It took 18 years and two attempts before EMS was recognized as an Emergency Medicine physician subspecialty

During EMS Week 2018 about 70 physicians were enrolled as EMS Fellows. This is a one or two-year graduate program focused on the Emergency Medicine subspecialty of Emergency Medical Services. During this time EMS fellows function as an assistant medical director, participate in peer-reviewed research, and work in the streets with EMS caregivers. They learn from a knowledge and skill curriculum based on the Core Content of EMS medicine. This program started in 2012 but took 18 years to make it happen.

When the American College of Emergency Physicians started in 1968 emergency medicine was a low-pay, low-prestige side job. The mom-and-pop community hospital with a dozen beds maintained a thinly equipped “Emergency Room” staffed with part-time or fill-in physicians.

Defining a Specialty

Medicine considers five factors in defining a specialty:

• A unique body of knowledge
• Professional Association
• Peer-reviewed vetting of knowledge acquisition
• Testing of competence
• Institutional training:
  • Internship
  • Fellow
  • Clerkship

Emergency Medicine was recognized as a physician specialty in 1979, the 23rd medical specialty recognized by the American Board of Medical Specialties  (ABMS). Certification by an ABMS Member Board helps demonstrate to the public that a physician meets nationally recognized standards for education, knowledge, experience, and skills and maintains their certification through continuous learning and practice improvement in order to provide high-quality care in a specific medical specialty or subspecialty.

Creating a subspecialty

The initial 1992 National Association of EMS Physician (NAEMSP) task force spent four years in an unsuccessful effort to get EMS approved as an Emergency Medicine subspecialty. After their first application to ABMS was rejected, NAEMSP members began to built-out the physician side of Emergency Medical Services.

• A unique body of knowledge: They produced a two-volume reference guide to the clinical aspects and medical oversight of emergency medical services.
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• Professional Association: The National Association of EMS Physicians – including an annual meeting, continuing education, and committees involved in development and delivery of physician direction and practice within EMS.
• Peer-reviewed vetting of knowledge acquisition: Prehospital Emergency Care has become a powerful peer-reviewed journal within the emergency medicine specialty.
• 
• Testing of competence: ABEM exam
• Institutional training:
  • EMS Medical Director’s Course and Practicum
  • EMS Fellowship

The American Board of Medical Specialties describes the Emergency Medical Services subspecialty this way:

An Emergency Medicine physician specializing in Emergency Medical Services has special knowledge and skills for the delivery of medical care of the acutely ill or injured patient in the pre-hospital setting. This care includes the initial patient treatment, stabilization and transportation in specially equipped ambulances and medical helicopters. The initial care for conditions such as heart attack or stroke may occur in patient homes, public places and wilderness settings. These medical specialists perform life-saving procedures outside the hospital setting, sometimes when people are still trapped in cars or buildings.

Once the EMS subspecialty was approved by ABEM, it took about two years to establish the structures and procedures for the EMS fellowships and board examinations.

Board certification of physicians makes a career and financial difference. One pay database shows a physician with “Emergency Skills” makes about $239,000 a year. Using the same database shows a paramedic makes about $45,000 a year.

What would you be willing to do to improve your salary, working conditions and career? What could you accomplish by EMS Week 2019?