Letter to the Editor
The article by Eric Blazar, MD, appears to maintain that we should restrict the number of EM residencies to limit competition for urban and suburban EM jobs. (“Emergency Medicine Doesn't Need More Residencies,” EMN 2019;41:6; http://bit.ly/2UET63Y.) Taken at face value, this appears to relegate the rest of the country to second-class emergency medical care.
Last summer I passed 40 years in a career in emergency medicine spent predominantly in rural areas. I have often been the only ABEM-boarded EP in such communities. Having been an ED director for two-thirds of my career, I have managed and taught family practitioners. It is easier to teach a smart FP things that make a functioning EP than it is to teach an academically trained EP to function in a rural setting without full backup resources. This is a gap in EM training. Urban hospitals only hire EPs with EM boards because they can, and marketing of status is at least as powerful as good medical care. An attempt to restrict mainstream EM training just to fill the demand for urban and suburban facilities is an abandonment of rural America.
ACEP endorsed such a perspective two decades ago when the board of directors voted to no longer allow working EPs not eligible for EM board status to be members. We may not be failing rural America, but we are largely ignoring it. There are a few EM residencies with a focus toward rural emergency medicine, and ACEP has had a rural EM section, which I left after seeing little benefit.
There are economic and intellectual costs to practicing in rural America. I live happily on less income than others. I have been able to bring up-to-date EM practices to rural communities.
Dr. Blazar identified a problem, but he has not convinced me that he is focusing on the community benefit. We are all the community, and if one of us needs emergency care in rural America, we should hope we have managed this dichotomy.
Bruce Parker, MD