Non-EM Attendings

[DocEspana]

So question.

My residency has a superstar attending who was IM trained >20 years ago and has spent her entire career in emergency departments. Whenever the residency review committee comes by we just throw her in a proverbial closet and ignore her for a week or two to act like we dont present to her. But again, she is a superstar.

So recently the program decided out of the blue that the way to handle this is to simply cut down her hours to almost nothing rather than attempt to find a way to grandfather her or some other mechanism to make her be a formally recognized part of the program.

My question is: does anyone actually know what the accreditation rules are for presenting to attendings who aren't formally EM trained? I read it two years ago when I first enrolled but now I cant find it. I want to appeal to the leadership to consider other options to keep her around at some reasonable level rather than just say "well lets just cut her down to this tiny morsel of hours per week" but Id need to know the actual rules before I open my mouth and ask them to reconsider.

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[Apollyon]

As I recall, the core faculty have to be EM boarded, but, beyond that, there can be non EM. It sounds like overkill in your program. There was a similar thing 15 or 16 years ago, at Duke - before I got there, I think it was "Black Thursday" (maybe another day of the week), where they cut loose every attending save 1 that wasn't EM-boarded. At that time, there were still a significant number of grandfathered EM docs, but these weren't. Now, many/most of the practice-track grandfathered docs are retired. If this person is qualified, it's not a big thing. It sounds somewhat ominous for such a screw job.

Look it up on the ACGME website. Requirements for faculty are there.

 

[Tenk]

Keep in mind there might be other politics involved with this decision that you are not aware of. I would honestly recommend not pursuing this other than to tell your core faculty that you really enjoy working with this attending and they contribute a lot to your education.

 

[NERDY]

I *think* the VA system allows non-boarded EM doctors. Is that an option for that person?

 

[EKGdoc]

All EM faculty- both core and non-core- must be EM boarded/eligible. See current EM-RRC requirements from the ACGME (attached).

 

[emergentmd]

So question.

My residency has a superstar attending who was IM trained >20 years ago and has spent her entire career in emergency departments. Whenever the residency review committee comes by we just throw her in a proverbial closet and ignore her for a week or two to act like we dont present to her. But again, she is a superstar.

So recently the program decided out of the blue that the way to handle this is to simply cut down her hours to almost nothing rather than attempt to find a way to grandfather her or some other mechanism to make her be a formally recognized part of the program.

My question is: does anyone actually know what the accreditation rules are for presenting to attendings who aren't formally EM trained? I read it two years ago when I first enrolled but now I cant find it. I want to appeal to the leadership to consider other options to keep her around at some reasonable level rather than just say "well lets just cut her down to this tiny morsel of hours per week" but Id need to know the actual rules before I open my mouth and ask them to reconsider.

I don't want to sound elitist but there are special privileges bestowed upon every board certified doctors, EM included. I am sure she is a great doc and can do everything as well as an EM doc, but this does not make her an EM boarded doc. And b/c I went through an EM training, I do not want all specialty having the same privileges as I have. No different than for me to pretend I am a dermatologist, open up a practice and advertise myself as one.

If she wants all of the privileges of an EM doc, go back to residency. Once you allow a loophole for non EM docs to have EM privileges (this ship has sailed), then it will water down my field and I will never agree with our field being watered down.

All of the hospital systems I have worked at requires boarded EM docs, no exception. My current full time gig requires her to be EM boarded to work in our hospitals no matter how bad a$$ she is.

 

[emergentmd]

I don't want to sound elitist but there are special privileges bestowed upon every board certified doctors, EM included. I am sure she is a great doc and can do everything as well as an EM doc, but this does not make her an EM boarded doc. And b/c I went through an EM training, I do not want all specialty having the same privileges as I have. No different than for me to pretend I am a dermatologist, open up a practice and advertise myself as one.

If she wants all of the privileges of an EM doc, go back to residency. Once you allow a loophole for non EM docs to have EM privileges (this ship has sailed), then it will water down my field and I will never agree with our field being watered down.

All of the hospital systems I have worked at requires boarded EM docs, no exception. My current full time gig requires her to be EM boarded to work in our hospitals no matter how bad a$$ she is.

As above, the only good way to qualify as an EM doc is to take an Em residency and pass your boards. Anything less is substandard

 

[deleted480308]

For what it's worth (regardless of if anything can be done or if it's politically "safe" for you to bring it up) I find your sense of loyalty to a quality colleague to be admirable. It's a good character trait you should hold on to no matter how this turns out

 

[Apollyon]

All EM faculty- both core and non-core- must be EM boarded/eligible. See current EM-RRC requirements from the ACGME (attached).

I looked at that same document, and did not arrive at the same conclusion. I see about the core faculty, but there's that line about "approved by the committee" or thereabouts. I did not see about non-core faculty.

Maybe I'm just a dope. I don't know!

 

[Danbo1957]

I don't want to sound elitist...

I don't want to sound elitist either... but you will never be as good a doctor in the ER as she is, and you will never know why.

 

[engineeredout]

I think the general thought process of only allowing us to work under EM trained/boarded docs is a good thing. Taking this measure to an extreme, a program could set you up to be training under a large amount of people who are simply not trained to do what you want to do. Medicine residency gives you some framework of how to manage some patients, but absolutely does not prepare you to run an emergency department.

I don't think the rules were set in place in order to exclude the family doctor who has been practicing in an ED for 30 years from working with you, it's to prevent a program from abusing the situation and having a large percentage of your attendings with variable EM experience trying to teach you Emergency Medicine. I doubt radiology residents want to learn from us how to read CXRs, or ophtho residents wanting to learn from us how to use the slit lamp etc...

 

[gman33]

I'm not sure the exact timeframe, but I think the ability to get grandfathered in for experience is no longer possible.
Even if this doc has been practicing for 25 years, that would have put them as starting in 1990.
There were tons of EM residencies available at that time for training.

I'll take your word that they are a great doc, but they probably should not be faculty at a residency program.
They choose to practice EM without doing a residency, and that training was available to them.

Just doesn't send the right message as to the importance of board certification.

 

[Apollyon]

The practice track window closed 1989. Greg Daniel sued in 1990, and the case went until 2005, until it was finally adjudicated against Daniel. However, he did make his millions by selling his group to Team Health about 4 years ago.

 

[umt433]

I can definitely understand the sentiment that docs should be board certified, and wholly agree with that. However, isn't it possible to be board certified any NOT residency trained? One of our top EM guys is FACEP, FAAEM, and I'm almost positive board certified in both EM and IM, after just doing an IM residency years and years ago.

 

[alpinism]

I can definitely understand the sentiment that docs should be board certified, and wholly agree with that. However, isn't it possible to be board certified any NOT residency trained? One of our top EM guys is FACEP, FAAEM, and I'm almost positive board certified in both EM and IM, after just doing an IM residency years and years ago.

For EM it was possible up until 1988 when the practice track closed.

http://epmonthly.com/article/expand...certified-docs-a-step-in-the-wrong-direction/

"The first emergency medicine (EM) residency began 44 years ago. It has now been 38 years since the American Board of Emergency Medicine (ABEM) was incorporated. Progress in EM, as well as any other specialty, demands rising standards that evolve into formal training being the only legitimate route to certification. By the time ABEM closed the practice track in 1988, after a 10 year grace period, there were enough excellent training programs that a practice track no longer made sense for our evolving specialty. We are now at the point that the practice track was closed before many of our EM residents had even been born. We have had more than 100 EM residency programs for twenty years now. Today, there are at least 209 EM residencies (allopathic and osteopathic), graduating in excess of 2,000 residents a year. It has been 24 years since Dr. Gregory Daniel sued the American Board of Emergency Medicine (ABEM) for restraint of trade, seeking to re-open the practice track — the suit was dismissed in 2005 after 15 years of litigation. At a certain point, a specialty needs to move on — I feel we are well past this point."

 

[Danbo1957]

The argument still is whether EM should be a specialty at all.

 

[emergentmd]

I don't want to sound elitist either... but you will never be as good a doctor in the ER as she is, and you will never know why.

First off, you have no clue how good or bad i am. Second, how good she is (I am sure she is exceptional) has no bearing on her standing in the EM community. If she wants ALL of the privileges of an EM doc, she needs to go through all of the hoops and training that I did. PERIOD.

If her application ever went to credentialing at any of the hospital I work at, it would be REJECTED before it even hits the committee's desk. It doesn't matter how many glowing peer references accompany her application, how many ED hours she has under her belt, or How many lives she has saved in the ED.

She is NOT Board trained and NOT board certified. She is an internist working in the ED. She is not an emergency medicine physician.

 

[emergentmd]

The argument still is whether EM should be a specialty at all.

I am sure you are not an EM doc and your argument has little weight. EM is a specialty, its board certified just like any other specialty.

 

[Druggernaut]

I am sure you are not an EM doc and your argument has little weight. EM is a specialty, its board certified just like any other specialty.

He's not. He's a sad, sad man who spends his weekends trolling other specialty boards. Unfortunately, he's also apparently faculty at UT Austin, and can plant these negative seeds in new surgeons (I assume) as well.

 

[Danbo1957]

You don't know me man. Sad about the current standards of medical education, true that. Thank God we now practice evidence based medicine...