Disposable Doctors 2: ER Docs Fight Back in NY

Posted: February 5, 2007 by Doc in Cartoons, ER Docs, Medical, Medical career

ER cartoon full size

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).

Disposable Doctors 1
American Board of Physician Specialties
US Alliance of Emergency Medicine
News from AAPS vs. NY-DOH

  1. tom says:

    Check out the criteria (ACOEP) for an Osteopath to become Board Certified in ED Medicine-Primary criteria, “must be intersted in EM”. Huge can of worms in my opinion-As I mentioned in a previous post-ABEM Certification demonstrates success on a test and only infers an ability to apply knowledge to to a given circumstance. Imagine being on the witness stand, Q: Dr. X is it not true that in the 12 months you have been working in the ED of Our Lady of Perpetual Deficits that 18% of those patients treated by you died? A:Yes, and I know it looks bad, and given the fact that I have my ABEM Boards I am at a loss to explain why those patients did not do well.

  2. docwhisperer says:

    Tom, as a hospital administrator, would ABEM vs. BCEM ER board certification be a significant factor in determining who would be hired or retained in your ER?

  3. tom says:

    Either would be fine for me, as would certifications in other specialties such FP/IM subject to a review of the individuals experience. My experience has been the bias is not on the part of the hospital administrator, but rather a bias on the Group-We only want certain credentials in our Group. My biggest issues with ED physicians have been with poor behavior with patients, staff and attendings.

  4. scalpel says:

    “My experience has been the bias is not on the part of the hospital administrator, but rather a bias on the Group-We only want certain credentials in our Group.”

    Exactly. Why spend almost $3000 when many elite (read: profit-sharing) ED groups aren’t going to recognize any non-ABEM Certification as equal? Some groups won’t even take non-residency trained ABEM certified docs who were boarded before the practice track closed.

  5. docwhisperer says:

    Yes, because those groups are run by ABEM certified, EM trained docs. As Oprah said, “Why give the power to the people who say ‘NO’ to you?” If BCEM certification is recognized as equal to ABEM certification (as it is in the states mentioned above) you can at the very least sue for discrimination in these states, which is a start. Why else would AAEM be fighting this issue?
    What I see here is a failure of leadership on the part of ACEP (any organization that does not meet the needs of 38% of its constituency is a failure) and a lack of organization and leadership of the non-ABEM non-EM trained physicians. At least ABPS is doing something, trying to provide an option for you. What other avenues are there?

  6. Flea says:

    Thanks for the Link, doc. I was lured over here from PGR. The blog is beautiful. Keep up the good work. You’re Flea’s pick of the week.



  7. 60 months? 12 years seems like a long time to work for a single certification.

    Still, at least something’s being done. Which puts you in a much better place than here in the UK, where 8000 doctors will lose their jobs this year without compensation. America here we come!

    (Oh, and Australia too.)

  8. […] The bill also wants to exclude all the physicians who are certified by the American Board of Preventive Medicine, the American Board of Pain Management, and the American Board of Facial Plastic Reconstructive Surgery all of whom allow non-specialty trained physicians to be certified, not to mention all the BCEM certified emergency room physicians who are not allowed to take the ABMS approved ABEM exams (see previous posts). […]

  9. trenchy says:

    actually ABPM does require residency training and or a masters level degree in the area of study… because of that I cannot be board certified to practice Occupational Medicine… although I am free to hang an Occ. Med. shingle.

  10. docwhisperer says:

    Hi Trenchy:
    Which ABPM are you referring to? The ABPM referred to in the post, is the American Board of Pain Medicine(which has nothing to do with Occupational Med, except peripherally).
    These are their requirements (from the American Society of Anesthesiology website), please note that they do not require a specific residency but have several pathways that include pain management training:

    Another means of attaining pain certification outside the ABMS member board structure is with the American Board of Pain Medicine (ABPM). This physician organization was founded in 1991 with a mission to serve the public by improving the quality of pain medicine.4 It offers a credentialing and examination process leading to the certification of pain specialists.

    ABPM eligibility requirements include:

    Possessing a valid, unrestricted and current license to practice medicine or osteopathy.
    Satisfactorily completing an ACGME-accredited residency training program that includes pain management.
    Currently board certified by ABA, AB Neurological Surgery, ABPN or ABPMR or currently certified by an ABMS member board showing documentation of ACGME-accredited training in pain medicine.
    Completion of two years of pain medicine practice since residency training.
    Minimum of 50 hours of continuing medical education relevant to pain medicine in the last two years.
    Two letters of recommendation with documentation of adherence to ethical and professional standards.

  11. trenchy says:

    american board of preventative medicine

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  15. Blesebiz says:

    hmmmm…very interesting!
    Thanks google

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  19. Bonjour

    I was only looking for images on triage of mental health patient when I came upon your blog and the fascinating drawing you have to image it.

    Could you tell me who is the artist ?



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