In January of this year, the Canadian Association of Emergency Medicine (CAEP) released a position statement on Emergency Medicine Definitions (go ahead, have a read). The statement provided explicit definitions of what the specialty of EM encompasses, as well as what should constitute an EM physician or specialist, and led to very strong and polarized responses from the EM community. So polarizing, in fact, that CAEP had to promptly post a “we’ll get back to you with a revision” message on their website in February, in response to what I can only presume to be negative feedback from across the country.
Defining a specialty: The CAEP Position Statement
This position statement shouldn’t come as a surprise. What is surprising is that it took the Canadian EM community this long to explicitly define the minimal standards of our specialty. A similar position statement by the American College of Emergency Physicians (ACEP) has been in existence since 1994, with multiple revisions and refinements over the years to help strengthen EM’s position as a bona fide specialty. Efforts in both the United Kingdom and Australasia to clearly define the practice of EM, and its practitioners, have also been critical in advancement of the field of EM.
Let’s be honest, as much as some of us might like to think that a physician’s scope of practice needs only to be defined by how much time you’ve spent doing something, this argument is becoming less and less defendable.
From an educator‘s perspective, one only needs to take a look at the latest Competency Based Medical Education (CBME) movement and the tremendous research driving it, to see that the antiquated “time-based” model is no longer adequate. The Royal College of Physicians and Surgeons of Canada (RCPSC) states that:
“…a system based exclusively on time is not optimal for meeting the education and assessment needs of physicians from residency through to retirement…“
From a licensing body‘s perspective, the current trend is moving away from the days of a so-called “general license” where a physician could self-define their practice. In Ontario, for example, the College of Physicians and Surgeons clarifies this issue in their Changing Scope of Practice Guide:
“This is a common misconception. Every member of the College has restrictions to their certificate of registration (license). In fact, every certificate has terms and conditions that states that the member may practice only in the areas of medicine in which the member is educated and experienced. Thus, there is no such thing as a “general license” regardless of how long you have been a physician in this province.”
But perhaps the most important perspective to consider is that of the patients. In the end, it is about ensuring a set of standards that any patient who arrives to any emergency department in the country can expect. If we all truly agree on the definition that emergency medicine involves providing
“timely evaluation, diagnosis, treatment and disposition of all patients with injury, illness and/or behavioural disorders requiring expeditious care, 24/7/365“,
then it is reasonable for our patients to logically expect those who provide that care to have formal and adequate training in the expert management of anything that rolls through the ER doors.
What should have the CAEP position statement suggested?
This is where I believe the current position statement fails in its delivery. The focus of the document is so provider-centric – so concerned with defining the practice, the certification, the difference between an emergency physician vs specialist, and the historical background – that the most powerful reason for this statement lies buried deep within the last page:
“It is CAEP’s clear vision that Canadians should expect to receive care in an ED from a physician with specific competencies appropriate for the practice setting, obtained through formal training and certification in emergency medicine“
They really should have led with that. Ultimately the question for all of us should be: What if it was one of my loved ones being brought into an ER as a patient? What competencies would I want in their doctor?
What do you think? Do you agree/disagree with CAEP’s position statement?