Physicians Seek Recognition for EMS as Subspecialty of Emergency Medicine

Posted: Friday, March 13, 2009
Updated: March 16th, 2009 02:20 PM EDT
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Physicians Seek Recognition for EMS as Subspecialty of Emergency Medicine




Theodore R. Delbridge, MD, MPH
Theodore R. Delbridge, MD, MPH


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As announced in this month's issue of EMS Magazine, (Click to read) the National Association of EMS Physicians (NAEMSP) along with the American College of Emergency Physicians have formally applied to the American Board of Emergency Medicine for EMS to be recognized as a true subspecialty of emergency medicine.

This will be the second appeal in two decades, but the feeling among physicians in the EMS community is that the time is right. EMSResponder.com spoke with NAEMSP president Ted Delbridge to learn more about this effort.

Over the years, he explained, the number of EMS fellowship and academic programs have multiplied, producing physicians who consider themselves to be specialists in EMS or prehospital care. So now, "There is a critical mass of physicians with an interest in this field," he said, and "As a whole, the group has become better able to articulate its specific fund of knowledge."

Delbridge explained that the process toward recognition as a subspecialty is well defined but entails many steps.

"The path we are pursuing is one on which the American Board of Emergency Medicine will consider the merits of a petition that has been spearheaded by NAEMSP and the American College of Emergency Physicians, and we hope they will consider the petition favorably," he said.

"Then it becomes the American Board of Emergency Medicine's job to carry that forward to the American Board of Medical Specialties, which ultimately declares EMS as a physician subspecialty, and along the way there's opportunity for the other specialty boards in medicine to weigh in on how they see the merits of the application or their interest in becoming involved."

The practical effect for EMS providers

"Hopefully what it will do over time is further develop the cadre of physicians that act as medical directors," Delbridge said. "As I travel around the country I recognize that providers don't always enjoy the most qualified of medical direction... and often that's because in their particular geography or community, there's not an abundance of physicians with an interest in EMS; they don't have access to someone who has enthusiasm like they do.

"Hopefully this will lend an added degree of credibility to the field that will attract other physicians, and they will become enthusiastic medical directors and leaders in prehospital care that ultimately other providers in the field will benefit from."

Next steps

Delbridge said EMS already exists as a subspecialty in Canada and is in the final stages of development in the UK, which is noted in the petition.

He hopes to have an answer to the petition sometime this calendar year. He expects the American Board of Emergency Medicine to look at it within the month and either give it a thumbs up or down. If it's a thumbs up, they can finalize their stand in the summer, he said, and then the American Board of Medical Specialties would hopefully take action within the year.

More about NAEMSP

This isn't the only effort underway at NAEMSP. "For an organization its size it is extraordinarily active, Delbridge said. "It finds to way to get involved or to be invited to really important events that represent efforts to improve the EMS system.

"I think that we are refocusing our efforts on advocacy, strengthening relationships with organizations that are supporters for EMS, and advocating for funding to strengthen the system in this country," he said. "...With our legislative advisors, we are working toward identifying priorities, especially at a time when their might be funding for healthcare or information technology."

Delbridge said NAEMSP continues to focus on its quarterly prehospital emergency medical care journal and recently finished a new EMS textbook for physicians, titled Emergency medical services: clinical practices and systems oversight.

For more on NAEMSP, including their annual meeting to which all providers are invited, visit www.naemsp.org.


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Comments

Posted by Peter Elkins in British Columbia, Canada
(03/14/09 - 03:00 PM)
Leadership
Medical Direction

Pre-hospital care practitioners of the future will need to be independent decision makers. As it is today, paramedics are responsible for pre-hospital patient care but ultimately it is the physician who is accountable for the paramedic. In Canada, as well as the United States, paramedics are under the direct and indirect supervision of physicians employed by or under contract with Emergency Medical Services. Is it time for a fundamental shift in which a paramedic is positioned to assume the role of the Medical Director?

Leadership starts with accountability. So in order to develop a pre-hospital care culture that will effectively address the needs of future paramedics, they must be put into leadership roles working collaboratively along side with physicians as opposed to working under the watch of physicians. To affect this change, clinical research, sound training, and responsible hiring practices would have to be implemented. The role of the physician would also have to change from one of leadership to one of consultant. Ultimately EMS must evolve in order to better serve the changing needs of our communities and ensure a better return on the investment of our health care dollars.


Is the leadership of Emergency Medical Services (EMS) being compromised by medical oversight? Is this preventing EMS leaders from reaching their full potential?

Please email Peter at elkins@gutz.com with your reaction.



Posted by medicsb in Philadelphia, Pa
(03/14/09 - 11:29 PM)
Disagree
Are PAs and RNs hindered from reaching their full potential because they work under a physician? No. I think there are many other factors hindering the advancement of EMS. Medical directors, by and large, are not one of them. Many medics work with medical directors to change practices. But ultimately at the end of the day, it is the physician that will (and should) have the final say on what can and cannot be done. 7 years of medical training (beyond undergraduate school) trumps even the most rigorous of paramedic training programs any where in the world.



Posted by Anne Castioni in Carmel, NY
(03/15/09 - 03:56 PM)
Medical Direction
Medical Direction is one of the few things that has gone right for EMS. The others aspects mentioned in previous comment that need strengthening: "clinical research, sound training, and responsible hiring practices," would enhance the service.
No question that leadership is needed, but medical direction is not an area where EMS has a problem.



Posted by Medicman in Hickory,NC
(03/15/09 - 09:36 PM)
EMS transition & transformation
As we all know,EMS has changed and improved greatly in its thirty plus year history.I feel the practicioners of the field have as well,and are still advancing to date. There have been great opportunities for medics in my area, where seasoned ER docs are now allowing us,(Paramedics),to work in ERs & Urgent Care centers.Many physicians in my area as well as across my state and our country are finally seeing the true value of the experienced field Paramedic as a clinician and a capable provider in their own right.The ER docs I have worked with value the Paramedic with good skill and diagnostician talent greatly.We as pre-hospital providers need to display our best with each & every call. I wish Dr.Delbridge much success in his venture and the same for us representing our industry. Remember, Paramedic means "beside the doctor".





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