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ABPS Diplomate Harry L. Wingate III, MD, FACEP, On the Rural Emergency Medicine Physician Experience

Harry L. Wingate III, MDI was blessed to be a recipient of the Georgia State Medical Education Board medical school tuition grant, also known as “the country doctor program.” In exchange for the state paying my medical school tuition, I agreed to practice Primary Care (PC) medicine in an underserved GA rural community. So, in 1990 after completing my residency in Family Medicine, I moved to Eatonton, GA.  While completing my PC practice obligation, I also worked for seven years in Rural EDs accumulating over 10,000 hours of experience.  Seeing the tremendous need for Rural EM doctors, I decided after successfully passing the rigorous oral and written initial Board Certification in Emergency Medicine (BCEM) exams in 1997 to transition to the full-time practice of Rural Emergency Medicine (EM).

But exactly what constitutes a Rural EM practice? Many organizations, including the Centers for Medicare & Medicaid Services (CMS), the American College of Emergency Physicians® (ACEP), and the National Rural Health Association (NRHA), have examined this question. As you would imagine, they have come up with varying definitions, based on factors like geography, population density, and healthcare manpower shortage etc. But I think the most practical definition is simply this: a Rural EM practice occurs in a remotely located single-provider covered emergency department with minimal staff and with limited to no local specialty resources – a practice setting perfect for challenging the Provider’s clinical and leadership skills. This definition describes almost a third of the approximately 5000 emergency departments (EDs) in the United States.

Rural EM is, by necessity, an engaging practice setting to say the least. As someone who is competitive and easily bored, I’ve found it perfect for my personality. The 1991 movie, “Doc Hollywood” starring Michael J. Fox, gives you a good idea of quirky situations found in practicing Rural EM. In hindsight, I shouldn’t have been so surprised at how accurately the movie mirrored the people, relationships, and challenges of rural life and medicine as it’s based on a book called “What? Dead Again?” by Georgia physician Neal B. Shulman.

What I like most about practicing medicine in a rural area is the appreciation and respect I’ve received from the community. As a rural physician, you are known and esteemed as a valuable community member.

The Board of Certification in Emergency Medicine (BCEM) has played an important role in my career, opening numerous opportunities. BCEM certification gives medical staff credential’s committees and hospital administrators a quick way to know that an applicant has mastered the core principles and skills needed to practice safe, high-quality emergency medicine. While I was FM trained, going through the systematic board review process for the BCEM exam gave me a new appreciation of EM as a true and distinct specialty. It inspired me to join ACEP and become involved to advance quality care with other Emergency Physicians at the state and national level – ultimately serving as Chair of ACEP’s Section of Rural Emergency Medicine in 2010. Additionally, for the past 14 years, I have worked for Envision Healthcare Physician Services (formerly EmCare) – the depth of understanding EM and leadership skills acquired from having gone through the BCEM process have helped me advance within the organization to a Regional Director position overseeing a number of Rural EDs in GA, TN and AL. The lifestyle Emergency Medicine affords, with more free time than an office-based 5-days-a-week practice, has allowed me to pursue other passions and have more family time.

Today, rural EDs face several unique challenges, many stemming from the geography and demographics specific to rural America, concerns that have been nicely detailed by the NRHA. However, I think the biggest challenge for Rural EDs continues to be recruiting effective Site Medical Directors with EM certification, training and rural EM experience. The majority of our rural EDs are staffed by physicians/mid-levels trained in Primary Care medicine. However, an effective leader can guide their staff in the transition from a PC mindset to the EM mindset to advance a modern safe and cost-effective EM approach to patient care. Rural EM experience plus a rigorous EM Board certification process ensures the highest-quality care for our friends and families in Rural America.

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Patient Care Is Our Priority

Medical organizations throughout North America understand that our rigorous certification standards prove that ABPS Diplomates are capable of delivering the best patient care possible.

Far too often, medicine is led by less than 5% of non-practicing physicians taking away and replacing the voice of the 95% of physicians practicing and placing patient safety and care first on the front lines every day. The American Board of Physician Specialties has raised the standards in physician board certification not only in the quality of their boards of certification, but in hearing and allowing for the voice of those active physicians caring directly for patients. Having been a part of the ABPS over the last 28 years has allowed me to grow as a woman leader in a field often wrought with challenges. It helped me and others raise the bar of the standards of care in my specialty, Emergency Medicine, through their Board Certification in Emergency Medicine (BCEM). ABPS also helped raise the standards of care for 21st century medicine through their certifications in other specialties, particularly in Integrative Medicine & Disaster Medicine. Having physician voices heard matters to medicine and is essential in the betterment of patient safety and care.

Sarah E. Gilbert, MD, FAAEP
Sarah E. Gilbert, MD, FAAEP
Emergency Medicine
On October 18, 2007, President George W. Bush released Homeland Security Presidential Directive 21 (HSPD-21), calling on our nation, among other initiatives, to “collectively support and facilitate the establishment of a discipline of disaster health”. It is a great testament to the wisdom and foresight of the American Board of Physician Specialties that it immediately set to work and created, within the short span of only one year, an educational blueprint and set of certification examinations, both written and oral, for a new subspecialty of disaster medicine—and it is why I chose to be part this vital initiative and this wonderful organization. This is but one of the many innovative programs initiated by the American Board of Physician Specialties over the years, and why I am proud to support its work on behalf of our nation’s public health.

Art Cooper, MD
Disaster Medicine
When the American Board of Physician Specialties offered to host the American Board of Integrative Medicine, ABPS became a landmark organization working to move medicine into the twenty first century. Certifying physicians who have completed rigorous academic training in Integrative Medicine ensures that the field of Integrative Medicine will continue to develop academically, clinically, and professionally. The leadership of ABPS continues to impress me - they are diligent in constantly innovating to provide certifications for physicians who want to advance their careers and their areas of expertise. I am honored to be a part of this organization.

Ann Marie Chiasson, MD
Integrative Medicine
There are many ways board certification advances a physician career. ABPS Board examination verifies your accuracy, precision, and reflects your mastery of your residency training verifying your expertise. ABPS Board certification demonstrates your level of expertise beyond your practice experience, primary education degrees, and training which are necessary for insurance reimbursement and practice privilege requirements. Attaining your ABPS Board Certification will clarify your purpose, secure your practice growth, and expand into leadership positions. Board certification can serve as an indication of a physician’s commitment to medicine, beyond the minimal standards and competency of training, their measurement to quality of care, and attaining an award for excellence.

Chris Kunis MD
Internal Medicine
When I think historically, advancement in medicine and patient safety and care has been driven by the diversity of people and scientific thought. That’s what I found at the ABPS and more. For over 60 years that is just who we are. I found a physician certifying body that provides a choice and voice to all physicians ensuring that patients are always placed first.

Jerry Allison, MD
Emergency Medicine
When I decided to pursue a full time role as a physician executive it was important to me to obtain additional professional training, education and work experience. Board certification through the ABPS in Administrative Medicine is validation of my efforts and a demonstration of dedication to professional development. We need more physicians to become full time health care executives, knowing there is a board certification option in Administrative Medicine encourages physicians to take the leap from full time clinical practice to healthcare organizational leadership.

Richard Paula, MD
Administrative Medicine
The American Board of Physician Specialties has provided me with the opportunity to demonstrate mastery of internal medicine through board certification. As a hospitalist, board certification is an expected credential, and hospitals recognize the American Board of Physician Specialties (ABPS) as one of the three standard credentialling bodies for Internal Medicine. Additionally, the ABPS has helped me develop leadership skills as a Board member and Committee Chairperson. ABPS has also helped me sharpen critical thinking skills as a test question developer and reviewer. The Allopathic (MD) and Osteopathic (DO) physicians in the ABPS are lifelong learners and frequently pursue multiple board certifications. I enjoy the camaraderie of my peers in ABPS.

Loren Jay Chassels, DO
Internal Medicine
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