As a boarded emergency physician, I have followed the debate regarding fellowship status in ACEP and AAEM closely. My job options are numerous, but it is difficult for others to get what I have, namely board certification in emergency medicine. I may be able to get jobs easier and demand higher pay, so of course I like that, but at the same time, I see young, non-board eligible physicians putting up with all kinds of nonsense because they are happy just to have a job in a real ED.
Putting patient care aside for a moment, it affects me when non-boarded colleagues accept things that board certified EPs do not. It affects all of our job sites and salaries. Twenty years from now, these doctors will say the same things older, non-boarded doctors say now: “I have a ton of ED experience and a medical license, so how dare these EPs fresh out of emergency medicine residencies push me out, and how dare the establishment allow it.”
I do, however, believe most doctors working solo in EDs need training that is specific for that environment. From what I see, emergency medicine residencies are the only places that training reliably occurs. It is unfortunate that good FPs and internists have few options when they discover a love for the ED late in their careers. Because the cost restricts them, many cannot complete an emergency medicine residency even if they want to. It seems to me a two-year fellowship run by emergency medicine residencies leading to board eligibility for FPs, IMs, or even surgeons might be a viable option to put this debate to bed once and for all. If a young FP is truly committed to a career in emergency medicine, two years of fellowship training should not be too much to ask. Fellowships pay a bit more than residencies, the doctors are presumably board certified in their field, and the reimbursement should be good for hospitals using them. Ultimately the training should make up for emergency medicine deficiencies in IM and FP.
I was seriously considering a fellowship in critical care, but decided against it because I will not be eligible for board certification when I'm done, no matter how good the program is or how good I am. It seems silly that after four years of training and subsequent years working in EDs that EPs can complete various fellowships but not become board certified or even take the test. I know other EPs in similar positions. If we want the internal medicine folks to open their doors to us, perhaps we need to do the same thing for them. After all, what is most important, the best care for patients or staking out and maintaining medical territory?
Many groups are starting fellowships in emergency medicine for FPs, and if residency trained emergency physicians don't get in the game while it's still early, the influence of emergency medicine residencies will be diminished, and we may find ourselves doing battle over board certification in a very different way in the coming years.
Jessica Sims, MD