DOI: 10.1097/MEJ.0b013e32830fe97c
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PMID: 18784501
Issn Print: 0969-9546
Publication Date: 2008/10/01
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Excerpt
In the early days, the establishment of emergency medicine residency programs at many academic institutions often faced the hurdle of surgeons or internists who managed ‘emergency rooms.’ They often served as triage agents, consulting other services for primary care in areas where they lacked familiarity. In many localities, academicians in other specialties actively opposed the establishment of emergency medicine residency programs. They perceived physicians with inferior training intruding on their areas of practice and interfering with the training of their residents.
Rampant provincialism led to a mentality whereby many specialists felt only they could manage emergencies within their area of practice. Other specialists felt the only real emergencies were those that they could handle. Some remembered the ‘good old days’ when they moonlighted in ‘emergency rooms.’ Not realizing what they did not know, or unwilling to recognize what they did not know, they became convinced their narrow training and limited experience obviated the need for training in emergency medicine.
Many specialties felt they had a right to control the practice of emergency medicine within the areas of their provincial interest. For example, at Charity Hospital in New Orleans where I spent most of my career, emergency physicians gained the right to perform rapid sequence intubation and procedural sedation only after a 20 year effort to overcome objections from anesthesiology. This delay in the implementation of modern techniques for airway management led to increased morbidity and mortality [4].
Today, emergency medicine in the United States has still faces challenges from a number of other specialties. Some family practice residency programs developed emergency medicine fellowships as subspecialty training programs within the field of family practice. The American Academy of Pediatrics criticizes general emergency departments for a perceived lack of skill in caring for children, and takes the position that hospitals should develop separate pediatric emergency departments. Very recently, a prominent journal in the United States published an article written by a neurologist claiming that emergency physicians lack the skill to evaluate dizzy patients [5].
Emergency Medicine in the United States has made great progress in the past 40 years, but significant problems still remain. By expanding the number of training programs, establishing high academic standards, and adhering to rigorous regulatory oversight, well-trained emergency physicians have populated an ever-increasing number of hospital emergency departments. As a result, residency training in emergency medicine and certification by the American Board of Emergency Medicine defines the emergency medicine specialist in the United States. In many communities, other physicians routinely rely on the expertize of their emergency physicians and routinely refer unscheduled patients to the emergency department for evaluation. As a result, emergency departments in the United States now evaluate more than 115 million patients per year, an increase of 25% in the past 15 years.
Training in anesthesiology or any other specialty does not adequately train a physician to practice emergency medicine. One would never presume to think that training in emergency medicine would prepare a physician to practice anesthesiology. Rather than a provincial outlook, physicians should all appreciate the expertize of colleagues in other specialties.
