Submitted by: Joy Cutler

Emergency medicine physicians must complete rigorous training, just as all physicians do. Interestingly, however, the American Board of Emergency Medicine (ABEM) was at one point granting board certification to non-emergency medicine trained physicians if they had already spent a certain number of hours working in an emergency department (ED). This period lasted from 1979 to 1988, but after that time, the policy was changed so that only physicians who completed an emergency medicine residency were allowed to receive the designation of being board-certified. After 1988, more board certified emergency medicine physicians were sought after and hired in hospitals around the United States as the medical community recognized the benefits of employing specialists who have this training. Surprisingly however, this was not the case in Veteran s Affairs hospitals.

The Veterans Health Administration (or VHA) is part of the United States Department of Veterans Affairs, and it administers outpatient clinics, hospitals, medical centers, and even nursing homes for veterans. For reasons that are unclear, emergency departments at VA hospitals did not respond to the changes in emergency medicine education; in 1993, only 26.1% of surveyed hospitals run by the VA were seeking to hire board-certified emergency physicians. A more recent study completed in 2009 sought to examine whether this was still the case, and to explore possible changes that have occurred over the past 15 years.

To complete the study, 120 VA hospitals were surveyed. Surveys were sent to the section chiefs of each hospital, and only those hospitals with fully functioning emergency departments were selected for participation. To help ensure that the data were interpreted accurately and without bias, all statistics were analyzed by an independent statistician with no knowledge of the purpose of the study. The authors sought to find whether any statistically significant changes had occurred since the original 1993 study that examined emergency departments in VA-run hospitals. That is, they sought to determine how the numbers of emergency medicine residents and physicians had changed over the past 15 years and whether these changes were statistically significant.

The results of the survey study were somewhat encouraging. All 120 hospitals employed a full-time physician all days of the week and all 24 hours per day; these attending physicians were either board certified in emergency medicine, internal medicine, or family practice. 65 out of the 120 hospitals (65%) employed either a full-time or part-time physician who was board certified in emergency medicine. 45% of the hospitals were thus employing physicians who were certified in either internal medicine or family practice, but not emergency-medicine. Only a small portion of the facilities that were surveyed (7.5%) had hospital coverage that was provided only by emergency medicine residents (rather than physicians who were board-certified). In contrast, 51.7% of the hospitals had coverage that was only provided by attending physicians (i.e. those board-certified in internal medicine, family practice, or emergency medicine) without residents. So regardless of their specialty, most hospitals at least had board certified physicians, and 65% had at least one physician certified in emergency medicine.

The authors point out that the growth in the numbers of emergency-medicine certified physicians is at the very least promising, but the numbers of residents employed at VA hospitals have not grown significantly. The reasons for this are not entirely clear, but one good point that the authors bring up is that if more emergency medicine residents are given the opportunity to complete their residency training at VA hospitals, they will be better prepared for the unique challenges and expectations required when treating patients at a VA hospital, and possibly more likely to eventually choose to work in a VA hospital. The authors suggest that emergency medicine programs should strive to partner more frequently with VA hospitals and health centers in the future.

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