Emergency medicine specialists in short supply

The solution to the ER doctor shortage is the same as the primary care doctor shortage. American doctors are avoiding these specialties and choosing more lucrative, less demanding specialties. But there are thousands of foreign medical graduates in places like India who would love to come here and practice. Open up the residencies to foreign medical graduates, and the shortage will be solved in just three years. The RedSox and Yankees don't just depend on their own farm system to stock their teams. They also bring in free agents. American Medicine can do the same.

The reason: The American College of Emergency Physicians has LONG restricted the # of physicians who can qualify to take the Emergency 'Boards' and has done everything possible to limit the # of slots available for Emergency Medicine training programs. All the better to pump up the income of its members!

Perhaps we should rethink getting more emergency medicine physicians and focus our efforts on training more primary care physicians, getting patients access to that care and hopefully reducing the numbers of people needing EDs? Fixing the problem early and up front before many people need emergent care might make the most sense.

Not surprising The ER is a very stressful place for a doctor to work, especially when s/he is the only doctor there...and let's not forget that the need to staff ER's 365/24/7 contributes to major burnout of doctors. Not many doctors can work night shifts for long periods of time. The stress on body and mind is tremendous. Believe me, you don't want to have an emergency at 6 a.m. with a doctor who has been working since 7 p.m.

Response to #2--IF you do not train in Emergency Medicine, you cannot and should not be allowed to sit for the ABEM boards. There is a difference in care from those that are actually trained in ER. You would not want someone trained in OB/GYN performing your cardiac cath; so why would I not want ONLY an MD trained in ER??? Allowing 'other' non ER trained docs to sit for the boards and work in the ER dilutes out the specialty and often times allows for less than 'excellent' care.

This article points out nothing that is new. Emergency Medicine, like any other specialty, has certain requirments in terms of training in order to efficiently and safely practice the trade. I don't see primary docs doing plastic surgery or reading xrays. I trained in Emergency Medicine because I wanted to take care of patients in their golden hour, no matter what the problem or complaint. I left my training program confident that I could handle an emergent medical case anywhere in the world. I have gone on to do just that in my career.
Unfortunately, we have a demanding and litiginous society whose expectations far exceed what is necessary to give the patient excellent medical care. This has only served to push up costs in terms of unecessary tests, labs, procedures, xrays,etc. in order to practice "fast food menu driven" and "defensive" medicine. Yet our excess money spent per capita has been a complete waste as we have not improved our lives at all, especially compared to other industrial countries. Preventitive medicine is a great political message, but the very doctors who are supposed to deliver this primary care don't exist. Maybe the focus of primary care should change to create "departments" that can handle all these primary needs that don't need to be in the Emergency Department in the first place. This would reduce excess waits in the ED and thus lower poor outcomes which would mean less money spent per capita. By the way, it took me 3 months to get a new primary care physician in Boston - no wonder so many people are flooding the ED's...

This research reveals nothing new; it only points out what has become a worse problem. More patients go to the Emergency Department because they either do not have a primary care physician or they can not get an appointment. If primary care was made as lucrative a job as other specialties, or at least provide the primary docs with a "department", with ready access to labs and xrays, then patients could be offloaded from the ED to allow Emergency Medicine specialists to do our job more efficiently and safely. I find it interesting that the very experts who propose using secondary care providers to handle the excess numbers would only want a physician caring for them if they were a patient. Stop trying to bandage the system by spending excess money and instead focus money on improving access to primary care.

I've been an active ER doc for 20 years yet have never qualified to sit for the boards secondary to the aforementioned restriction. The very first ER docs were grandfathered in to the specialty. I would place my experience up against a newly graduated doc from an ER residency any time. The longtime conflict of the board certified docs and the rest of the non boarded docs is a well known and long simmering political conflict within the specialty. Addressing the shortage by importations of workers might solve the problem but one has to question why all american workers and professionals might not be similarly replaced.

Response to #2--IF you do not train in Emergency Medicine, you cannot and should not be allowed to sit for the ABEM boards. There is a difference in care from those that are actually trained in ER. You would not want someone trained in OB/GYN performing your cardiac cath; so why would I not want ONLY an MD trained in ER??? Allowing 'other' non ER trained docs to sit for the boards and work in the ER dilutes out the specialty and often times allows for less than 'excellent' care.

comment to this message. I agree that there is a difference in care and in the ER it is not always the ER doc who performs more respectably. Emergency Medicine training is extremely weak in very important aspects of medicine primarily even in relation to emergencies. Try to watch an ER doc try to deliver a baby in an emergent situation and you will see what I am talking about. Most do not obtain experiences giving lytics to strokes and MIs independent of multispecialty backup. Trauma is usually learned at the bedside of a fully functional trauma team of surgeons. What is this "unique" knowledge you are alluding to? I am an advocate of training of ER training but I believe there are other routes to practicing the specialty, it is acute medical generalism which is by definition NOT a specialty. Midwives do an excellent job of delivering infants and knowing what needs further help. should we ban them from deliveries because they are not OBGYNs? Many OBs are giving up that altogether. Many FPs are excellent at Obstetrics including sections??

many boarded er docs who both practice and train residents I have found to not even perform RSI correctly.

The world is much greyer than you make it