Emergency MedicineEmergency Medicine

Training in the USATraining in the USA

Gloria Kuhn, DO, Ph.DGloria Kuhn, DO, Ph.D

NeedNeed

Patch work of carePatch work of care

– KnowledgeKnowledge

– TrainingTraining

– ExperienceExperience

NeedNeed

Needs of PatientsNeeds of Patients

– Unique body of knowledgeUnique body of knowledge

– TrainingTraining

– ExperienceExperience

CurrentCurrent

StandardizationStandardization

– Trained in EMTrained in EM

– Equivalent trainingEquivalent training

CurrentCurrent

Certified by the American Board of Certified by the American Board of

Emergency Medicine (ABEM)Emergency Medicine (ABEM)

– Written examWritten exam

– Oral examOral exam

– Continuing certificationContinuing certification

Structure of TrainingStructure of Training

Total NumberTotal Number 127 127

Three year Three year 9595

four year programsfour year programs– 2-42-4 1616– 1-41-4 1616

ABEM ExamABEM Exam

FellowshipsFellowships

– ToxicologyToxicology

– Sports medicineSports medicine

– Pediatric EMPediatric EM

– Undersea and Hyperbaric Undersea and Hyperbaric

No ExamNo Exam

FellowshipsFellowships

– ResearchResearch– AdministrativeAdministrative– EducationEducation

Training CertificationTraining Certification

Accreditation Council for Graduate Accreditation Council for Graduate

Medical Education (ACGME)Medical Education (ACGME)

– General EssentialsGeneral Essentials

– Residency Review CommitteeResidency Review Committee

Training CertificationTraining Certification

Residency Review CommitteeResidency Review Committee

– Special RequirementsSpecial Requirements

– Determines concepts of trainingDetermines concepts of training

– Evaluates program, personnel, institutionEvaluates program, personnel, institution

ABEMABEM

Administers board exam and certificationAdministers board exam and certification– Competency to practiceCompetency to practice

ImplicationsImplications

PracticePractice

– Hospital credentialsHospital credentials

– Academic credentialsAcademic credentials

FinancialFinancial

– ReimbursementReimbursement

RecertificationRecertification

Road to Current StatusRoad to Current Status

PoliticalPolitical– American College of Emergency Physicians American College of Emergency Physicians

(ACEP)(ACEP)

Training Training – Liaison Residency Endorsement Committee Liaison Residency Endorsement Committee

(LREC)(LREC)

CertificationCertification– ABEMABEM

15 Years of Negotiation15 Years of Negotiation

American Medical Association (AMA)American Medical Association (AMA)

American Board of Medical Specialties (ABMS)American Board of Medical Specialties (ABMS)

– ABEMABEM

ACGMEACGME

– RRCRRC

Conjoint BoardConjoint Board

Co-sponsorsCo-sponsors

Shared responsibilitiesShared responsibilities

Shared powersShared powers

Conjoint BoardConjoint Board

Family PracticeFamily Practice

Internal MedicineInternal Medicine

Obstetrics and GynecologyObstetrics and Gynecology

OtolaryngologyOtolaryngology

PediatricsPediatrics

Psychiatry and NeurologyPsychiatry and Neurology

SurgerySurgery

Other RepresentativesOther Representatives

AMAAMA

ACEPACEP

UA/EMSUA/EMS

Challenges to ExistenceChallenges to Existence

Recognition of unique body of Recognition of unique body of

– InformationInformation

– SkillsSkills

– ExperienceExperience

Financial ChallengesFinancial Challenges

Definition of emergencyDefinition of emergency

FinancialFinancial– Right to practiceRight to practice– ReimbursementReimbursement

Control of careControl of care

Training ChallengesTraining Challenges

Equal statusEqual status (Mutual needs)(Mutual needs)

– SupervisionSupervision

– AutonomyAutonomy

– Access to patientsAccess to patients

FutureFuture

Continuing NegotiationsContinuing Negotiations

Recognition of specialtyRecognition of specialty

Political issuesPolitical issues

Financial Financial

TrainingTraining

Keys to SuccessKeys to SuccessConquer from WithinConquer from Within

NegotiationNegotiation

InclusionInclusion

PersistencePersistence

DemonstrationDemonstration– Unique body of informationUnique body of information– TrainingTraining– ResearchResearch