Introduction to the Specialty of Emergency Medicine

This chapter was reproduced from the Emergency Medicine Clerkship Primer, 2008, Chapter 1, with the permission of the Editor, for ease of viewing on mobile devices.

For centuries, physicians have been called on to provide emergency care for patients. However, in the house of medicine, the formal specialty of emergency medicine is still relatively young—measured in decades. Emergency medicine developed differently from perhaps many of the other more traditional medical and surgical specialties. In the case of emergency medicine, public demand more than scientific inquiry fueled the formation and growth of the specialty. In the 1950s and 1960s, with more physicians seeking specialty training, the number of general practitioners began to decline. At that time, hospitals were becoming more modernized and technologically advanced. Ultimately, these factors, along with the changing demographic and social conditions of the post–World War II era, led to an increased public reliance on hospital emergency departments for the provision of unanticipated medical care.  Unfortunately, a uniform system for providing high-quality emergency care did not exist. At that time, junior medical and surgical house officers staffed many hospital emergency departments with little or no attending supervision. Most of these physicians did not have the necessary clinical skills to properly care for the increasing complexity of cases seeking medical attention. It was also becoming evident that the physician staffing patterns were inadequate to keep up with the ever-increasing patient volume.

Change began in the early 1960s when a group of physicians left their respective practices and devoted their full-time practice to the care of emergency department patients.

Change began in the early 1960s when a group of physicians left their respective practices and devoted their full-time practice to the care of emergency department patients. In 1961, four physicians, led by James Mills, MD, started the first full-time emergency medicine practice at Alexandria Hospital in Virginia. That same year, a group of 23 community physicians began providing around-the-clock emergency department coverage at Pontiac General Hospital in Michigan. By the late 1960s, hundreds of “emergency physicians” were in practice throughout the country. In 1968, John Wiegenstein, MD, and seven other full-time emergency physicians founded the American College of Emergency Physicians (ACEP), our specialty’s first professional medical society. Later that same year, during the first national meeting, ACEP was recognized as the national emergency medicine organization. The American Academy of Emergency Medicine (AAEM), a new professional society, was founded in 1993 to promote fair and equitable practice environments for emergency physicians.

The first emergency medicine residency-training program was established at the University of Cincinnati in 1970. That same year, the University Association of Emergency Medical Service (UA/EMS) was founded by medical school faculty practicing emergency medicine, followed by the formation of the Society of Teachers in Emergency Medicine (STEM) in 1975. These two organizations merged in 1989 to form the Society for Academic Emergency Medicine (SAEM), our specialty’s current premier academic organization promoting research and education. In 1974, the Emergency Medicine Residents Association (EMRA) was formed. By 1981, there were 56 emergency medicine residency-training programs across the country. As of 2008, there are 143 accredited allopathic and 37 accredited osteopathic emergency medicine residency training programs in the United States. Formed in 1989, the Council of Emergency Medicine Residency Directors (CORD) is an educational and scientific organization whose purpose is to improve the quality of emergency medical care and to establish and maintain high standards of excellence in emergency medicine training programs.

Our specialty represents one of the few medical specialties that has shown a consistent and steady increase in the number of residency positions offered in the national residency matching program, representing 6.3% of all PGY-1 positions filled in the 2008 match.

One of the first steps toward formal recognition of our specialty occurred in 1973 when emergency medicine was granted a provisional section council seat in the American Medical Association House of Delegates; permanent status was granted in 1975. In 1976, the American Board of Emergency Medicine (ABEM) was formed. Thereafter, ACEP and ABEM embarked on the process of establishing primary board certification status for the specialty of emergency medicine. In 1979, the American Board of Medical Specialties (ABMS) formally recognized ABEM. Ten years later, in 1989, ABMS granted ABEM primary board status, thus formally recognizing emergency medicine as the 23rd primary medical specialty.

The emergence of osteopathic physicians in the field of emergency medicine occurred in 1975 when the American College of Osteopathic Emergency Physicians became an affiliate college of the American Osteopathic Association (AOA). By 1978, the American Osteopathic Board of Emergency Medicine (AOBEM) was established as an affiliate specialty board of the AOA. The following year, the first osteopathic emergency medicine residency-training program was established at the Philadelphia College of Osteopathic Medicine.

Over the last 30 years, the growth of emergency medicine has continued at an extraordinary pace. The future of our specialty is especially bright as we continue to attract high-quality medical students interested in pursuing a career in emergency medicine. Our specialty represents one of the few medical specialties that has shown a consistent and steady increase in the number of residency positions offered in the national residency matching program, representing 6.3% of all PGY-1 positions offered in the 2008 match (National Resident Matching Program, 2008). Emergency medicine is now the fourth most common specialty that US graduating medical students choose to enter, behind internal medicine, family medicine, and pediatrics (Newton et al., 2003). Collectively, across the country, emergency medicine residency-training programs graduate approximately 1,500 emergency physicians each year.

In 2008, the SAEM’s Board of Directors approved the formation of the Academy of Clerkship Directors in Emergency Medicine (CDEM). CDEM consists of medical student educators who are committed to enhancing undergraduate medical education within our specialty.

Suggested Reading

  • Newton DA, Grayson MS. Trends in career choices by US medical school graduates. JAMA. 2003;290:1179–1182.
    • This article describes trends in career choices for US medical school graduates from 1987–2002.
  • National Resident Matching Program. Results and Data. Table 7, All Applicants Matched to PGY-1 Positions by Specialty, 1999–2007. Available at: www.nrmp.org/data/resultsanddata2007.pdf. Accessed March 25, 2008.
    • This document reports the results from the 2007 National Residency Match.
  • National Resident Matching Program. Advance Data Tables: 2008 Main Residency Match. Available at: www.nrmp.org/data/advancedatatables 2008.pdf. Accessed May 16, 2008.
    • This document reports the results from the 2008 National Residency Match.
  • Zink BJ. Anyone, Anything, Anytime: A History of Emergency Medicine. Philadelphia, Pa: Mosby; 2006.
    • This book reviews the history of emergency medicine, chronologically covering issues such as the earliest concepts of emergency care, the development of national professional organizations, the establishment of the board examination, the accreditation of emergency medicine residency-training programs, and the subsequent expansion of the specialty.