History of EM Series: Benson Munger
Author: Benson Munger, PhD (founding Executive Director of the American Board of Emergency Medicine, https://www.linkedin.com/in/bensonmunger/) // Reviewed by: Alex Koyfman, MD (@EMHighAK) and Brit Long, MD (@long_brit)
Emergency Medicine is an amazing specialty, but how did it develop, and where do we go from here? This new series looks at these questions and more with write-ups from the masters of our field.
Why EM then?
Emergency Medicine was a classic example of a patient-driven specialty. At the end of the Vietnam War, there were few Emergency Departments as you currently think of them. As patients began to expect a higher level of care there developed a group of physicians who saw that need and began to work with hospitals to fill it. This was happening at a time when physicians were beginning to see the advantages of a group practice. In retrospect, the movement to the adoption of Emergency Departments as we currently know them was very rapid and particularly when hospitals understood its implications to address many of their administrative issues.
Most interesting personal EM story and tidbit of EM history…
From the inception of ACEP’s identification of specialty status through the American Board of Medical Specialties (ABMS), the goal was a primary board, equivalent to the existing 22 primary boards such as Surgery, Pediatrics, etc. The College expended dues, raised voluntary contributions and organized their strategy toward that end. The first and overwhelmingly negative vote in ABMS was a complete rejection. Certification is at its core an academic process. It addresses the way physicians are trained in a specialty and defines the relationship among the primary specialties. In the late 1970s, the other 22 primary boards had control of the Emergency Departments in academic medical centers and they were unwilling to cede control of those spaces for training their residents.
At that vote, it was obvious to everyone that the current mindset had to change. The current Executive Director of ABMS, Glen Laymaster, called a meeting in Chicago of all primary boards with a stake in Emergency Medicine. At that meeting, there was a lot of discussion of the need for Emergency Medicine to reside within the other primary specialties. Clearly the other primary specialties saw Emergency Medicine as important but as subordinate. In historical context, it was critical that the ABMS has not yet conceived of the idea of a joint subspecialty that would reside in multiple primary specialties, something that exists today.
At a particularly important part of the Chicago meeting. Dr. John Wiegenstein asked each of the other primary boards to outline the training in their specialty they felt would be required. By the time the group was finished the number of years exceeded 20. From the end of that exercise, the concept of Emergency Medicine as a subspecialty was never raised again and the discussion moved rapidly toward the unique solution that created the path for Emergency Medicine to eventual certification as the 23rd primary board in medicine.