Emergency Doctors Found Lacking Special Training

Many emergency rooms are staffed by doctors who have never received special training in the basics of trauma care--how to treat a heart attack or handle a head injury, for instance--and the result is hit-or-miss treatment for patients, according to a national report to be released Monday.

The report, written by a panel of medical experts, takes particular aim at the practice of moonlighting in which young medical students or relatively inexperienced doctors staff emergency rooms to pick up extra cash.

The panel’s conclusions highlight what many in the field already know: The practice of emergency medicine, which became a certified medical specialty in 1979, has made great strides in the last 25 years.

But there is still a long way to go before patients can be assured that they are being seen by professionals trained to recognize subtleties that, in an emergency, can mean the difference between life and death.

“The reality is that a good emergency medical physician knows how to take care of a heart attack,” said Dr. Arthur Kellermann, associate professor of emergency medicine at Emory University in Atlanta and an author of the report. “But a second-year surgery resident who may be very good at treating bleeding is not going to be very good at a heart attack.

“If you come in with a bleeding ulcer and get the surgery resident, you’re going to do just fine,” Kellermann added. “But if you come in with a heart attack, you’re out of luck.”

The report, paid for by the Josiah Macy Jr. Foundation, a New York philanthropy dedicated to improving the training of health care professionals, cited “a crisis” in emergency medicine. Among the problems it highlighted:

* Only about half the nation’s 25,000 jobs in emergency medicine are being filled by doctors who are certified to provide emergency care. Although an increasing number of doctors are choosing emergency medicine as a specialty, there are still more jobs than there are trained doctors to fill them.

* The public has no way of knowing whether the staff of any emergency room has been appropriately trained. The panel recommended a uniform system of classifying emergency rooms.

* Fewer than 20% of U.S. medical schools have required courses in emergency medicine in their curricula, and fewer than half of all medical schools have academic departments devoted to emergency medicine. The authors called for medical licensing boards to require doctors to have specific training in emergency care during medical school.

* Practices for certifying emergency departments date back 20 or 30 years before emergency medicine was a specialty in its own right. Rather than examining the training of the doctors in the department, Kellermann said, certification depends on having other specialists--surgeons, cardiologists and the like--on call.