The following is an eloquent response to the EM Pulse Editorial “Like it or Not, The Future is Emergency Medicine Residency Training”
BCEM vs. ABEM controversy: “Why Can’t We All Just Get Along?”
by James Meade, M.D., BCEM
I am a life member of ACEP, FCEP, the AMA and the FMA, as well as being a member the American Association of Physician Specialists, and certified by the Board of Certification in Emergency Medicine. However the following are my own personal views and not those of any organization that I belong to.
The continuing controversy over board certification ABEM v BCEM is counter productive and serves no good purpose. I find it baffling since we all have the same goals: to improve the practice of emergency medicine. The Florida Board of Medicine after a 3 year study, decided that “The American Association of Physician Specialists (which includes the board of Certification in Emergency Medicine) is a legitimate and bone fide organization … and …should be granted approval as a specialty recognizing agency’
This has been challenged 5 times by the FMA, FCEP and ACEP and the Board has confirmed its original decision in each case, even though the composition of the board has almost completely changed during that period. The FMA apparently gave up the battle, but FCEP has not. Other approaches have been tried, such as writing ABEM into the statutes. A short lived attempt was tried during the last session to require that EMS medical directors be emergency medicine residency trained. A hearing before an administrative law judge recently reaffirmed the decision of the Board of Medicine. All of these efforts have accomplished nothing and just waste time and money, on both sides which would be better spent elsewhere.
Dr Frederick Blum, past president of ACEP in a recent letter to the Section on Certification states “I understand why many of you sought certification with BCEM. In your position I would have done the very same thing. (Dr. Blum is not residency trained in Emergency Medicine). I will support your right to do so and your rights as members….and your ability to practice unfettered. My actions, and those of Dr Suter before, back those words up”.
Dr Brian Keaton, president of ACEP has stated that “Legacy physicians (that is emergency physicians who started practice before 2000) fill a valuable role and I commend those who strive to improve their ability to practice the highest quality emergency medicine. Preparing for and passing BCEM may be an excellent way to accomplish that end ACEP is on record as being supportive of this group of members.”
I believe that we have the same mission in mind: to improve the practice of emergency medicine. Now it is stated that all emergency physicians should be residency trained and ABEM certified… This is a utopian idea. Let us look at the numbers.
There are 23,818 members of ACEP as of March of this year, of which about 19,000 are ABEM Boarded, but not necessarily residency trained. Not all ABEM boarded physician belong to ACEP. The remaining 5000 are either BCEM or have other specialties certifications. There are about 32000 full time equivalents practicing emergency medicine in the USA. According to the most recent workforce study. That means that there are about 13000 non ABEM certified physicians practicing, some of whom are not boarded in any specialty.
Last year there were 154 emergency programs with 1,244 graduates of EM residencies in the United States; this year there will be 1,251. That means it will take 10 years before there are enough ABEM boarded (not all of whom have EM residencies) to fill all of the available positions. Although there are a number of new programs who are coming on line, their contribution will be small in relation the total number, and we still have not factored in the attrition rate which about equals the number of new graduates. For instance The Sterns survey found that 40% of emergency physician have considered leaving the field due to mal practice and other concerns. In Florida last year over half of the graduates form Florida EM Residencies promptly left after graduation this year and went to less stressful environments.
It will be well over 12 years before we have enough residency trained physician to completely cover the available positions. What we should concentrate on at this time is to improve the status of that non residency trained who are training in other specialties
In reviewing disciplinary cases that come before the board, I see no correlation between doctors who have failed to meet the standard of care and board certification.
What we are trying to do at the Board of Certification of Emergency Medicine is to improve the practice of this specialty by setting up rigorous standards to certify those physicians who do not qualify for ABEM and who cannot take a residency.