Dr. Dark: We noticed over the past couple of years changes in the proportions of residency slots filled, and it looks like emergency medicine is back on track. But one of the observations we have noticed is that a larger number of those slots are being filled by international grads. I’m curious if ABEM has been tracking that and noticed any change in the in-training exam based on those kinds of criteria.

Dr. Gorgas: I think it’s very perceptive, and you’re absolutely correct that emergency medicine residents are now coming from multiple medical school backgrounds. Osteopathic residents traditionally were 10 percent or less of emergency physicians. Now, that number is increasing to the 30 percent range. We don’t know that there is an association, and we have not determined if there is a causation of the expansive number of residents and diversity of residents and the in-training exam and the qualifying exam scores. Again, you can use statistics in many different ways, and I would say that we don’t know if there is a link.

Dr. Dark: One thing that ACEP believes is that the gold standard is to have a board-certified emergency physician in every emergency department. Why do you think that the public should demand that?

Dr. Gorgas: We’re beginning to see publications that show outcomes are different when there isn’t a board-certified physician present. We’re beginning to understand that, and ABEM has published a few articles on it. I’m looking at State Medical Boards, disciplinary actions against physicians, and the fact that if you are board-certified in emergency medicine, practicing in an emergency department, your risk of a State disciplinary action is lower than if you are practicing in emergency medicine and not board-certified. We know that there are some early studies looking at resource utilization and board-certified emergency physicians versus non-physician providers in the emergency department.

There is no doubt that the rigor of the training, the rigor of the testing, and the rigor of continuing certification within emergency medicine is unmatched from a provider point of view in emergency medicine. And we think that ABEM is really the gold standard of that. Every patient should have access to an ABEM-certified physician when they come to the emergency department.

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References

1. ABEM. 2024 ABEM Qualifying Examination Scores.
2. ABEM. EM Model.
3. Gladwell M. Outliers: The Story of Success. San Francisco, CA: Little, Brown and Company; 2008.
4. JACEP Open. Differences in Exam Passing Rates Among Programs.
5. ACEP. ACGME Releases Proposed Changes to EM Program Requirements.