In response to: Missed the point?
Actually, no points missed — these are very longstanding issues on the web going back at least 10 years. Best chronicled at EMED-L archives.
Most of my comments were not directed at you specifically, my first point. But you do echo many of the themes that are pervasive in EM. Again, I have no reason to question your position — in fact quite the contrary; however, there are other views in and on EM. I think you need to consider my post as a response to your initial post and your subsequent comment. There were some misconceptions about ABMS and monopoly — very common threads that are only directed at EM of all the 24 recognized specialties, when in truth all 24 speciality boards are as equally monopolistic (to use your characterization).
Defensive? Perhaps. I consider it to be the position of an apologist (advocate) for a different perspective on EM than the position and perspective you are serving as an apologist (advocate) for.
Of course I understood that you were responding to a comment in your blog — as I was. It is just (and I know you know this) that board certification and who practices EM are lightening rod areas in EM. In no other specialty would rotations during medical school and a surgical internship constitute “well train[ing]” in a specialty that requires a minimum of 3 years to be board eligible. No one would make a similar statement about Internal Medicine, Neurology, or even Family Medicine. It serves only one purpose and that is to raise up the ineligible practitioner (in terms of certification only) and to bring down the specialty by suggesting that the cognitive and technical skills requiring 3 years of residency training may be sufficiently obtained in a much shorter time frame and in many other fashions. All the other arguments are non-sensical, e.g., who works in the rural setting, who is better, who will work for less, etc. Why? Because no other specialty is trivialized in such a manner — whence the crux of my post and the core point — there is a double standard employed with regards to board certification in EM by those self-disenfranchised and either boarded in another specialty or not residency trained in any specialty.
Too much belaboring here, I know you understand the issues. And the points have been made …
4 Comments
I am not one who trivializes the specialty of EM. Obviously, one does dot need to be EM board certified to be an effective physician in the ED.
However, you seem to have lack of perspective regarding other specialties, especially FP, with you statement, “no other specialty is trivialized in such a manner” ignores one of my points, that there are very many not board certified FP/IM docs out there practicing general medicine. What do you think about a cardiothoracic surgeon opening a general medicine clinic? I just don’t see other specialties being as sensitive about it as some EP’s are.
I am not one who trivializes the specialty of EM. Obviously, one does dot need to be EM board certified to be an effective physician in the ED.
However, you seem to have lack of perspective regarding other specialties, especially FP, with you statement, “no other specialty is trivialized in such a manner” ignores one of my points, that there are very many not board certified FP/IM docs out there practicing general medicine. What do you think about a cardiothoracic surgeon opening a general medicine clinic? I just don't see other specialties being as sensitive about it as some EP's are.
With regards to “there are very many not board certified FP/IM docs out there practicing general medicine” and “about a cardiothoracic surgeon opening a general medicine clinic” I think we would very much agree; however, there is a major difference, where your analogy fails — general medicine is not a specialty and has no specialty board. Additionally, no one practicing general medicine challenges established certifying boards or suggests that established boards are monopolistic.
And with regards to “other specialties being as sensitive about it as some EP’s are,” the seeming uniqueness of this sensitivity stems from the uniqueness of EM being the only specialty that is commonly challenged by those not board certified as to the quality of the certification and to monopolistic practices. Again the core of my argument is that there is a double standard invoked with EM — your analogies and conclusions only serve to accentuate that double standard at play.
It really is very simple. ABMS certifies the specialty boards and the specialty boards certify the training of medicine’s specialist. All specialties and all certified specialist should be treated similarly. If, for whatever reason (and there are good ones), you, as a physican, have chosen either not to go through the recognized specialty certification process primarily or at some later time choose to practice in a specialty where you don’t desire certification in (all well in good) there should be absolutely no criticism or suggestion of unfairness, monopolistic practices, etc. The rules are plain for everyone, if you want to be board certified in a specialty this is what you do[.]
Similarly, the notion that training in one specialty is “well train[ing]” for another specialty is sheer conjecture — it says more about the individual’s quality than the quality of original training. It is inconceivable that a surgical internship would provide anything more substantial than an R1’s exposure to surgical cases that may have presented to the ER. It provides no training for the 70-80% of the ER population, which constitutes general medical and many social problems.
Where I practice we have had an FM training program for many years, the FM residents do their 1 or 2 months in the ER. It is the rare one that demonstrates the wherewithal to be able to practice EM right out of the box (residency). Those that “can,” are the types of physicians that really would do well in any specialty (we all knows those types) — it just so happens that they chose a residency that they became disenchanted with (many reasons). Will they do will in EM practice? Probably just fine, but that speaks more (at least to me) of the quality of the person and less so to a particular type of specialty residency.
To draw this to a close, the sensitivity you perceive is based upon the perceived uniqueness in the manner EM is treated by those that come to EM by other paths other than board certification. Unless you can show otherwise, that treatment is a profoundly unique double standard amongst the House of Medicine’s 24 specialties.
Emergency Medicine is a specialty, we don’t want to be treated special, we want to be treated just like all the other specialties! No double standards!
With regards to “there are very many not board certified FP/IM docs out there practicing general medicine” and “about a cardiothoracic surgeon opening a general medicine clinic” I think we would very much agree; however, there is a major difference, where your analogy fails — general medicine is not a specialty and has no specialty board. Additionally, no one practicing general medicine challenges established certifying boards or suggests that established boards are monopolistic.
And with regards to “other specialties being as sensitive about it as some EP’s are,” the seeming uniqueness of this sensitivity stems from the uniqueness of EM being the only specialty that is commonly challenged by those not board certified as to the quality of the certification and to monopolistic practices. Again the core of my argument is that there is a double standard invoked with EM — your analogies and conclusions only serve to accentuate that double standard at play.
It really is very simple. ABMS certifies the specialty boards and the specialty boards certify the training of medicine's specialist. All specialties and all certified specialist should be treated similarly. If, for whatever reason (and there are good ones), you, as a physican, have chosen either not to go through the recognized specialty certification process primarily or at some later time choose to practice in a specialty where you don't desire certification in (all well in good) there should be absolutely no criticism or suggestion of unfairness, monopolistic practices, etc. The rules are plain for everyone, if you want to be board certified in a specialty this is what you do[.]
Similarly, the notion that training in one specialty is “well train[ing]” for another specialty is sheer conjecture — it says more about the individual's quality than the quality of original training. It is inconceivable that a surgical internship would provide anything more substantial than an R1's exposure to surgical cases that may have presented to the ER. It provides no training for the 70-80% of the ER population, which constitutes general medical and many social problems.
Where I practice we have had an FM training program for many years, the FM residents do their 1 or 2 months in the ER. It is the rare one that demonstrates the wherewithal to be able to practice EM right out of the box (residency). Those that “can,” are the types of physicians that really would do well in any specialty (we all knows those types) — it just so happens that they chose a residency that they became disenchanted with (many reasons). Will they do will in EM practice? Probably just fine, but that speaks more (at least to me) of the quality of the person and less so to a particular type of specialty residency.
To draw this to a close, the sensitivity you perceive is based upon the perceived uniqueness in the manner EM is treated by those that come to EM by other paths other than board certification. Unless you can show otherwise, that treatment is a profoundly unique double standard amongst the House of Medicine's 24 specialties.
Emergency Medicine is a specialty, we don't want to be treated special, we want to be treated just like all the other specialties! No double standards!