
Emergency medicine training has incorporated more rural rotations to give EM residents some exposure to rural medicine and rural life, Dr. Jameson noted. But he wondered if there could be some kind of carve-out in these mandates for very low-volume facilities, an exception to ACEP’s aspirational standard.
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ACEP Now: Vol 44 – No 01 – January 2025Could the affected professional societies come together to define and advocate for training programs to better prepare PAs and NPs for the rural ED, given the reality that many rural hospitals now employ them without direct physician involvement? “We should at least advise that they need more training and help define that training,” Dr. Jameson said. And could telemedicine from urban centers provide more short-term support for the unsupervised clinicians that are already out there?
Family Physicians Want More Respect
The laws in Indiana and Virginia state that EDs should be staffed with a licensed physician, without requiring that physician to be board certified in emergency medicine. Rural hospital advocates point out that many of the physicians now working in rural EDs are family medicine doctors—and they bring invaluable skills to those settings.
Non-emergency-medicine physicians who work in EDs, typically family practice physicians, are actually really good at it,” Dr. Parker said. “I’ve worked with them.”
Dan Doolittle, MD, was trained in family medicine, served in the Air Force, and then, 30 years ago, started practicing emergency medicine exclusively. He deliberately sought out a career in a rural setting.
“I came to Southern Illinois, where I could buy land and raise my kids on that property,” Dr. Doolittle said. He grew comfortable practicing rural emergency medicine and opted not to be “grandfathered” into board certification when that was offered by the American Board of Emergency Medicine (ABEM) based on hours of clinical practice.
Recruitment of residency-trained emergency physicians to critical access hospitals can be incredibly difficult, Dr. Doolittle said. Many emergency physicians did their residencies in urban programs and are reluctant to move to rural areas to work in rural hospitals. Sometimes these physicians are uncomfortable being the only doctor in the hospital, perhaps in the whole county, during their shift.
“I get that. They’re really smart and trained in trauma medicine. They enjoy the fast pace, and they typically work eight-, 10-, 12-hour shifts in busy EDs,” he said. They have built relationships with their colleagues and hospitals. A rural EM service, by contrast, might ask them to work 24- or 36-hour shifts, which includes time for sleeping, Dr. Doolittle said. “In rural emergency medicine, we sell a whole different product—with a different pace.”
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2 Responses to “ACEP Takes Firm Stand on Physician Leadership”
January 7, 2025
Nate MinnickThere’s a catch for rural rotations for residents. The ACGME requires for EM:
“Faculty members supervising emergency medicine residents in an adult emergency department must either be ABEM/AOBEM board eligible or have current ABEM and/or AOBEM certification in emergency medicine.”
In the strictest sense, this limits programs from sending residents to sites that could possibly have FM physicians, since it would make scheduling more complicated.
Perhaps the ACEP Rural section can work with CORD to discuss with the ACGME. FM residents could to a rural rotation and work with EM or FM physicians.
January 12, 2025
Michael MenowskyI think this is a great first step for states and ACEP. I know Inwill catching a lot of backlash, but I believe Emergency Departments should be staffed by those trained to work there.
A 2 month of EM rotation during 3 yrs residency, I don’t think provides the knowledge or skills to provide quality, efficient and comprehensive Emergency Care. During residency I was required to do 3 months of Trauma Service, that does not make me a Trauma Surgeon.
With discussions of workforce shortages in EM and that being a factor in recent MATCH numbers, rural EM provides the opportunity for residents post graduation to expand into those areas.
I will leave you with this tale, I received a trauma patient that arrived as a transfer after a motor vehicle collision. The physicians I received the call from, told me he was a “family doctor” and did not know how to do a chest tube. He spotted the large pneumothorax on chest XRay. He stated he just wanted to get them out of the ED and asked if I would accept? Of course I did, the patient arrive in cardiac arrest, as soon as I did a thoracostomy, and 2 more rounds of CPR our team was able to resuscitate the patient. Trauma surgeon arrived and patient went to the OR for other injuries. My question, shouldn’t anyone working in an ED be capable of performing a chest tube, the ACGME requires that and many other to complete an EM residency?