Episode 55: Family Medicine in the Emergency Department

EMIGcast

Long before EM was established as a profession, Family Medicine was the predominate force in the Emergency Room. The state of affairs was a sad one merely 50 years ago with funeral directors and morticians providing the ‘ambulances’ as the only vehicles that could transport people in the horizontal position – hearses. With the Academy of Sciences publishing their infamous white paper on the state of accidental death and disability around the same time the first person was sent to space, the industry was primed for some much-needed overhaul.

The change was the creation and implementation of a new specialty that was sure to “steal patients” and “without its own base of research” at a time when the attitude was that there was “enough specialties already”. The time was the mid-seventies and it saw the birth of Emergency medicine.

As the decades have past and demand for emergency medical services has grown at almost double the rate of the population growth, we have seen many urban hospitals demand that their EDs be staffed by Board-certified physicians, sadly ignoring the well qualified Family Medicine trained physician community.

Surprisingly, nearly a quarter of physicians staffing EDs in the US are actually FM trained. They operate in rural centers predominantly, but they often staff some urban EDs as well, with around half of all FM emergency visits originating in Emergency Departments. As the need grows and hospitals continue to pull their emergency services out of rural areas for fear of losing profits, the need for ED providers will likely only grow in the coming years and much of that need can be met by a specialty not often associated with EM.

In this episode, Sam and Aaron will be your guides as we explore the history of EM, interview three FM docs and a very gracious PA on their thoughts about breaking into the ED without the burden of an EM residency.

Intro and interviews with Drs. Frank, Gideonse, and Eric Holden written and directed by Sam Matz(MS4) with assistance and interview with Dr. DeYoung by Aaron Wille (MS4).

Articles used for reference:

America’s Emergency Care Environment, A State-by-State Report Card
https://www.annemergmed.com/article/S0196-0644(13)01644-2/abstract

Family Physicians Play Major Role in Urban ERs
https://www.aafp.org/news/practice-professional-issues/20150929fpemergencies.html

Family Physicians Delivering Emergency Medical Care – Critical Challenges and Opportunities (Position Paper)
https://www.aafp.org/about/policies/all/critical-challenges.html

Family Physicians in the ED
https://www.hhnmag.com/articles/5434-family-physicians-in-the-ed

The Scariest Medical Job in America

The Scariest Medical Job in America

Emergency Department Coverage by Primary Care Physicians in a Rural Practice-Based Research Network: Incentives, Confidence, and Training
https://www.ncbi.nlm.nih.gov/pubmed/19785585

Nonemergency Medicine-Trained Physician Coverage in Rural Emergency Departments
https://www.ncbi.nlm.nih.gov/pubmed/18397454

Hospital Based Emergency Care At the Breaking Point
https://www.nap.edu/catalog/11621/hospital-based-emergency-care-at-the-breaking-point

Emergency medicine in the United States: a systemic review
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4129827/

FAMILY PHYSICIANS IN EMERGENCY MEDICINE: NEW OPPORTUNITIES AND CRITICAL CHALLENGES
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2975696/

The Rise of Emergency Medicine in the Sixties: Paving a New Entrance to the House of Medicine
https://elischolar.library.yale.edu/cgi/viewcontent.cgi?referer=https://www.google.com/&httpsredir=1&article=1056&context=ymtdl