[The author responds:]

Letters

CJEM 2006;8(2):77-78

Thanks to Dr. Bothma for taking the time to respond to my Letter.¹ I think that this is an important dialogue for our EM community to be having.

Variability is the norm in all areas of medicine. Depending on where one practises, the scope of practice and the sustained range of competence changes. General surgeons practising in more rural areas would be arguably wider in their scope of practice than colleagues in tertiary centres, but less comfortable with certain high acuity/low frequency problems. As such, tertiary groups of surgeons advertise for and attract physicians with more focused/subspecialized general surgery credentials (subspecialty fellowships, research training, etc.) than those sought in smaller communities (Dr. Manoj Raval, Fellowship-trained general surgeon: personal communication, 2006). Not all surgeons are the same, yet all are regarded as specialists.

The practice of EM is arguably even more variable. The emergency needs of communities and hospitals of all sizes call for a broad range of individuals with different skill sets to meet those needs. I feel that it is more productive for us to embrace the whole practice of EM which is, and always will be, practised in a variety of settings. To exclude those who practise "less than" tertiary care medicine from our community is self-defeating. I believe that we will gain much more strength as a larger, more unified community.

I would encourage CAEP and our EM community at large to engage in discussions about consolidated training, and wouldn't argue against "fellowships" and other recognitions of distinction in training. I believe that our EM colleagues from smaller centres will continue to be interested in educational opportunities and research initiatives designed by those with more training and with experience in high acuity/high volume centres. I propose that we look at a broader educational strategy to support our whole EM community rather than attempt to define a one-size-fits-all definition of an emergency physician that cleaves the majority from our ranks.

Adam Lund, MD
Department of Emergency Medicine
Royal Columbia Hospital
New Westminster, BC