Dr. Radtke correctly identifies that “there is a distinction between being an emergency medicine physician and being a physician who practices emergency medicine.” (Bold added for emphasis.) Emergency physicians who are residency trained in EM are true specialists in EM. Maybe we need new terminology to make this clear, but most physicians, and certainly most patients, care less about titles than competence. For example, rural EDs are still dependent on physicians who trained in family medicine, and many of these physicians are family physicians who provide emergency care who don’t care about a title. They think of ACEP as an elitist organization. Dividing the workforce of EM into categories of us and them is not a new idea, and it is part of the reason that the history of EM included a stage where there was intense controversy over who was an emergency physician.

Emergency medicine has expanding scopes of practice, many of which include on-the-job training (eg, critical care, hospitalist medicine, palliative care, urgent care, etc.). But the phrase “on the job training” is a dysphemism that minimizes many important issues in medical education. Lifelong learning is crucial for all physicians, and unlike the pioneers of EM in the 1970s, many of whom did not complete a residency, the majority of non-ABEM-boarded EP’s are residency trained in other specialties.

Both Dr. Smith and Dr. Radtke alluded to the workforce data that compel us toward more evidence-based workforce policies. The 2006 Institute of Medicine report on EM made it clear that more collaboration with other specialties was essential to meeting rural EM needs. Physicians who provide care in rural EDs make up a small percentage of the workforce but are almost completely excluded from mainstream EM (academic and organizational). “Improved access to high-quality emergency care for all acutely ill or injured patients across the entire United States” needs to be our goal.⁴

EM is now a well-recognized specialty, and adolescent angst about “turf wars” should be part of our past. As our specialty evolves to include broader scopes of practice, we need all physicians who provide emergency care to be part of our organization. As Rick Bukata recently wrote: “We need ALL emergency care physicians to be involved in ACEP for the sake of EM advocacy…Let’s follow the lead of other medical societies…[that] allow some sort of membership for non-boarded physicians. It’s also the right thing to do because we need to provide more support to our colleagues working in rural areas…It makes practical, fiscal sense, and it’s the right thing to do.”⁵