Board Certification

David Vega, MD FAAEM
YPS President

I have to admit that the oral boards generated more than a little stress for me. The 63 days spent waiting for the results seemed more like 63 months. I would fluctuate frequently between feeling good about the exam to being sure that I failed. When the letter from East Lansing arrived, I only read the first word, “Congratulations,” before I yelled a big “YES!!” and initiated my victory dance as my wife stood by, giving me that special look that only a spouse can give that says without words, “You are a strange man.” Okay, maybe I was a little over-jubilant, but in that one moment, all of those years of training and studying felt officially validated.

Some time later, as the initial excitement began to wear off a bit, I began to think a little more about the whole issue of board certification. What is really so important about it? Should we be that concerned about a series of two examinations?

To find some answers, we can start by looking at the simple yet profound mission statement of the American Board of Emergency Medicine – “The ABEM mission is to protect the public by promoting and sustaining the integrity, quality, and standards of training in and practice of Emergency Medicine.” (http://www.abem.org/public/portal/alias__Rainbow/lang__en-US/tabID__3333/DesktopDefault.aspx) Therein lies the crux of the importance of board certification. To ensure that the vast volume of patients cared for in emergency departments receive the best care possible, it is critical that residency training and board certification remain the standard for the practice of emergency medicine. The average emergency physician will likely have well over 50,000 patient encounters over the course of a career. These patients deserve the assurance that their physician has met the accepted standards required of a board-certified specialist.

Emergency medicine has evolved greatly since it was first officially recognized as the 23rd medical specialty in 1979 – and it continues to do so. During the infancy of our specialty, it was necessary and appropriate to have practical experience serve as a substitute for formal training in emergency medicine. Clearly, with the many advances our specialty has made in knowledge and technology, “on the job training” is no longer appropriate. Thus, board certification must involve more than just passing the qualifying and oral examinations. We must remember that these are only two measures of the specialists’ ability to adequately practice emergency medicine. Board certification actually begins for each new batch of candidates every year around July 1 with the commencement of residency training. It is only through intense, appropriately-supervised training that one can gather the basic skills necessary to practice emergency medicine today.

I know these concepts may seem like no-brainers, but there are many who still try to argue against the necessity of residency training and board certification so that they might be considered on an equal level with the fully-trained specialist. Fortunately, there were visionaries ahead of us who realized the associated risks to patient care and formed the AAEM to help protect our specialty against those acting solely in their own interests. I would encourage you to learn about the history of emergency medicine as a specialty and of AAEM as the organization that truly supports the specialty. Check out the AAEM website (www.aaem.org) and read some of the amazing history that has enabled us to practice as we do today. As the newer generation of emergency physicians, we must stay alert to the threats that face our specialty, just as our predecessors have in the past. Each of us must also serve as an advocate for the specialty on every occasion afforded us and continue to set high standards for ourselves and our residency graduates.

I hope the new year is going well for you, and I urge you to make this the year that you renew your efforts to support your specialty by getting involved with AAEM and the YPS.