Emergency Medicine is a SPECIALTY. Let's make it that, and not dilute it in order to be PC

Letters

CJEM 2006;8(2):77

To the Editor: I read the Commentary by Adam Lund¹ in the January 2006 issue of CJEM with interest, but am puzzled by his closing remarks. Is he implying that there is no distinction between service providers in the ED?

I would agree that subspecialization is something that might not best serve the interests of the EM community at the present time, as it will further splinter an already splintered area of medicine. Now is the time for setting up national standards for training, aiming toward minimum requirement for physicians wanting to practise in EDs, building on the number of certified emergency physicians (whether FR CPC or CCFP-EM), and ultimately aiming for consolidating EM as the SPECIALTY that it is.

I don't believe that EM is best practised by the "available physician." Completing an EM residency obviously enables one to practise at a different level than someone with no formal training. Even the 1-year residency offered by the CCFP enhances the skill and knowledge level of the physicians to the point that they mostly narrow their practice of medicine to EM. I don't believe that there is a substitute for appropriate supervised training, such as a residency provides. We as a specialty should strive for the ultimate goal of a unified qualification/certification process.

Until there is a shift in the current paradigm, emergency physicians will continue to meet opposition and a lack of recognition from the "established" specialties due to the enormous variability in performance level. And you cannot blame them, since they interface with such a wide variety of competencies — it is no wonder they don't know what a "specialist" in EM is (even though the "specialty" has existed for more than 30 years).

What I would like to see is a set of criteria set forth by CAEP as to what an emergency physician is, and perhaps supplement this by awarding a "FCAEP" to suitable individuals (similar to the FCFP awarded by the College of Family Physicians of Canada). This would be a start to a process that would hopefully, eventually lead to ONE qualification, ONE type of residency training, and a UNIFIED body of physicians able to practise the "Model of the Clinical Practice of Emergency Medicine".

Daniel Bothma, MB, ChB
Emergency Medicine Specialist
daniel.bothma@vch.ca