As an aside to the ACEP/PEM discussion: here is my little plug of bitterness.
I am residency trained in both pediatrics and adult emergency medicine.
During my first year of adult residency the rules for board certification
changed and I am no longer eligible to sit for the PEM boards. This is
clearly a politically motivated decision and I challenge anyone to suggest
that after six years of clinical residency that I lack any of the skills of a
more formally PEM trained physician. Some theoretical reasons can be brought
up but will hold little weight.
The reason I picked adult EM was twofold. One is that of the three years, all
three are clinical in nature and more demanding than the tradition PEM
fellowship (which has less overall clinical time); and second, my pediatric
residency was heavily weighted with ED time (hence my career choice) and I
believed that if I learned emergency medicine from a different perspective it
would make me a stronger pediatrician. For example, how much CHF in kids do
we see. By seeing a lot in adults, I feel much more comfortable in children.
I am not suggesting I am better than any other PEM physician by any means and
please do not construe that. I made my choice for personal reasons. What I
resent is that if given the opportunity I could pass the PEM boards TOMORROW;
but I will never be given the opportunity. And even though I can practice in
a peds EM department I will never be able to be a peds EM fellowship director
and pursue a similar pediatric EM academic career. This change did not occur
until I had started my residency and I find my opportunities affected by the
decisions of politics that lead to the kind of discussions that we just had
concerning adult and ped EM docs.
Rick Place, MD
INOVA Fairfax Hospital
Falls Church, VA
Pediatric Subsection, Department of Emergency Medicine
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