Respectfully,

—Larry Goldhahn, MD

What’s missing in this conversation is the topic of what the core skill is in emergency medicine. Consummate emergency physicians are masters of management as a whole, not just differential diagnosis or doing procedures. Leadership and management define the core of EM, but our residency programs and professional societies have so far not embraced this philosophy. Because we haven’t done so, we are a fractured specialty. We argue over who really is an EP and who deserves to be boarded without being clear on who we are to begin with.

If we embrace this philosophy and act on it, we will take our specialty to new heights as leaders in health care. It is something we sorely need in today’s health care climate.

I commented extensively on this in an article written last year: http://www.kevinmd.com/blog/2013/09/leadership-management-define-core-emergency-medicine.html.

—Anoop Kumar, MD

It would be helpful to recognize that ACEP is not solely a political organization advocating for those who are being trained by the current model. I believe it short sighted to assert that learning can only occur one way. Training is not the only way to create a mindset and approach to quality. I believe ACEP should be advocating for the physician on the front line at the critical access hospital who was trained as a family physician but felt the pull to do emergency medicine. Does ACEP become stronger by excluding that physician from membership or dialogue. To suggest that emergency medicine cannot be learned any way but the way I learned it is dangerous for our patients and our college. I suggest that those advocating an isolation position walk in the shoes of those they wish to exclude. Probably can’t be done in the halls of a big city academic institution.

—Ed Boudreau, DO, FACEP, FAAEM

I’m personally against allowing non-emergency medicine–certified physicians acceptance into the College.

Why can’t I get acceptance into the American College of Surgeons? Or Cardiology? There are plenty of regions throughout the country that are in need of specialists and the services that they provide. This is hardly a problem unique to ER and, pardon my sarcasm, a lousy reason to allow someone admission into what is supposed to be a crowning achievement.

I’m a pretty smart guy. I know my anatomy, I am procedurally adept, and I learn fast. Furthermore, all specialty books and procedures can be found online on YouTube. I can learn on the job just like anyone else. So why can’t I just start practicing?