Regarding the FACEP loophole (EMN 2008;30:1), as an academic chair and former program director, I have to say I am stunned and saddened that EMRA supported the efforts of noncertified emergency physicians to become fellows of ACEP. It is highly unlikely that the new fellowship criteria would have passed if EMRA had taken a hard line and stood up for the value of their training and board certification. Why then was EMRA complicit in this decision? EMRA and ACEP membership are linked. Did pressure from high-ranking ACEP leaders influence EMRA? Would a truly independent EMRA have taken a supportive position?
The ACEP Certification Section's October newsletter describes how it went down, stating, “It was noted that the ACEP President-Elect was instrumental in gaining EMRA's support for this resolution.” By virtue of the intimate relationship, there is open access to and influence on EMRA by ACEP. The same newsletter announces that Ted Switzer, MD, one of the noncertified physicians newly eligible for FACEP is the incoming chairman of the ACEP Certification Section. Let's get it straight. EMRA supported awarding the FACEP title to Dr. Switzer, who had this to say about emergency medicine residents on the EMED-L list a little over a year ago: “We have all seen EM residency graduates who are inferior clinically to most grandfathers. Give me a good, seasoned legacy physician any day. You speak as if residency training in emergency medicine is somehow better than other routes to clinical excellence; that residency training in EM is somehow guarantees clinical excellence. Where is your evidence?”
Can we be happy with this? EMRA has now assisted Dr. Switzer and his colleagues whose primary purpose in the “Certification Section” is to get equal recognition for BCEM. Switzer et al want to raise this alternative board, which does not require legitimate emergency medicine residency training, to the same plane as ABEM and AOBEM. The above quote shows you their opinion of residency training. And EMRA has now assisted these physicians by allowing them to sign FACEP behind their names. AAEM is currently engaged in New York where the BCEM forces have sued the state regarding board certification issues. There is an active state-by-state plan by BCEM to fully equilibrate itself with ABEM and AOBEM. That exact effort was just defeated in North Carolina last year. EMRA has just made this struggle more difficult as we now have a whole host of BCEM FACEPs who can line up on the other side.
If EMRA unlinked its membership from ACEP or if there were a new, truly independent emergency medicine resident organization, the residents could change the face of our specialty quite quickly. Emergency medicine residents are the future dues-paying members of all the major emergency medicine organizations. All would have to listen carefully to what they say. If an independent EMRA said, “We will tell our members not to go to emergency medicine meetings or [and not] to join organizations that take support from corporate groups,” the tide of emergency medicine would change tomorrow. Instead, what we have is an organization that has just handed a gift to those who believe that emergency medicine residency training is worthless.
I just cannot understand why the representatives of the new generation of emergency medicine sacrificed the principle of the primacy of residency education to define a specialist in emergency medicine, a principle that my generation fought so hard for.
Robert McNamara, MD, FAAEM