When I was a medical student, I considered family medicine (FM) as a residency, but I wanted to be able to treat emergencies and keep up with the latest in life-saving techniques. My faculty and mentors in the family medicine world told me, “It’s OK, you can do an FM residency but still moonlight in the ED.” As I got closer to declaring my residency desires, I found by talking to more and more EM physicians that that advice was not entirely accurate. Sure, a family doc could moonlight in a small, rural ED. But if I wanted to treat trauma, overdoses, arrests, and higher acuity, EM was the only preparation that would get me there. I committed to my specialty. Why should those who did not commit to our pathway reap the benefits?

Should we extend membership in 2014? Well, perhaps.
Does the American College of Surgeons have non-surgeons as members? Doe the American College of Physicians have non–internal medicine docs in their membership? They do…as affiliate members only, according to their sites. I would be OK with ACEP allowing non-EM docs to join our membership, but as observers. If ACEP would extend affiliate membership to non-EM docs, I think that’s not unreasonable. However, it should be clear that such membership would never lead to Fellowship or voting privileges. These stipulations should be codified unambiguously. Otherwise, my vote is a resounding “no.”

If so many are concerned that there aren’t enough emergency physicians to man the rural EDs, maybe we need to increase the number of EM docs. Maybe the medical students that have interest in FM/IM and EM should consider committing to one specialty or do a dual residency.

I also would like to suggest a policy idea for ACEP to champion: Perhaps, if safety/quality is the big concern, as intimated by the “pro” article in this month’s ACEP Now, maybe there should be a rating system for EDs, like there are for trauma centers.

As an example, Level 1 would be an ED where the public knows that each and every physician working in that ED is a board-certified or board-eligible emergency medicine specialist. Level 2 would be where greater than, say, 80 percent of the physicians are EM boarded or eligible. Level 3 is an ER from the past where there may be good physicians working there, but they are not held out to the public as emergency physicians. Trauma goes to non trauma centers, but there is recognition that the more severe trauma should divert or be stabilized & transferred. Just a thought…