First, The News: 

ACEP members will now, under some circumstances, be able to put FACEP behind their name, even if they haven’t passed the certifying exams administered by ABEM or AOBEM. That was the decision reached by the Certification Section of the American College of Emergency Physicians and ratified by the ACEP Council at the October Scientific Assembly in Seattle. The criteria for fellowship status are more stringent for LEPs (non-ABEM/AOBEM certified or so-called ‘legacy emergency physicians’) than for ABEM certified members, explained John Newcomb, MD, co-chair of the Certification Section. “Specifically, it requires ten years of active involvement in EM as the physicians chief activity (rather than three), exclusive of training and it requires either active involvement in state ACEP or National ACEP plus two additional activities.  ABEM certified members can meet any three of ten approved activities (not necessarily related to support of the College).”

 

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Free at last, free at last!
by Sonny Saggar, MD

President of the United States Alliance of Emergency Medicine (USAEM)

 

The passage of Resolution 11(07) by the American College of Emergency Physicians, on October 7th 2007, was as important to the specialty as granting universal suffrage was to women, and as abolishing slavery was to African-Americans. It is by no means the end of prejudice, as many have commented, but it is a start.

 

The prejudice has been going on arbitrarily against those physicians who had been unceremoniously excluded from the practice track for taking the ABEM, when many of their colleagues, who were perhaps only weeks or months less experienced but were somehow deemed ‘unqualified’ to be eligible to sit for their boards with ABEM. With no door open to ABEM, they either took no EM boards, or they took the equivalent board BCEM, as administered by another board certifying authority. Why do some folk not recognize BCEM, when BCEM diplomats and practice-track ABEM diplomats have exactly the same training and experience? They refuse to answer. The answer is self-preservation, a closed-shop mentality, and their infamous attempts to arbitrarily reduce the true number of emergency physicians, and thus increase their salaries by suddenly becoming a commodity in short-supply.

Just like a true feminist has nothing against men, or like a civil rights activist has nothing against Caucasians, those of us who have been campaigning for equality amongst those who have the same competency levels in our specialty, have nothing against those who are residency trained in emergency medicine. Many of these fine physicians, who did emergency medicine residency training, feel like we do, that the litmus test is in the ability, not in the curriculum vitae. As long as the physician has a medical license; as long as the physician knows how to manage an airway, a tPA requiring CVA, a STEMI, a child with meningitis, all the orthopedic emergencies, and so on, then it should not matter whether he completed his formative residency training in family practice, internal medicine or emergency medicine. The ability I am talking about is REAL and developed without the sheltered environment of a residency program attending looking over you; it is not practiced in a simulator as some would try to mislead you. It is developed in the real world.

Most authors of the textbooks, used as companion ‘bibles’ in emergency medicine residencies were written by physicians who completed training in family practice or internal medicine. Surely if there is an 800 pound gorilla in the room, there it is.

Let us sit down and reason together, with a good dose of civility and patience, the following questions:  How do we propose to staff every ED in one state, much less the entire country, with all emergency medicine residency trained (EM-RT) physicians? What method should we use to gauge or insure competency if you cannot staff every ED with EM-RT physicians? When do we expect to be able to staff every ED with all EM-RT physicians?What data are we using for our responses to the above?

 

I am aware that a certain organization, competing at any cost for members, and which was appropriately snubbed by ACEP when a merger was proposed earlier this year, will try to exploit the good judgment of ACEP (which has 6 times the membership population) by declaring that such an announcement of equality (the passing of Resolution 11) is unfair to the EMRT physician. It is not. This is like declaring that a confederate state/academy will not ratify the abolition of slavery, and so all the slave masters are welcome to do business there, and the slaves be damned, “because they’re just not proper citizens anyway”.

 

Dr. John Rupke, one of the founders of ACEP, spoke during the deliberations in Seattle, at the ACEP Scientific Assembly. It is important to be aware that ABEM was founded by ACEP, not by AAEM or any other pretender to the House of EM. Dr. Rupke once supported Board Certification in ABEM as a requirement for FACEP. He admitted to making a mistake in Ref. Comm. Hearings and that that mistake was in tying Fellowship in ACEP with ABEM certification.

He stated he made the bar too high for FACEP. At that time all that was required for FACEP was ACEP membership and ABEM certification. He did not have the foresight to see that this would someday pit EP against EP within ACEP. He was not involved in the closure of the ABEM practice track.

Let’s assume for the sake of argument, that the Gold Standard of the future is emergency medicine residency training. There are no good people or bad people in this debate. There are only those living in the present reality (ACEP) and there are other organizations living with some delusions. We must do what is best for our patients first, not what is best for our salaries by arbitrarily making announcements that lead to the erroneous conclusion that there is a shortage of emergency physicians. This is an artificial and deliberate deceit. Finally, an organization should work hard for the betterment of ALL its members and their charges – our patients. Unfortunately some have seen fit to spend the bulk of their members’ dues money on futile legal battles challenging free enterprise and the American way of life. There is no other valid emergency medicine organization for physicians other than the American College of Physicians.

I am proud to be a member of the only professional organization that continues to defend all emergency physician specialists, regardless of their curriculum vitae, who have demonstrated proven ability in the field, not in a sheltered academic fishbowl.

 

We must defend our standards

by Tom Scaletta, MD
President of the American Academy of Emergency Medicine (AAEM)

 

AAEM defends the public expectation that emergency medical care ought to be delivered by a specialist in emergency medicine defined as a physician with ABEM/AOBEM certification (or eligibility). Since the practice track closed two decades ago, becoming board eligible requires completion of an approved emergency medicine residency program. Self-learning emergency medicine is past history. Board certification is a non-negotiable prerequisite for AAEM fellowship. Certainly, it would be a disservice to the public and disrespectful to those who achieved legitimate board certification for AAEM to abandon this position.

Acceptance into an emergency medicine residency is a privilege for those at the top of their medical school class and believed to be psychologically and physically suited to rigors of our profession. Accredited emergency medicine training programs carefully select candidates and then provide
direct training over the course of several years to assure each is ready for independent practice upon graduation. This process is highly effective. If one discovers a passion for practicing emergency medicine after completing another program, the solution is to reapply and retrain.

The AAEM website lists several research articles, covering trauma, cardiology, and airway management, that conclude formal emergency medicine training improves safety. Thus, it is no surprise that emergency medicine liability insurance providers demonstrate a significant risk reduction with ABEM/AOBEM certified physicians.

 

The founders of emergency medicine, those who essentially “created” the specialty, deserve our deep gratitude. They introduced emergency medicine training programs and made plenty available by the time the practice track closed. In fact, our highest honors include the David K. Wagner Award and Peter Rosen Award, who’s namesakes are such leaders. AAEM does not discriminate against those certified via the ABEM/AOBEM practice track even though we will not reconsider this pathway.

 

AAPS advocates promote their alternative board using the argument that there is an undersupply of emergency physicians. They convey concern that low-volume, rural emergency rooms cannot generally attract a full complement of ABEM/AOBEM certified physicians. AAEM recognizes that certain regions may lack emergency medicine specialists as well as other specialists. Certainly a primary care physician willing to cover the emergency department may be a second tier option.

 

Even though the fifteen-year-long Daniels suit, filed on behalf of those adversely affected by ABEM’s decision to close the practice track, was dismissed last year, relentless challenges by the AAPS continue. Though they failed to be recognized in Florida (Senate bill derailed in 2005) and North Carolina (rejected by the Board of Medicine in 2006), this year the AAPS wants to take the New York Department of Health to court because the AAPS alternative board is not acknowledged on a public website.

 

Raising and maintaining the quality bar is a public expectation in professions that have many lives at risk. Imagine the notion that someone who has mastered Microsoft Flight Simulator ought to be interchangeable with an FAA-certified commercial pilot. It’s inconceivable. I am proud to serve a professional organization that continues to defend ABEM/AOBEM certification as today’s standard.