Development and direction of the American Board of Emergency Medicine

Abstract

HISTORICAL PERSPECTIVE A scant six years ago, in the fall of 1976, the Bicentennial was in full swing and the University Association for Emergency Medical Services had held its annual meeting in the city of Philadelphia. The Liaison Residency Endorsement Committee (LREC) had been functioning for about two years. It had reviewed and endorsed, with its inhouse process, some 30 programs in emergency medicine. In that environment, the American Board of Emergency Medicine (ABEM) became an incorporated entity. The purpose of ABEM was to establish credentials that would allow access to a certifying examination in emergency medicine, to develop a certifying examination, and to subsequently certify as having competence in emergency medicine those individuals who passed such an examination. Although the American Board of Medical Specialties (ABMS) did not recognize ABEM, it was not unprecedented to become incorporated and begin to develop outside the accepted approval process. In fact, of the then 22 recognized boards, eight had previously become incorporated in a year other than that in which final approval for recognized certification occurred. As a matter of fact, in one instance, that of thoracic surgery, there was a 20-year hiatus between incorporation and final ABMS approval for certification. Seven years earlier, in 1969, family practice had become incorporated and approved as a primary board. At the time of its board approval, it was the first board to be recognized in 20 years, for preventive medicine and colon and rectal surgery had been approved in 1949. In 1971, ABMS approved two boards as conjoint. These were Allergy and Immunology and the American Board of Nuclear Medicine. Over the ensuing five years, these specialties had struggled to function in an efficient and effective fashion. The prime reason for this inability to function appeared to be a stipulation in their bylaws mandating that all policy be approved by all boards or societies making up the sponsoring organizations. This inability of conjoint boards to function smoothly and independently was of great concern to those negotiating for the newly incorporated board of emergency medicine, and led to rejection by ABEM of an ABMS offer of conjoint status until a more workable set of bylaws could be allowed. Many will remember this did not come easily. In 1979, after many meetings with various committees of ABMS, with individual incorporated boards, and with the AMA, an attitude evolved which fundamentally said, We will give you (ABEM) a board with independence if you will accept a new status which we will call conjoint* modified. A conjoint board* modified comes with all the independence, both ,in finances and policy, of the other 20 primary boards. It has, however, one limitation the prohibition by ABMS bylaws of issuing certificates of special competence within subspecialty areas of the discipline. For example, it is essential that we obtain the assurances of the ABMS that emergency medicine diplomates who subsequently take fellowships in critical care medicine be allowed to sit for any certification examination in critical care medicine that will be developed in the near future. A board and a certifying examination in critical care medicine is supposed to surface in 1984. we have