Regarding the recent controversy of the ability of American Board of Physician Specialties emergency medicine certified physicians to fulfill the role of an emergency medicine attending, I find the comment by Dr. David Lawhorn, in the recent issue quite disturbing. (“TeamHealth Recruiting Letter Riles Tennessee EPs,” EMN 2009;31:1.) He is quoted as saying that one of the significant differences between primary care and emergency medicine is that primary care physicians begin to lose many of their procedural skills, such as intubations or central lines, due to the demands of the office-based practice. He further stated: “It is in these critical care areas that the emergency medicine-trained physician stands out and performs confidently, knowledgeably, and routinely.”
In other words, they have no problems with assessment, diagnosis, and plans. What three years of residency training in emergency medicine come down to is placing central lines and intubating patients. What a sad commentary about the specialty. Sadly enough, I agree with him. I have always found IM and FM-trained physicians better than EM-trained attendings in assessment and diagnosis. This is also reflected by the fact that most doctors who ultimately take care of ED-admitted patients (and are therefore responsible for ultimate evaluation and plans) are in fact FM or IM trained.
It also appears from Dr. Lawhorn's comments that he has no issue with those ABPS-certified doctors who have already been working in the ED for years, many as full-time attendings, only with those who are too busy in their primary care practice. So the issue is not which body certifies the doctor but rather the extent of further training and experience. From my experience during more than 20 years of working in various EDs starting with moonlighting during IM residency and continuing with many years of full time ED work, procedures are generally not the issue. In fact most ABPS EM-certified doctors I know work in EDs full time and have plenty of procedural experience in the process.
Does Dr. Lawhorn truly believe that critical care-trained doctors or community surgeons, for example, lack procedural experience (and should therefore not attend in the ED)? They do not, and neither are those of us who have been doing this for many years. The real issue should be for the ED director to test prospective attending doctors' procedural skills (just as is routinely done for ECG reading skills) and retrain them if necessary.
Don Osterer, MD
Mountain View, CA