Am Fam Physician. 2008 Jan 15;77(2):148-149.
Without the contribution of family physicians, large areas of the country would be without adequate emergency medical care.1 At least one third of the emergency medicine workforce is trained in family medicine.2 More than 65 percent of family physicians provide emergency care, and many family physicians have made lifelong careers in emergency medicine.3,4 The American Academy of Family Physicians approved a position statement in 2006 that discusses some of the critical challenges that face family physicians in emergency medicine.5
The provision of emergency medical care is an essential public service. Providing comprehensive emergency medical services to a diverse population requires a cooperative relationship between the specialties of emergency medicine and family medicine. In fact, the Future of Family Medicine project emphasizes an integrative and generalist approach that is essential for emergency care, particularly in rural areas.6,7
The urban location of most emergency medicine training programs, combined with the large patient population required to support an emergency physician, contributes to a maldistribution of emergency medicine-trained physicians.8 Family physicians provide most of the emergency medical care in rural communities. The specialties of family medicine and emergency medicine share similar broad knowledge and skill sets. However, collaboration between emergency medicine and family medicine on meeting workforce needs has been limited.
In addition to this lack of cooperation between the specialties, certification and credentialing issues have developed, resulting in restrictive policies and the elimination of many competent family physicians from the practice of emergency medicine. Family physicians have been viewed as competitors. The academic emphasis on board certification in emergency medicine has strengthened the specialty and improved the knowledge base, but it has led to a debate over the appropriate qualifications for emergency medicine credentialing.3,4
Fortunately, several recent events may improve collaboration. The Institute of Medicine's comprehensive report, The Future of Emergency Care, calls for “an evidence-based, multidisciplinary process” in emergency medicine credentialing and emphasizes the importance of an integrative approach.9 Recently approved family medicine/emergency medicine residency training programs require cooperation, and expanded emergency care curricular requirements for family medicine residencies will necessitate collaboration.
The physician's most important objective must be the provision of the highest quality care. This requires that all physicians practice within their degree of ability, as determined by training, experience, and competence. Family physicians are trained in the breadth of medical care and are qualified to provide emergency care in a variety of settings. The Comprehensive Advanced Life Support course (http://www.calsprogram.org) provides training in “first-hour” emergency care for family physicians in rural areas, and it serves as a model for collaborative approaches between family medicine and emergency medicine.10
Cooperation between the two specialties is requisite to resolving the growing crisis in access to emergency care. Provision of the highest possible quality of patient care must be the main objective. Recognition and support of the competencies family physicians provide in emergency care—especially in rural and remote areas—is paramount. Improvement of the ailing U.S. emergency health care system demands nothing less.
Address correspondence to Perry A. Pugno, MD, MPH, at firstname.lastname@example.org. Reprints are not available from the authors.
The AAFP Board of Directors would like to acknowledge the AAFP Task Force on Family Physicians in Emergency Medicine for their efforts in developing this summary: Anthony Gerard, MD, FAAFP; Kim A. Bullock, MD, FAAFP; Arlen R. Stauffer, MD, MBA, FAAFP; Inis Jane Bardella, MD, FAAFP; Perry A. Pugno, MD, MPH, CPE, FAAFP; John S. Cullen, MD, FAAFP; William MacMillan Rodney, MD, FAAFP.
1. Graham Center One-Pager. Family physicians help meet the emergency care needs of rural America. Am Fam Physician. 2006;73(5):1163.
2. Moorhead JC, Gallery ME, Hirshkorn C, et al. A study of the workforce in emergency medicine: 1999. Ann Emerg Med. 2002;40(1):3–15.
3. Bullock K, Rodney WM, Gerard T, Hahn R. “Advanced Practice” family physicians as the foundation for rural emergency medicine services (Part I). Texas J Rur Health. 2000;17:19–29.
4. Bullock K, Rodney WM, Gerard T, Hahn R. “Advanced Practice” family physicians as the foundation for rural emergency medicine services (Part II). Texas J Rur Health. 2000;18:34–44.
5. Critical challenges for family medicine: delivering emergency medical care—“equipping family physicians for the 21st century” (position paper). http://www.aafp.org/about/policies/all/critical-challenges.html. Accessed September 13, 2007.
6. Martin JC, Avant RF, Bowman MA, et al., for the Future of Family Medicine Project Leadership Committee. The Future of Family Medicine: a collaborative project of the family medicine community. Ann Fam Med. 2004;2(2 suppl 1):S3–32.
7. Williams JM, Ehrlich PF, Prescott JE. Emergency medical care in rural America. Ann Emerg Med. 2001;38(3):323–327.
8. Moorhead JC, Asplin BR. Distribution of emergency medicine residency graduates. Ann Emerg Med. 1998;32(4):509–510.
9. Institute of Medicine, Committee on the Future of Emergency Care in the United States Health System. Hospital Based Emergency Care: At the Breaking Point. Washington, DC: Institute of Medicine, National Academies Press, 2007.
10. Carter DL, Ruiz E, Lappe K. Comprehensive advanced life support. A course for rural emergency care teams. Minn Med. 2001;84(11):38–41.
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