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ABPS Diplomate Dr. Harry L. Wingate III, MD, FACEP, on the Unique Challenges Emergency Medicine is Facing in Rural America

Harry L. Wingate III, MDAs defined by the American College of Emergency Physicians, rural emergency medicine is urgent or emergent medicine practiced in geographic areas with low population densities and resource constraints, including ready access to more specialized care facilities. In rural America, emergency departments provide critical services for their communities but continue to face several challenges, not the least of which is the ongoing shortage of qualified emergency medicine physicians. Rural EDs also have limited access to medical specialists and advanced testing, and their geographic isolation and limited stabilization capabilities can make patient transfer to a tertiary care facility difficult when time is of the essence.

While rural and urban patients share many of the same lifestyle-related health problems— smoking, obesity, and drug abuse, for example—some issues like snake bites, farming accidents, and a lack of access to primary care physicians are unique to the rural EM setting. In general, urban EMs have a much larger and more skilled support team available to care for patients with complex issues, and the higher volume of such patients provides opportunities for greater skill proficiency in critical procedures.

It’s not hard to understand why there is a shortage of rural emergency physicians. Physicians are predominately trained at tertiary care centers and want to practice in the same or similar type of medical setting. There is also a well-documented pay gap between urban and rural EM ranging from 25% to 50%. Additionally, many emergency physicians are not comfortable working in a “single Doc Shop” that’s geographically isolated and resource-limited.

Still, there is no serious debate whether EM training will make you a better EM physician. Certainly, in the 21st Century, there are plenty of EM residencies that train professionals to meet our urban needs. The challenge comes in finding ways to improve the training and EM skill gap for a shrinking and aging rural emergency physician workforce. The most practical and fastest way to “up your game” in emergency medicine is to pursue certification with the Board of Certification in Emergency Medicine (BCEM), a Member Board of the American Board of Physician Specialties®. Given that the majority of full-time rural emergency physicians are trained in primary care medicine or surgery and that the median age of this group is 58—according to a National Emergency Medicine Workforce Study—they have most likely met the BCEM practice and residency requirements for certification eligibility. The physician benefits of BCEM certification are numerous:

  • More confidence in ruling out emergency medical conditions
  • More efficient workups
  • Better patient outcomes through more decisive decision-making that comes from greater knowledge.
  • Better patient education and reassurance
  • A greater spirit of professionalism
  • More opportunities to take on leadership roles.

Physicians who are currently in a primary care residency and plan to practice in a rural setting should consider adding a 1-year EM fellowship to their training that will allow them to also obtain BCEM certification. Those who are primary care trained and are early in their rural EM career should become familiar with the practice pathway criteria for BCEM certification.

Pursuing BCEM certification is without question the most comprehensive didactic activity primary care-trained emergency physicians can practically accomplish within a year to improve overall EM skills and demonstrate their commitment to providing a high standard of patient care.

 

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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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