July 15, 2012
Dear Council Members:
I am proud to support the application of SEMES, Sociedad Espanola de Medicina de Urgencias y Emergencias, as a primary medical specialty in Spain.
Throughout my professional career, I have experienced the challenges, opportunities and gratification of Emergency Medicine development in the United States. The specialty began in the US in the 1970’s as a neglected, even disparaged type of practice. But today it is one of the most successful and sought after specialties, one of the top three specialties in the US. The specialty is skyrocketing around the world, with established residency programs and board recognition in more than 50 countries. It started because of the demand from the community, from patients, for care at a time of extreme vulnerability, in the emergency department, by care from trained physicians, rather than from the least-experienced physicians that had been typically assigned to the emergency department.
Several years ago, I had the pleasure of visiting the Emergency Department at Reina Sofia Hospital in Cordoba, Spain, and was very impressed with the medical and administrative skills of the emergency physicians in that department. So impressed, that I encouraged several of my US emergency medicine residents to travel to Cordoba for a rotation in the emergency department. They returned with a great admiration and respect for the emergency physicians they worked with.
Why is Emergency Medicine unique among other specialties? Emergency Medicine is the only population-based specialty- emergency physicians are trained to see all types of patients with all types of disorders. The emergency department is a microcosm of the illnesses, injuries, and socioeconomic and behavioral disorders that affect the surrounding community.
Emergency Medicine is structured so that its practitioners can recognize, treat, and organize the near instantaneous specialty consultation for time-sensitive disorders: disorders such as sepsis, stroke, acute myocardial infarction, anaphylaxis, cardiac arrest, hyper- and hypo-thermia, etc etc. Of course, and providing an example, the definitive treatment of acute myocardial infarction is the provenance of cardiologists—but it is the emergency physician who must identify-- out of literally hundreds of patients who present with chest pain—those who truly have STEMI or NSTEMI.
Emergency Medicine is unique because emergency physicians are trained to see multiple patients at a time. For example, while the surgeon or orthopedist will care for one patient at a time, or the clinic physician sets up appointments for one patient at a time, the emergency physician must see many- 20, 30, 40 patients- nearly simultaneously. Training in emergency medicine provides physicians with the skills and encourages aptitudes for this type of practice.
Emergency Physicians are trained to develop unique administrative skills – serving large numbers of patients requires training in triage and multi-tasking. Emergency Physicians are partners with the hospital and with other specialists in practicing efficient medicine- providing emergency treatment so the patient can be safely discharged; arranging primary care physician followup; understanding the community and hospital resources for ambulatory care; and identifying those patients who truly need hospital admission.
Emergency Medicine is symptom-based. Other specialties are diagnosis-based. Diagnosing and treating any type of symptom, illness, injury, or behavioral disorder, in a patient of any age, requires training that has very broad scope that is not found in any other specialty.
Why is it important to approve Emergency Medicine as a primary specialty?
Specialty status means that standards for emergency medicine training and practice are developed and applied in the clinical environment. Specialty status means that training unique to emergency medicine can be provided to all those who work in emergency department, and all those who aspire to be emergency physicians. Specialty status makes it possible for emergency physicians to communicate the excellent work they do as specialists, to the community and to other physicians. Specialty status means that certification examinations will be developed and utilized to assure the public and other specialists that those who practice in emergency departments are well qualified. The training and practice of emergency medicine is so unique that around the world, it is recognized as a primary specialty, because the approach to practice and immense scope of knowledge is best provided through training as a primary specialty.