ACEP Disagrees With EM Residency Survey Method Used by US News & World Report


ACEP and the leaders of other medical specialties representing emergency medicine, have taken issue with a recent survey of emergency medicine residency programs, by US News & World Report and Doximity. Below is a letter from Dr. Rosenau to US News & World Report.

September 12, 2014

Mr. Ben Harder
Managing Editor and Director
Health Care Analysis
US News & World Report
105 Thomas Jefferson Street, NW
Washington, DC 20007

Dear Mr. Harder:

As leaders of the top organizations representing emergency medicine, we have been contacted by scores of emergency physicians from around the country about a survey being conducted by Doximity and publicized by US News and World Report. We appreciate your recognition of emergency medicine as an academic medical specialty with a unique core of knowledge and robust research agenda.

However, we are concerned about the sampling method chosen for this survey, because we believe it will fail to achieve your objective for this survey — to identify America’s top emergency medicine training programs. Asking only physicians enrolled in a social media website to nominate their five most preferred residencies will result in egregious sample bias and is not capable of resulting in a scientifically valid result. The results will be based solely upon opinions expressed by physicians who have no first-hand knowledge of any residency training programs other than the ones they attended themselves.

While not a formal ranking of residency programs, the results would convey that some programs provide better training than others. However, given the limitations, this would not be an accurate portrayal — to medical students or to the public. It also would not be useful to many medical students, because research shows that more than 75 percent of emergency physician residents report the number one reason for selecting a residency program is geography.

More concerning, the results could send a dangerous public health message to people with medical emergencies. It implies they should consider bypassing hospital emergency departments with residency programs that fared poorly in the survey. In a medical emergency, people should seek emergency care at the nearest emergency department, not one that scored better on a highly subjective opinion survey.

Patients need confidence in their physicians in times of crisis, especially since comparison shopping among doctors is not an option when someone is having a medical emergency. Emergency medicine residency programs train physicians in the emergent and acute conditions of just about every medical specialty in health care. As a result, emergency physicians are uniquely qualified to handle a full range of adult and pediatric emergencies. In addition, they see every kind of human drama imaginable, often treating multiple patients at a time.

The overall quality of medical care delivered in emergency departments in the United States is excellent, thanks to the uniformly high standards that govern the accreditation of residency programs in emergency medicine. Emergency medicine residencies collaborate openly with shared curricular tools built around a core model of clinical practice, an approach that is fairly unique in medical education. Ranking training programs above others is contrary to the principles of our specialty, although we recognize that certain programs are best suited for certain trainees.

Many factors contribute to a successful residency program, not all of which can be measured or compared. If your target audience is medical students contemplating a career in our field, we would be happy to work with you to identify objective, measurable factors to help students find the best program for their individual needs.

Unfortunately, our organizations, which represent more than 40,000 emergency physicians, could not recommend or encourage participation in the current survey by emergency physicians. We would, however, be happy to meet with you and help to identify the parameters that might better accomplish that purpose. If you are interested, please contact Marjorie Geist at 800-798-1822, ext. 3290.

Sincerely,

Alex M. Rosenau, DO, CPE, FACEP
President, American College of
Emergency Physicians

Meaghan Mercer, MD
President, American Academy of Emergency
Medicine Resident and Student Association

Mark Mitchell, DO, FACOEP
President, American College of Osteopathic
Emergency Physicians

Jeffrey N. Love, MD, MSc
President, Council of Emergency Medicine
Residency Directors

Jordan Celeste, MD
President, Emergency Medicine Residents’
Assocation

cc: Avery Comarow, Health Rankings Editor

  1. #1 by Andrew - September 13th, 2014 at 11:54

    Why can’t ACEP be this upset about Press-Ganey? Same made up stats.

  2. #2 by Mark - September 20th, 2014 at 09:22

    Great first question Andrew.
    Not only should ACEP “REPRESENT” it’s members AND the patients they serve by being upset with Press-Ganey, as a body, ACEP should “REPRESENT” (there’s that word again) its members and the patients they serve by refuting the touted value and exposing the downside truth of nearly ALL customer satisfaction models as we currently know them. Perhaps ACEP is following the lead of the AMA when they went “All In” for the Affordable Care Act. History will show how well the AMA members were “REPRESENTED” on that day.

  3. #3 by Scott Korvek, MD, FACEP - September 23rd, 2014 at 18:36

    Interestingly, back around 2004, when I was an EMRA leader, the EMRA board wrote a letter to US News & World Report asking them why they didn’t rank and recognize top hospitals for emergency care as they do many other specialties. Their response was plainly that they did not want people to pick and choose hospitals when they were having an emergency. It seems like much has changed since then, both with US News & World Report, but also with the Federal government.

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