The case for maintaining strict membership requirements for ACEP
The discussion on opening up ACEP membership to non–emergency medicine boarded physicians is not a new one, but it is one that is important to continue. When considering this issue, I feel it’s important to question why a non–emergency medicine boarded physician would want the ACEP affiliation in the first place. The answer is simple: the affiliation means something now more than ever.
When our specialty was in its infancy, there were no “emergency medicine” physicians. There were certainly people who worked in the emergency environment, however, who had the wisdom to recognize the need for something better. Those pioneers saw the need for specific emergency medicine training, and over time, the emergency room became the emergency department, and the specialty was born. Since that time, there has been a marked evolution of what is expected from the emergency department and of those who provide emergency care. We are now the gatekeepers to the hospital and the providers of the bulk of ambulatory care in this country. Certainly, this is a far cry from the emergency room of old.
Our founders had to “learn on the job,” as new doctors in emergency department roles, without the benefit of formal emergency medicine training, are still doing the same thing. Although this is still an unfortunate reality, I do not feel it is in the best interest of the College to support this method of meeting our patients’ needs by endorsing the individuals who did not train in emergency medicine. Emergency medicine training prepares us to work up complaints in a different manner. The ordering of our differential diagnosis is different. Our skill set for approaching problems is different. These differences matter—period. Just because physician shortages force us to accept non–emergency-trained physicians in emergency department roles does not mean that we should fail to recognize that emergency medicine is best practiced by emergency-trained physicians and that those who work in the emergency environment who lack our specialty training are markedly dissimilar from us. On-the-job training is no longer appropriate just as simply passing written and oral exams is insufficient to demonstrate knowledge. To state that ACEP needs to incorporate non–residency-trained physicians into emergency medicine discounts the effort, knowledge, and dedication of emergency medicine–trained residents. It also sets a dangerous standard for the care of our patients.