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How EMS physicians became recognized and rewarded

How our physician colleagues got respect

To follow up on last night's discussion on compensation, a board-certified emergency medicine physician with five to ten years experience earns an average of $258,000 per year, or $124/hour. (2009 data)

It was not always so. Forty years ago emergency medicine was a low-pay, low-prestige side job. The mom-and-pop community hospital with a dozen beds maintained a poorly equipped "Emergency Room" staffed by part-time or fill-in physicians.

Defining a Profession:

Medicine considers five factors in defining a specialty:

  • Unique body of knowledge
  • Professional association
  • Peer-reviewed vetting of knowledge acquisition
  • Testing of competence
  • Institutional training: internship, fellow, clerkship

Three organizations have pushed emergency medicine and EMS physicians into the light.

1968: American College of Emergency Physicians (ACEP)

The first professional organization, established Annals of Emergency Medicine in 1972 as their peer-reviewed scientific journal.

Establishing a scientific journal is a major component in establishing a specialty, from the Annal's website:

Annals is the emergency medicine journal most frequently cited by authors and has the highest impact factor over the years of all 19 journals in the emergency medicine category of the SCI (Science Citation Index). The impact factor (the average number of citations per published article) is the commonest measure of journal influence; the 2010 impact factor for Annals was 4.14, placing it in the top 12% of all 8,005 science and medical journals tracked by the SCI.

Not only is Annals most frequently cited, but it is cited more promptly and longer than any other emergency medicine journal (9.5 years, 83% longer than its nearest competitor). In the past 5 years, more than1,200 different journals in the ISI science journal database cited an article in Annals, and in a typical year, Annals articles are cited by more than 400 different scientific journals, most of them from a broad range of specialties outside of emergency medicine.

In 1979 Emergency Medicine becomes the 23rd specialty recognized by the American Board of Medical Specialties.

1984: National Association of Emergency Medical Service Physicians (NAEMSP)

One hundred emergency physicians established NAEMSP to define the needs and specialties unique to an EMS Physician. The first effort was a task force started in 1992 to establish EMS as an emergency medicine subspecialty. Their efforts moved the ball forward, but not enough to achieve recognition. The task force disbanded in 1996.

In 1997 Prehospital Emergency Care (PEC) was created as the scientific journal for emergency medical service physicians.

From the 2011 NAEMSP annual report:

In July, PEC received its third Impact Factor, which increased to an impressive 1.889. This Impact Factor placed PEC as the 8th most oft-cited Emergency Medicine journal out of the 23 that are currently rated by the ISI Web of Knowledge.

PEC had an even more impressive Immediacy Index, which indicates how rapidly articles that are published in PEC are cited in the same year. PEC had an Immediacy Index of 0.533.

This ranks PEC 4th out of the 23 EM journals that are ranked in terms of being rapidly cited. PEC continued to be placed ahead of such well-established journals as Journal of Emergency Medicine, Pediatric Emergency Medicine, Journal of Emergency Nursing, Emergency Medicine Clinics of North America, and European Journal of Emergency Medicine.

PEC is also the official journal of the National Association of State EMS Officials (NASEMO), the National Association of EMS Educators (NAEMSE) and the National Association of EMTs (NAEMT).

1998: United States Metropolitan Municipalities Medical Directors Consortium

Known as the "Eagles," this group is comprised of most of the jurisdictional EMS medical directors for the nation's largest cities 9-1-1 services. Read more about them HERE (510 minutes that shape EMS: The Eagles speak in Dallas)

Establishing a unique body of knowledge

By 2005 the professional, peer-reviewed literature was sufficient to make a second effort at establishing EMS physicians as an emergency medicine subspecialty.

NAEMSP members wrote a four volume Emergency Medical Services Clinical Practice and Oversight publication that covered four areas:

  1. Clinical aspects of prehospital medicine
  2. Medical oversight of EMS
  3. Evaluating and improving quality in EMS
  4. Special operations medical support

The books were published in 2009.

The content and organization of EMS Clinical Practice and Oversight matched the proposed curriculum for the EMS subspecialty fellowship.

EMS was recognized as an emergency medicine subspecialty in 2010. You can go HERE (How medicine approaches EMS credentialling) for details of the ems physician fellowship. The first board exam is anticipated in late 2013.

You get what you invest in.

I appreciate Skip Kirkwood's response to yesterday's article. It provides an appropriate conclusion to today's example:

My frustration comes from the failure of, or the unwillingness of, so many EMSers to "engage," to spend even a few minutes or a few dollars to advance their profession.  MANY are willing to speak, but a willingness to speak without the willingness to WORK on what you are speaking about is just whining.  And as a kid I learned (whap!) that there are few things worse than a whiner.

My second source of frustration comes from the "What's in it, or what's easy, for me" focus. Improving the stature of EMS in our communities, and improving the lot of EMTs and paramedics, is not rocket science. It involves improving educational standards, becoming active in political regulator affairs, and stepping up to take control of our profession and our work environment. Unfortunately, the response seems to be "If they're not going to pay me more, up front, I'm not going to make any additional effort in this arena."

Folks, you make the investment first, then you get the dividend. It works that way in the stock market, and it works that way in the economic, political, and academic environments.

Mike "FossilMedic" Ward

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