day and age potentially harmful and definitely unfair to our patients.
As the non-EM-trained physicians retire, they should naturally be replaced with
residency-trained emergency physicians. The argument that we will never fill all emergency departments with EM-trained physicians is a ridiculous one. More and more programs are opening up and more and more EM trained physicians are entering the field and several that I know personally have left the academic and urban world to go to some of the underserved and less-populated areas to live and practice. Even so, if a physician who is a family practice doctor chooses to work in these areas in the ED, that is fine, but s/he is still a family practice doctor,not an emergency physician and there is no shame in that.
Just don’t misrepresent who you are.
In the same way,when I do a pelvic exam, I do not tell the patient I am a gynecologist, and when I put in a chest tube, I do not say I am a cardiothoracic surgeon. I’m an emergency physician and I am proud of that. You should be proud of your specialty too.
This fight is not over and we will continue to pursue residency training in EM as the only appropriate pathway into emergency medicine today, but it is time for the emergency medicine residency-trained docs to stop sitting on the sidelines and join this fight. We need your
support too. Don’t assume we’re going to fix the problem and that we will naturally prevail. We need to make our voices heard. Contribute to FLACPAC, write articles,
come to EM Days and visit your legislators at home to push this issue. Feel free to contact me and I’ll put you on a list of people who want to help and let you know how you can get involved. We don’t expect you to give thousands of dollars, but every little bit helps. When you
send your checks to FLACPAC, write residency training on the “for” line. We need to spark the same passion for the importance of residency training in emergency medicine board certification as these other physicians have in undermining our progress. Like it or not, residency training
in emergency medicine is the future. It’s just a matter of time.

LINKS:
Response to Florida ACEP: “No Correlation Between Doctors WhoFailed to Meet Standard of Care and Board Certification”

Supply of Board Certified Emergency Physicians Unlikely to Meet Projected Needs Across the US

American Board of Physician Specialties (ABPS)

Disposable Doctors 2: ER docs fight back in NY

Not So Disposable Doctors
Florida to Say, “Bye bye Grandpa!”
Disposable Doctors 1

An ER Doc’s Top Ten List