Sorry if this was covered in some other thread (doubtin a bit on that), but I didn't have time to search exhaustively for it! Also had troubling Googling it.

Does anybody know the historical reason(s) for EM to be a division of some surgery departments? I mean, traditionally, FPs and internists staffed ERs, so why the connection with surgery departments??

Muchas gracias!

Sorry if this was covered in some other thread (doubtin a bit on that), but I didn't have time to search exhaustively for it! Also had troubling Googling it.

Does anybody know the historical reason(s) for EM to be a division of some surgery departments? I mean, traditionally, FPs and internists staffed ERs, so why the connection with surgery departments??

Muchas gracias!

Trauma...

Yale's program is still under the surgery department.

Sorry if this was covered in some other thread (doubtin a bit on that), but I didn't have time to search exhaustively for it! Also had troubling Googling it.

Does anybody know the historical reason(s) for EM to be a division of some surgery departments? I mean, traditionally, FPs and internists staffed ERs, so why the connection with surgery departments??

Muchas gracias!

UBC Emergency Medicine still falls under the Department of Surgery.

I mean, traditionally, FPs and internists staffed ERs, so why the connection with surgery departments??

Muchas gracias!

Not true. In the very early days it was more often surgery retreads (like me!) Plus the EDs in the big U.s were either split or under Surgical administrative control. Anyway, when young guys like me came out of EM residencies, we were the most senior EPs. But we were far from ready to run a dept. Of course I thought I was! Come to think of it, I was ready. :D

Deans usually made the programs divisions of Surgery, sometimes IM (U of C, second program) until the faculty matured.

Not true. In the very early days it was more often surgery retreads (like me!) Plus the EDs in the big U.s were either split or under Surgical administrative control. Anyway, when young guys like me came out of EM residencies, we were the most senior EPs. But we were far from ready to run a dept. Of course I thought I was! Come to think of it, I was ready. :D

Deans usually made the programs divisions of Surgery, sometimes IM (U of C, second program) until the faculty matured.

Thanks BKN! But according to Wikipedia (http://en.wikipedia.org/wiki/Emergency_medicine), "Prior to the 1960's and 70's, hospital emergency rooms were generally staffed by doctors trained in other specialties, such as internal medicine and primary care." This might be particularly true in smaller rural or medium-sized cities, even after the 70's, from what little I know. I'm not quite certain what you meant by "the very early days," so maybe that quote clarified where I was coming from.

So, I'm still curious why the surgery departments? Were the first sets of EM residents really mostly former surgery folks (I'm assuming that's what you meant by "surgery retreads")? I don't see how that would lead to EM becoming a division of surgery...doesn't seem like a strong reason. Does it just come down to a rather whimsical choice or historical happenstance on the part of deans or other such higher-ups??

invent a time machine, go find out, and return with the answer.
sounds like it was program dependent.

invent a time machine, go find out, and return with the answer.
sounds like it was program dependent.
nice...

Thanks BKN! But according to Wikipedia (http://en.wikipedia.org/wiki/Emergency_medicine), "Prior to the 1960's and 70's, hospital emergency rooms were generally staffed by doctors trained in other specialties, such as internal medicine and primary care." This might be particularly true in smaller rural or medium-sized cities, even after the 70's, from what little I know. I'm not quite certain what you meant by "the very early days," so maybe that quote clarified where I was coming from.

So, I'm still curious why the surgery departments? Were the first sets of EM residents really mostly former surgery folks (I'm assuming that's what you meant by "surgery retreads")? I don't see how that would lead to EM becoming a division of surgery...doesn't seem like a strong reason. Does it just come down to a rather whimsical choice or historical happenstance on the part of deans or other such higher-ups??

As usual, the wikipedia is bogus. Prior to the 1960's, hospital emergency rooms weren't staffed at all! On call physicians, surgeons or the patient's private physicians were called when a patient showed up. The exceptions were military hospitals where the was a diffferent Medical Officer of the Day on rotation and teaching hospitals where the rotating interns and junior residents usually from Surgery and Medicine staffed.

This was before hill-burton and emtala, hospitals could refuse to take care of the unfunded.It all changed when medicare and medicaid were introduced in the mid 60s. Patients gradually began to come to private hospitals for emergency care. There was now a social and medical need to staff community hospital EDs.The first doctors to cover such EDs were in Alexandria, VA and Pontiac Mi. The Drs of the hospital in Alexandria used a rotating schedule similar to the the military MOD system. The doctors in Pontiac were the first true specialists. From there it kind of built up.

BTW, I wasn't implying that the reason the most academic depts started as a Division of Surgery was due to more of the early resdients coming from a surgical background. Rather, in the teaching the hospitals, Surgery had adminstrative control of the ED more often than not, because prior to 1965, most of the patients were surgical. In fact when I was a resident in th late 70's the unoffical name of the JHH dept was still the accident room. EM was called accident and casualty medicine in UK well into the 90s and you had to have completed surgery and trauma before you could train in A&CM to be a consultant.

As close to an EM history as I've found:

http://www2.acep.org/bookstore/index.cfm?go=product.detail&id=10258

I'm still waiting for someone to buy it for me. Looks like it should answer your question and more.

Take care,
Jeff

somebody just bought it for me when i matched :D i'm reading it now

Those two topics provide some insight into the evolution of emergency medicine and its eventual separation from surgery. Admittedly, there exists a synergy of ideas. At UMaryland, for example, R Adams Cowley was central to securing funding for the trauma center concept. Emergency medicine, in a way, evolved from the need to staff such specialized institutions. As BKN and others have noted, the body of knowledge that currently is emergency medicine has only recently been consolidated. What a long road it has been! The most recent issue of Annals contains an interesting point/counterpoint discussion about the evidence based need for trauma surgical presence upon patient arrival at a trauma center (I sense another thread in the making) ....Its important to take a step back and remember that our specialty is about thirty years old. It doesn't have quite the institutional power and clout that other, more established disciplines do. Just as ABEM and ACEP have been successful in closing the grandfather and practice tracks into emergency medicine, the speciality will continue to define itself. We already have sub-specialty boards and are making inroads into international and critical care medicine. Its only a matter of time before 'divisions' of emergency medicine mature into full-blown departments. On that note, the University of Maryland just recently achieved full departmental status at the medical school!!!

-PuSh

As usual, the wikipedia is bogus. Prior to the 1960's, hospital emergency rooms weren't staffed at all! On call physicians, surgeons or the patient's private physicians were called when a patient showed up. The exceptions were military hospitals where the was a diffferent Medical Officer of the Day on rotation and teaching hospitals where the rotating interns and junior residents usually from Surgery and Medicine staffed.

This was before hill-burton and emtala, hospitals could refuse to take care of the unfunded.It all changed when medicare and medicaid were introduced in the mid 60s. Patients gradually began to come to private hospitals for emergency care. There was now a social and medical need to staff community hospital EDs.The first doctors to cover such EDs were in Alexandria, VA and Pontiac Mi. The Drs of the hospital in Alexandria used a rotating schedule similar to the the military MOD system. The doctors in Pontiac were the first true specialists. From there it kind of built up.

BTW, I wasn't implying that the reason the most academic depts started as a Division of Surgery was due to more of the early resdients coming from a surgical background. Rather, in the teaching the hospitals, Surgery had adminstrative control of the ED more often than not, because prior to 1965, most of the patients were surgical. In fact when I was a resident in th late 70's the unoffical name of the JHH dept was still the accident room. EM was called accident and casualty medicine in UK well into the 90s and you had to have completed surgery and trauma before you could train in A&CM to be a consultant.


To this DAY most "ERs" in the U.K. are called either "A&E" (accident and emergency) or, simply, "casualty".

In fact, there's a low-budget version of ER in the UK that is called Casualty. Almost as realistic with almost as much sex.