Not So Disposable Doctors: Progress in ABPS-NY fight and others

Posted: June 4, 2007 by Doc in ER Docs, Medical career

Fight the power
ABPS NEW YORK UPDATE: If you recall from the previous posts (Disposable Doctors 2, “Fighting to Level Playing Field”),in December 2006, the ABPS filed a complaint against officials of the New York Department of Health and Department of Education claiming arbitrary denial of recognition as a legitimate certifying body in New York State. The motion to dismiss the case will most likely be denied and the case will move forward , unless any machinations by the opposing side derail our efforts. If successful, this case will open the door for non-ER trained, non-ABEM certified ER physicians to continue their careers and maintain their livelihoods in New York. It is critical that there be a show of support from the ER community during the hearing so that the judge can see that his ruling affects so many lives.
The hearing will take place at:June 15, 2007, 9AM, Judge Charles I. Brieant
United States District Court
Southern District of New York
300 Quarropas Street
White Plains, NY 10601-4150
corner of Quirropas and Lexington,White Plains, New York, 6 story red brick building, 2nd floor only judge with court on that floor.
GET INVOLVED, ABPS NEEDS YOUR SUPPORT!
Link: AAPS Reply to Motion to Dismiss

FLORIDA UPDATE: The bill sponsored by ACEP and AAEM in Florida in February, which would have allowed ONLY physicians with residency/ fellowship training in a specialty to say that they are board-certified in that specialty was defeated. This means that Florida (as well as Oklahoma and Utah, and hopefully soon New York and North Carolina) continues to recognize ABPS board certification.

ABPS also successfully defeated a resolution sponsored by the Nebraska board of Medicine and Surgery at the Federation of State Medical Boards (FSMB), an association of state licensing authorities, to recognize the American Board of Medical Specialties (ABMS) as the ONLY certifying board for medical specialties (excluding the AOA, ABPS, and other non-ABMS boards) in ALL states.

The progress made shows that with hard work, vigilance, and organization; it is possible to fight back. The Institute of Medicine report (see Annals of Emergency Med article below) validates the country’s need for non-ABEM, non- ER residency trained ER docs to continue meeting the needs of the public. Thanks and kudos to our colleagues at ABPS and their legal team. But these are only the initial skirmishes, there is still much to be done.

I encourage you to read Mary McKenna’s excellent article: “IOM Report Ignites New Debate on Who Should Practice Emergency Medicine” in the May 2007 issue of Annals of Emergency Medicine.

LINKS:
American Board of Physician Specialties (ABPS)
Disposable Doctors 2: ER Docs Fight Back in NY
Disposable Doctors 1
PUMA MD
An ER Doc’s Top Ten List
United States Alliance of Emergency Medicine (USAEM)
“Tribal Thinking and the Ultimate Confounder”

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Comments
  1. Anon says:

    That’s ironic, because in upstate NY if you go to the ER you are probably going to see a PA or NP.

  2. docnq says:

    These small rural hospital ED’s are being staffed by Nurse practitioners and physician assistants. This is indeed another example of divide and conquer. As a rural practicing physician, when I send a patient to the local hospital, I’m actually sending them to a lower level of care. The regulatory agencies seem to be turning a blind eye.

  3. Ooh. Most of this is way above my puny lecture-theatre-bred head, but I’ve read all the previous posts and agree that this is a terrible injustice (sadly, exactly the sort that the boneheads here in Britain would come up with as well). Plus I like NY. A lot. Due in no small part to it being home to my idol Donald Trump. But, uhm, enough about that. Yeah. The ERpire Strikes Back!

    (God that was lame.)

  4. EM Rez says:

    Your challenge to find a newly EM grad who is better than a non-EM trained doc who has worked in a busy ED for 10 years is flawed for a number of reasons. First, a large number if not the majority of non-EM trained docs do not work in busy EDs. Secondly, how many of the non-EM trained docs are have experience with difficult airways, toxic infants, chest tubes, TPA with stroke and the list goes on. The non-EM docs that are practicing in the ED are not trained in the unique body of knowledge that compromises Emergency Medicine. Is it ethical for a doc to learn on the job? Where is the surgeon getting training in stroke management? Where is the IM doc getting training in chest tube placement or caring for pediatrics? Thirdly, the non-EM docs that are practicing in the ED are not trained in the unique body of knowledge that compromises Emergency Medicine. Is it ethical for a doc to learn on the job? Where is the surgeon getting training in stroke management? Where is the IM doc getting training in chest tube placement or caring for pediatrics? Thirdly, extending your line of reason that experience must count for something, why not let experienced CRNAs sit for the anestheisa boards? Why not let PAs or NPs with 10 years experience in a busy ED have the ability to be board certified in EM?

    I am not trying to undermine the many outstanding non-EM trained docs the practice in the ED. I am not opposed to a standard or certification to distinguish docs who are competent to practice in the ED. There does however, need to be a distinction between the doc who is residency trained in their respective specialty and those who are not.

    The public has an understanding of what a residency and specialty entails. Presenting oneself as boarded in a specialty, when one has not completely residency training in that field is fraudulent in my mind.

  5. Docwhisperer says:

    It is presumptious to assume that just because a physician has not done a formal residency does not mean that he or she does not have the skill set to be competent at their job. Speaking as a physician in practice for over a decade, many of the current skills and knowledge I am currently applying I’ve learned “on the job” due to the fast pace of advancement of medical technology. To think that learning stops after residency training reveals a lack of understanding of real world practice.

    I always thought that the purpose of board certification was to ensure that the physicians practicing in a specialty had the required knowledge and skill base to practice in that specialty. This is because that residency programs do not provide the level of exposure required to become skillful in certain areas. If finishing an ER residency training was all you needed to show that you were a competent ER doc, then why even have board certification at all?

    If it were true that the ER residency trained docs are so superior to the career ER docs, then why not let the career ER docs take the board certification test? Oh, I forgot, they already did that when they grandfathered in all those guys in the nineties. I don’t think there was any difference then, and I doubt there is any difference now since ABEM and ABPS pretty much give the same test.

    It all boils down to politics, with groups like the AAEM trying to artificially raise the salaries of board certified and residency trained ER docs by claiming “shortages” meanwhile ignoring the fact that by their actions, they are injuring the careers and livelihoods of experienced but non-ABEM ER docs and limiting the public’s access to traned physicians in underserved areas. For shame!

  6. EMRez says:

    There is no other training other than an Emergency Medicine residency that can prepare onself adequately for work in the ER. You have not addressed whether you think training in another specialty prepares one for working in the ED. Do you think a residency in surgery, medicine etc. adequately prepares you for seeing pediatric patients? Knowledge can be obtained to most anything, but clinical skills need to be learned in a hands on fashion. How many chest tubes do you think someone with an IM background has done? Do you really think it is ethical for them to learn on the job? I surely hope many of the clinical skills you have learned were done in residency and not on the job due to advancements in “medical technology”. Your comment about learning stopping after residency is completely unsupported. Of course learning continues after residency and it should until the day one retires.

    Nearly every specialty in medicine has a residency. All of the specialties also have boards to pass. Boards exist so to ensure residents have acquired the knowlege base and it acts as a standard to apply to all graduating residents. Boards do not adequately test for skill sets. One could read at length about intubation and know the correct answer for every exam question, but it certainly does not mean they have the “skill base” to perform one. I agree that residency programs “do not provide the level of exposure required to become skillful incertain areas” and these are residencies in surgery, medicine etc.

    If experience counts for so much, why not let NPs or PAs sit for the boards if they have “practiced for over a decade”. Just because they have not done a formal residency “does not mean he or she does not have the skill set to be competent at their job.”

    I find it interesting that ABEM and ABPS give “pretty much the same test”. Now that is presumptuous! (unless you have taken both tests several times or write questions for both the exams). How can you make that conclusion?

    I agree that this issue largely does boil down to politics. ABPS is trying to dilute the specialty of Emergency Medicine by creating their own board certification process. ABEM already exists and is recognized nationwide. Just because a physician chooses not to practice in the residency in which they were trained is not reason to create another set of boards. There is no shame in trying to maintain the integrity of a specialty.

  7. docwhisperer says:

    You seem to be confused regarding the comparisons being made. The ABPS diplomates are IM/ FM/ Surgery grads who have WORKED IN ERs FOR 10-15 YEARS, not new grads which you seem to be comparing with the new EM residency grads.
    The IM/ Surgery residency itself does not prepare docs to see kids, it is the 10-15 years of having worked in the ER and seeing thousands of kids that does. I also argue that the EM residency by itself does not sufficiently prepare one to see children, otherwise why is there a special Pediatric ER specialty (which is a fellowship, not a residency). And what about the FM grads who already see kids?
    Your other points are the same tired argument espoused by the minions of AAEM (American Academy of Emergency Medicine), which thankfully are not shared by other ER organizations. (see the ACEP position statement, “The Role of Legacy EM Physicians in the 21st Century”
    link: http://www.acep.org/webportal/PracticeResources/PolicyStatements/certcred/legacyep.htm )
    which specifically states
    ” ACEP acknowledges that legacy emergency physicians, by virtue of their primary training and emergency medicine practice experience, play an important role in the current emergency medicine workforce and patient care safety net.

    ACEP supports the efforts of legacy emergency physicians who seek additional training and continuing medical education to enhance their ability to provide high quality patient care.

    ACEP believes that the quality of care delivered by legacy emergency physicians should be a primary determinant of their hospital privileges and credentialing. Legacy emergency physicians should be subject to the same quality standards as ABEM/AOBEM certified emergency physicians. Legacy emergency physicians should not be forced out of the workforce solely on the basis of their board certification status.”

    I find it interesting that your concept of maintaining the integrity of a specialty involves excluding the very people who helped create that specialty in the first place. We live in sad times for medicine indeed.

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