ACEP Releases Statement on Texas Medical Board Action


ACEP President Angela Gardner, MD, FACEP, released the following statement on December 10, 2009 regarding the ruling by the Texas Medical Board that physicians certified by the American Board of Physician Specialties could advertise themselves as board certified.

ACEP, and the entire emergency medical community, was surprised to learn that on Oct. 20, the Texas Medical Board (TMB) ruled that physicians certified by the American Board of Physician Specialties (ABPS) could advertise themselves to the public as board certified. ABPS certifies physicians in 17 specialties. Its emergency medicine board is the Board of Certification in Emergency Medicine (BCEM).

After learning of the ruling, ACEP contacted the Texas Medical Board and requested under the Texas Open Records Act, copies of all materials pertaining to this ruling. We are expecting the documents in the next several days, and once they have been reviewed we will decide on a course of action. We may ask that the board hold public hearings, or that this action be overturned.

As outlined in ACEP’s policy statement “ACEP Recognized Certifying Bodies in Emergency Medicine,” ACEP recognizes ABEM and AOBEM as the only certifying bodies for emergency medicine. This has been ACEP’s position for many years and it has not changed. In recent years, ACEP and its chapters have actively defended this position in opposing similar ABPS initiatives in other states including Florida, Kentucky, New York and North Carolina.

ACEP’s opposition is based on concerns that BCEM allows and encourages new physicians to enter unsupervised practice without residency training in the specialty. ACEP has maintained a consistent position on the critical importance of residency training for physicians entering emergency medicine. The specialty has grown such that residency training is widely available and should be the pathway for new physicians entering the practice of emergency medicine. In fact, the first sentence in our policy statement, “The Role of the Legacy Emergency Physician in the 21st Century” states, “ACEP believes that physicians who begin the practice of emergency medicine in the 21st century must have completed an accredited emergency medicine residency training program and be eligible for certification by the American Board of Emergency Medicine (ABEM) or American Osteopathic Board of Emergency Medicine (AOBEM).” Unfortunately, BCEM does not share this commitment to the importance of residency training for new physicians and as a result, ACEP opposes efforts to allow those physicians to advertise themselves as board certified.

It is important to distinguish our position on board certification from our position on ACEP’s legacy physicians. ACEP was founded more than 40 year ago when residency training in emergency medicine was not available. The physicians who founded the specialty, and many who came after them, did not have the opportunity to attend a residency or become board certified. These “legacy” physicians remain a critical component of the emergency medicine workforce. They are also vital contributors to the success of America’s emergency care system and they will remain so for many more years.

Our position on BCEM pertains to the important role of residency training today. BCEM certification provides equivalent recognition to new physicians who simply choose not to seek residency training in emergency medicine. Allowing new physicians without emergency medicine residency training to advertise themselves as board certified in emergency medicine would dilute and deemphasize the critical importance of residency training. It also misrepresents to the public the level of training these new physicians have received. Therefore, ACEP continues to oppose efforts to allow BCEM-certified physicians to advertise themselves as board certified.

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  1. #1 by a specialist in emergency medicine - December 15th, 2009 at 02:34

    “As pointed out on this blog earlier,
    critical care does not require a residency in critical care for certification. There
    are various possible tracks.”

    Critical care is not an independent specialty. It is a fellowship done after completing a full residency in an independent specialty (e.g., internal medicine, surgery, pediatrics, anesthesiology). Emergency medicine is a full-fledged, independent specialty and I believe it deserves that status. That means the completion of a residency IN emergency medicine before taking boards.

  2. #2 by a specialist in emergency medicine - December 15th, 2009 at 02:41

    I understand that most of you who post here came along at an unlucky time in history from your point of view. If I hadn’t matched in an EM residency back in 1985 my plan was to finish my internal medicine residency and then practice EM, so I sympathize. I would have been proud to call myself a board certified internist, who practices emergency medicine. It never would have occured to me to seek certification in a specialty other than that of my residency, from a “board” not recognized by the American Board of Medical Specialties. I don’t think you will be successful in your quest to obtain recognition from the medical profession for the AAPS and BCEM, but if you are it will seriously damage the specialty you seek to be part of.

  3. #3 by a specialist in emergency medicine - December 15th, 2009 at 02:51

    Do the vast majority of ACEP members support recognition for the AAPS/BCEM? If most defend legitimate board certification, why isn’t that reflected in the comments on this blog? Are the posts here a statistical anomaly or is the leadership of ACEP out of touch with its membership?

  4. #4 by Arlen Stauffer - December 15th, 2009 at 06:15

    TO: “a specialist in emergency medicine”.

    Come out of the closet, please. Everyone here is providing their name except you.

    TO: all….

    ACEP has the right to recognize whatever board(s) it chooses to recognize. As a member organization that is NOT in the certification business, it can make those choices.

    Texas — and every other state medical board — has the right to choose which board(s) they will recognize.

    ACEP, not being in the certification business, should stay out of the state medical board’s hair, other than to politely provide their own policy on recognizing boards….when asked for it.

    The old tired arguments about non-EMRT doctors somehow ruining the “true specialty” are hogwash, and I challege “a specialist…” or anyone else to reveal how I and the thousands of other non-EMRT docs are somehow hurting the specialty now.

    This is an old issue with a lot of history, and I am sorry to see ACEP pushing it back up to the front burner again at this time, when so many more important issues confront our specialty and medicine in general.

  5. #5 by Arlen Stauffer - December 15th, 2009 at 08:39

    a specialist in emergency medicine :Do the vast majority of ACEP members support recognition for the AAPS/BCEM? If most defend legitimate board certification, why isn’t that reflected in the comments on this blog? Are the posts here a statistical anomaly or is the leadership of ACEP out of touch with its membership?

    If you judge by the posts here, the vast majority of members don’t think ACEP leaders should be spending their time on this issue. Regarding the answer of your last question, I’ll leave that up to you.

    ACEP is a membership organization, not a certification organization. They have a right to recognize whatever they want to recognize, and the state medical boards have that same right based on their own criteria.

    The real “safety net” is the thousands of non-EMRT doctors working all those shifts and locations that you and other EMRT doctors won’t go. Many (?most?) EDs in America hire non-EMRT doctors for some or all of their coverage, and it works out pretty darn well.

    That’s the real world.

  6. #6 by Specialist in Emergency Medicine - December 15th, 2009 at 12:01

    ACEP is attempting to do is nothing short of restriction of trade.
    For many years MD’s fought the DOs from ‘encroaching’ onto their turf. Same thing here.
    ACEP wants to represent ‘all’ EPs except for those who are helping to bridge the gap of emergency medicine’s needs. Thanks a lot.

  7. #7 by Nathan Sherwood M4 - December 15th, 2009 at 19:32

    Pardon a naive medical student, but where did all of you non-EM residency trained physicians get your EM skills? I dare say years of experience is what was required and now that you have those skills by practicing in rural and community EDs you feel that ALL FP/IM/Peds trained practitioners should have the ability to gain EM board cert? I hope you say off course not…lots of experience is necessary first. So with that thought isn’t board certification offered to those that complete a residency in said specialty and isn’t this normally achieved shortly upon finishing ones residency? So if BCEM is equivalent to ABEM why not let new graduates of FP/IM/Peds take the test? I believe it is because the skills you have were gained outside of residency through trial and error and years in the ED. So today those long practicing non-EM trained EPs have the skills as residency trained physicians do but new grads from other specialties don’t! And going forward with more and more ED residency trained physicians the need for others will diminish. Just ask yourself if you were in an MVA and were being treated by a new attending in the ED would you want the FP or EP to place your chest tube and secure your airway?

  8. #8 by DocW - December 16th, 2009 at 10:43

    Why can’t I access all the previous comments on this post? Is this censorship via “technical difficulties”?

  9. #9 by DocW - December 16th, 2009 at 10:52

    Mr. Sherwood, you are obviously unaware of the history of this issue, I would refer you to http://www.docwhisperer.wordpress.com for some history which has spanned for over 20 years since ABEM unwisely and prematurely closed its practice track. The argument is not to compare new ED attendings but to compare the “legacy” physicians who are not EM residency trained and are being unfairly denied board certification with EM residency trained docs.
    For anyone who’s having difficulty with this thread, you can communicate your views with Dr. Gardner directly at her blog:
    http://gardnersgate.blogspot.com/

  10. #10 by Greg Owens - December 16th, 2009 at 14:38

    Here is that Workforce study from Mass. General:

    Acad Emerg Med. 2008 Dec;15(12):1317-20. Epub 2008 Oct 17.
    Assessment of emergency physician workforce needs in the United States, 2005.

    Camargo CA Jr, Ginde AA, Singer AH, Espinola JA, Sullivan AF, Pearson JF, Singer AJ.

    Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA. ccamargo@partners.org

    OBJECTIVES: The objective was to estimate emergency physician (EP) workforce needs, taking into account the diversity of U.S. emergency departments (EDs) and various projections of EP supply and demand. METHODS: The 2005 National ED Inventory-USA (http://www.emnet-usa.org/) provided annual visit volumes for 4,828 U.S. EDs. The authors calculated annual supply based on existing emergency medicine (EM) board-certified EPs, adding newly board-certified EPs, and subtracting board-certified EPs who died or retired. Demand was estimated at each ED by dividing the number of visits by the average EP volume (based on 2.8 patients/hour, 40 hours/week, and 34% nonclinical time). The models assumed that at least 1 EP should be present 24/7 in each ED, which would require at least 5.35 full-time equivalents (FTEs) per ED. Based on annual EP attrition estimates, results for best-case, worst-case, and intermediate scenarios were calculated. RESULTS: In 2005, there were approximately 22,000 EM board-certified EPs, but 40,030 EPs would be needed to staff all 4,828 EDs (55% of demand met). A total of 2,492 (52%) EDs had a visit volume that required the minimum number (5.35) FTEs, of which 47% were rural. In the unrealistic (no attrition), best-case scenario, it would take until 2019 to staff all EDs with board-certified EPs. In the worst-case scenario (12% attrition), supply would never meet demand. Our intermediate scenario (2.5% attrition) suggested that board-certified EPs would satisfy workforce needs in 2038. CONCLUSIONS: Supply of EM residency-trained, board-certified EPs is not likely to meet demand in the near future. Alternative EP staffing arrangements merit further consideration.

    PMID: 18945242 [PubMed – indexed for MEDLINE]

  11. #11 by O. Marquez M.D. - December 16th, 2009 at 14:45

    Here is that Massachusetts General Hospital study :

    Acad Emerg Med. 2008 Dec;15(12):1317-20. Epub 2008 Oct 17.
    Assessment of emergency physician workforce needs in the United States, 2005.

    Camargo CA Jr, Ginde AA, Singer AH, Espinola JA, Sullivan AF, Pearson JF, Singer AJ.

    Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.

    OBJECTIVES: The objective was to estimate emergency physician (EP) workforce needs, taking into account the diversity of U.S. emergency departments (EDs) and various projections of EP supply and demand. METHODS: The 2005 National ED Inventory-USA provided annual visit volumes for 4,828 U.S. EDs. The authors calculated annual supply based on existing emergency medicine (EM) board-certified EPs, adding newly board-certified EPs, and subtracting board-certified EPs who died or retired. Demand was estimated at each ED by dividing the number of visits by the average EP volume (based on 2.8 patients/hour, 40 hours/week, and 34% nonclinical time). The models assumed that at least 1 EP should be present 24/7 in each ED, which would require at least 5.35 full-time equivalents (FTEs) per ED. Based on annual EP attrition estimates, results for best-case, worst-case, and intermediate scenarios were calculated. RESULTS: In 2005, there were approximately 22,000 EM board-certified EPs, but 40,030 EPs would be needed to staff all 4,828 EDs (55% of demand met). A total of 2,492 (52%) EDs had a visit volume that required the minimum number (5.35) FTEs, of which 47% were rural. In the unrealistic (no attrition), best-case scenario, it would take until 2019 to staff all EDs with board-certified EPs. In the worst-case scenario (12% attrition), supply would never meet demand. Our intermediate scenario (2.5% attrition) suggested that board-certified EPs would satisfy workforce needs in 2038. CONCLUSIONS: Supply of EM residency-trained, board-certified EPs is not likely to meet demand in the near future. Alternative EP staffing arrangements merit further consideration.

    PMID: 18945242 [PubMed – indexed for MEDLINE]

  12. #12 by O. Marquez M.D. - December 16th, 2009 at 15:53

    Dr. Camargo study confirms that there are not enough emergency residency trained physicians to cover all of the nation’s emergency departments now or possibly ever. The data strengthens the belief that there is an ongoing need for non-emergency residency trained physicians to help staff emergency departments for the foreseeable future. I suggest anyone that is interested play with the workforce calculator to see how the different computations do not lead to the stated goal of covering all emergency departments for a minimum of 40 years or possibly never attained.

    See details from the abstract on PubMed above comment #8 and a workforce calculator that illustrates this data in an interactive manner at the links below:

    http://www.emnet-usa.org/nedi/workforce.html

  13. #13 by Bob Petrella - December 16th, 2009 at 16:26

    >>Critical care is not an independent specialty.

    Technically, this is true, of course. But the fact that one can achieve board certification in critical care through so many different pathways/specialties implies that it really does not belong to any one of them, and so is, in effect, its own species. Moreover, the convention of independent specialties to hold the completion of their own full, dedicated residencies as an absolute requirement for board eligibility is not an inviolable law of nature.

  14. #14 by a specialist in emergency medicine - December 17th, 2009 at 06:24

    “The real ‘safety net’ is the thousands of non-EMRT doctors working all those shifts and locations that you and other EMRT doctors won’t go. Many (?most?) EDs in America hire non-EMRT doctors for some or all of their coverage, and it works out pretty darn well.”

    Exactly. That is why the whole “workforce needs” issue is a strawman. Nonboarded docs are already working in ED’s, and are welcome to continue to work anywhere that will hire them. Allowing them to call themselves board certified specialists in emergency medicine wouldn’t fill a single empty job. It would only confuse and mislead the public, that quite rightly equates “specialist” with someone who has completed residency training IN THAT SPECIALTY. It would also lower emergency medicine in the eyes of the rest of the medical profession, since all other specialties require residency training IN THE SPECIALTY.

    I don’t see why you can’t be proud of, and content with, calling yourself a board certified internist, family practitioner, etc. who chooses to practice emergency medicine. There is nothing wrong with that.

  15. #15 by a specialist in emergency medicine - December 17th, 2009 at 07:18

    This does it for me folks. We are clearly never going to change our minds about this, and are now simple being redundant. Since we are arguing in circles I won’t be wasting my time with additional posts. I hope that, for the sake of the specialty I love and have worked in for over 20 years (and for the sake of Mr. Sherwood and the other medical students who hope to become board certified specialists in emergency medicine), the AAPS/BCEM are never equated with legitimate medical specialty organizations.

  16. #16 by greg owens - December 17th, 2009 at 22:50

    In my experience the hallmark of all world class organizations is an overriding commitment to something bigger than self. In medical organizations the order of priority for me would be something like this:

    1. Patient welfare
    2. High quality care
    3. Ethical business practices
    4. The welfare of the specialty
    5. The capability of its practitioners to deliver these

    Like many teenagers, the specialty of EM seemed to lose its way in its teens in the 1990s when both ACEP and AAEM reversed this order, each in an effort to prove that they were more the provider’s advocate than the other. What got lost was the overriding commitment to the specialty itself.

    I don’t see how any emergency medicine professional society can claim leadership of the specialty while simultaneously ignoring or actively lobbying against the interests of 40% of its practitioners who fill a critical specialty need. A need that residency trained emergency physicians are unlikely to want to fill anytime soon.

  17. #17 by Edd Thomas MD - December 18th, 2009 at 12:15

    Ladies and Gentlemen …. and “a specialist in emergency medicine”,
    This my first visit back to this thread since I posted the requirements to even sit for BCEM. A bit more stringent than that for ABEM in regards to demonstrated experience, it is, and seems to no longer be in this thread. Wonder where it is?
    Moving on, there is a parallel issue that needs to be added which I believe has significant yet unspoken affect upon the naysayers for reopening ABEM & others. As a BC ABFP I can say this with some disgust, ABFM has closed its boards also despite a shortage of 20,000+ primary care physicians. So, it is not only ABEM at fault here.
    But regards to BCEM, I would lots rather have a BCEM doc taking care of my family member than one without any certification in EM.
    Does that help in perspective?

  18. #18 by Ken Cartaxo - January 15th, 2010 at 20:50

    ACEP decision on the Texas acceptance comes as no surprise from the self serving organization which claims to represent the interests of emergency physicians. The article keeps referring to “new” physians and how they need to do a residency. What about all the old physicians like myself who have been praticing EM for 25 years and have been locked out of ABEM? Does the public benefit by having a large pool of physicians working the ER who are not allowed to prove their competence by taking the board exam? There are not enough ABEM boarded physicians to man the ERs now and there were even fewer 22 years ago when the practice track was closed. ACEP and ABEM has no one to blame but themselves, for the shortsighted and self serving policies that has created this current situation. If they focused on serving the public instead of themselves there would be no BCEM. I am no fan of BCEM with their excessive fees but at least I can comply with hospital bylaws and keep my job.

  19. #19 by greg owens - January 21st, 2010 at 17:55

    Dr. Gardner:

    I find it most interesting that ACEP, who considers themselves the “voice of emergency medicine physicians,” continue to do battle with the American Board of Physician Specialties (ABPS).

    ABPS, and its parent organization the AAPS, were founded in 1950 —fully 18 years before ACEP was founded.

    I understand that one of ACEP’s major complaint against ABPS board certified EM docs, if not the only complaint, is that ABPS doesn’t require residencies in EM.

    If this is ACEP’s major complaint against ABPS’ BCEM, why is it OK for ACEP’s president-elect, Sandra M. Schneider, MD, FACEP, to not have completed a residency in EM?

    Why is it OK for Andrew E. Sama, MD, FACEP, ACEP’s Secretary-Treasurer not to have a residency in EM?

    Why is it OK for Michael J. Gerardi, MD, FAAP, FACEP, ACEP board member not to have his residency in EM?

    Why is it OK for Jay A. Kaplan, MD, FACEP, ACEP board member not to have his residency in EM?

    Lastly, why is it OK for Robert C. Solomon, MD, FACEP, ACEP board member not to be residency trained?

    You may retort that when these physicians did their residency training that EM residencies were not available. That is NOT the case — several EM residencies were in place in the mid-70s.

    There are other “leaders” in the EM field that don’t have their residencies in EM —

    Members of the board of ABEM itself, for example:

    Robert E. Collier, MD, Director, American Board of Emergency Medicine — no residency in EM.

    Joel M. Geiderman, MD, Director, American Board of Emergency Medicine — no residency in EM?

    Do I have to go on?

    6:24 PM

  20. #20 by Sue Reagan - July 6th, 2010 at 11:35

    Dear dear Nathan (Sherwood),
    You certainly are a naive medical student, as stated by you. If I were in a MVA, I would like to be taken care of a group of competent and experienced physicians, no matter what their qualification. Residency does NOT equate with competence. Many ER residency trained physicians are not competent in chest tube placement, because the surgical residents did it at their place of training. I know this as I work with these colleagues. Some even equate every Chest Pain with an MI, the bread and butter of ER Docs. So my friend, lose your naivete, and try to find out what happens in the Real world out there. Do not be influenced by your self-serving ACEP mentor.

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