The Association of Emergency Physicians criticized a report released last week that raised questions about the quality of the nation's more than 11,000 non-board-certified emergency physicians.
The report, compiled for the Josiah Macy Jr. Foundation of New York, concluded that graduate medical education funds for emergency medicine should be exempt from potential healthcare reform cutbacks to ensure the steady increase in board-eligible emergency physicians.
"It would be fair to say that lives could be saved...if all emergency departments were staffed by appropriately trained individuals," said L. Thompson Bowles, M.D., president of the National Board of Medical Examiners, Philadelphia.
Dr. Bowles was chairman of a group of 38 healthcare experts who met in a round-table discussion in April to develop the basis for the report.
"They are off-base in their charges," said Ian Cummings, M.D., president of the Association of Emergency Physicians, a Chicago-based group of 1,000 non-residency-trained emergency physicians. "The crisis is that there are not enough emergency physicians."
Dr. Cummings is a board-certified internist and medical director of the emergency department at 124-bed Day Kimball Hospital, Putnam, Conn. He also charged that the Macy report is a thinly veiled effort to discredit physicians who have specialized in emergency medicine but aren't board-certified.
Dr. Bowles said some non-board-certified emergency physicians "are good, some are not." He added that "optimal care is provided by board-certified emergency medicine physicians."
However, Dr. Bowles said there are no empirical studies that link higher quality of care or competence with board-certification in emergency medicine.
About 14,000 of the nation's 25,000 emergency physicians are board-certified in emergency medicine. Experts have warned during the past 10 years of a shortage of board-certified emergency physicians.
In 1988, however, the American Board of Emergency Medicine changed its certification policy to eliminate the "practice track." Before 1988, physicians specializing in emergency medicine could qualify to become board-certified if they met several criteria, including logging more than 7,000 hours and five years of practice in emergency medicine.
Dr. Cummings said the result was that ABEM and other supporting groups created an artificial "shortage" of board-certified emergency physicians.
In 1993, more than 150 emergency physicians, including Dr. Cummings, filed an antitrust lawsuit against the ABEM and 30 hospitals, charging the groups engaged in anti-competitive conduct. The suit was filed in U.S. District Court in Buffalo, N.Y. A trial date hasn't been scheduled.
Dr. Bowles said the panel discussed practice-track eligibility but didn't consider it a solution to increasing the number of board-certified emergency physicians. "I don't think we ought to compromise on that issue," he said.
The report also called for a revision of the classification system of emergency departments that would give the public information on the levels of care available. The Joint Commission on Accreditation of Healthcare Organizations currently has such a system, but Dr. Bowles said it needs to take into account the qualifications of emergency physicians.
Ronald Anderson, M.D., president and chief executive officer of Parkland Memorial Hospital in Dallas, said many hospital administrators will oppose the posting of signs that indicate levels of care.
"It could make some feel second-class," Dr. Anderson said. "But it will happen over time with reform. The public will demand it."
