Additionally, the cush hours and moderate level of competitiveness of EM are a very new development, and that field is still very much finding its way in terms of shift work, privatization and the like. It will be a few more decades before we know exactly how EM is going to be regarded. Until then, it is very premature to talk about adding it to ROAD.
I agree, EM is a relatively new specialty; its development began greater than 40 years ago and was recognized as an official specialty greater than 30 years ago. However, there really isn't any "finding its way" going on, possibly with the aggressive incorporation of new technology, such as sonography in everyday care, but nothing really to do with the industry as a whole. The concepts of shift work and privatization have really been unchanged since the initial models were developed in the mid to late eighties (of course there has been tweaking along the way, but that is true of any specialty).
"It will be a few more decades before we know exactly how EM is going to be regarded", I am not sure exactly what you mean by this statement, all specialties are in a constant state of flux, though Ill give you, some more than others. For instance, the face of anesthesia may change with the emergence of more nurse anesthetists (with the need to decrease costs) or the face of radiology may change with the ability to outsource film reading overseas. And as far as the future of EM, projections are that the need for EM physicians will continue to increase over the next 10-15 years (regardless of Obama-care). With that demand, the compensation is not likely to decrease in the near future. EM is lucky because federal law basically makes it a requirement that hospitals provide emergency care. Hospitals can survive without a radiologist (outsource), a cardiologist (transfer when necessary), a surgeon, etc, but all hospitals have to have an Emergency Department (EMTALA).
I actually have heard quite a few big names in the field utter concerns about whether residents are being adequately trained given the lesser hours involved at some programs, so don't write off the possibility of a whipsaw effect in the not too distant future.
While I cannot comment on what you did or did not hear from "big names in the field". I can assure you, as well as the other readers of this thread, that the concern of insufficient training is held by a small minority. Nearly 95% of the EM programs out there are 3 year programs versus the other 5% that are 4 year programs. And of these 4 year programs, most of the extra year is not filled with core EM training, but filled with extra time for academic/research pursuits or more elective time. Furthermore, of all the 3 year programs out there, only one has decided to increase its training to 4 years, and that was to give residents an extra year to pursue other interests in EM and not feel so rushed in residency. To date, the Society of Academic Emergency Medicine, the American Academy of Emergency Medicine, and the American College of Emergency Physicians all agree that a three year residency program is sufficient to produce competent and successful EM physicians. There isn't even a whisper of increasing the length of programs because the training is insufficient.
