The Role of Emergency Medicine in the Future of American Medical Care

Abstract

[Josiah Macy, Jr, Foundation: The role of emergency medicine in the future of American medical care. Ann Emerg Med February 1995;25:230-233.] No reprints available from the author. author. Reprint no. 47/1/61944 The conference was held in Williamsburg, Virginia, from April 17 to April 20, 1994, to examine the future of the medical specialty of emergency medicine. The conference was chaired by L Thompson Bowles, MD, PhD. During the past 30 years, emergency care of seriously ill and injured patients has become an essential component of the US health care system. Most of this care is provided in the emergency departments of acute care hospitals in conjunction with community-based emergency medical services. Within the current health care system, EDs are the only institutional providers mandated by federal law to treat anyone who presents for care. As emergency care has dramatically saved greater numbers of patients whose lives are at risk, the demand for these services has escalated. EDs are the first responders in a society that has been increasingly concerned about violence and addiction to drugs and in which large-scale disasters seem to be more common. In addition, EDs have become principal providers of primary health care to the poor, homeless, unemployed, substance abusers, prisoners, and all others who have no regular source of health care. Providing these services has produced severe overcrowding and serious financial losses for EDs, and, although EDs are widely available, they vary considerably in quality and accessibility from region to region and, in many cases, from neighborhood to neighborhood. In recent decades, as emergency care has become more sophisticated and complex, the new medical specialty of emergency medicine has emerged. It has established standards of competence for physicians who specialize in treating acutely ill and injured patients and has developed and enforced standards for programs that educate emergency medicine specialists. In 1979, emergency medicine was officially recognized as the 23rd, and now second youngest, medical specialty. Currently, there are 16,000 members of the American College of Emergency Physicians, and 10,500 physicians are certified by the American Board of Emergency Medicine as emergency medicine specialists. In addition, approximately 2,200 physicians are being educated in the 101 accredited emergency medicine residency programs, and each year, these programs graduate about 800 physicians who are eligible to be certified as specialists. Ironically, as the specialty of emergency medicine advances both academically and clinically, it is confronted by issues that threaten its future. The role of the specialty in health care is poorly understood, and plans for health care reform have neglected emergency care. The boundaries and scope of practice of the specialty are broad and are contested by other specialties. Emergency medicine has failed to develop an agenda for research, and the specialty has received less academic recognition than most other medical specialties—emergency medicine specialists have a very limited role in the general education of physicians, especially during medical school, and during the graduate medical education of other generalist physicians. In response to this crisis, and at the request of the Society of Academic Emergency Medicine, the Josiah Macy, Jr, Foundation appointed a planning committee to organize a conference that would examine the future of the medical specialty of emergency medicine. The committee was chaired by L Thompson Bowles, MD, PhD and consisted of Raymond J Baxter, PhD; Lewis Goldfrank, MD; Louis J Ling, MD; and L Gregory Pawlson, MD. The conference focused on the specialty's role in clinical service, medical education, and medical research. The conference brought together 38 experienced and influential leaders from government, public health care advocacy groups and other medical specialties, as well as leaders from the medical specialty of emergency medicine and from other nonphysician professions that provide emergency care. The foundation commissioned the following five papers, which served as major focal points for discussion—History of Emergency Medicine, Peter Rosen, MD; What Is Clinical Emergency Medicine? Arthur L Kellermann, MD, MPH; The Emergency Department as Safety Net for Non-Emergent Care, Ron J Anderson, MD; Education in Emergency Medicine, Glenn C Hamilton, MD; The Future of Emergency Medicine Research, Gabor D Kelen, MD, and Charles G Brown, MD. These papers, together with a summary of the proceedings of the conference, will be published and distributed in March 1995 by the Josiah Macy, Jr, Foundation, New York, New York.