1978: Snowed in, But Not Knocked Out

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John Wiegenstein’s marathon push for EM specialty status in 1978 nearly killed him

John Wiegenstein, MD, founder and first president of the American College of Emergency Physician, lay in a snowbank a short walk from his home in Michigan a few days before Christmas in 1978. His wife had sent him out to the grocery store during a blizzard. The roads were impassable, so he walked. Wiegenstein was exhausted, and as it turns out, very ill.

The weeks before had been very hectic, with Wiegenstein and a small band of emergency medicine leaders and negotiators focused on a single thing – gaining approval from the American Board of Medical Specialties (ABMS) for the proposed American Board of Emergency Medicine (ABEM). The initial resounding defeat of ABEM by the ABMS House of Delegates – 100 to 5 against in September 1977 – was deeply disappointing and humbling for the leaders of emergency medicine. Fifteen months of intense wrangling with the other boards had led to a compromise that seemed promising. Other boards would be given seats on ABEM and have a role in developing the new board as a “modified conjoint board.” While some younger emergency physicians rebelled against this idea, those who had fought the battle for specialty status realized that this could be their foot in the door, and decided in the fall of 1978 to put the new proposal up for an ABMS vote that would occur in March 1979.

Formal approval of the modified ABEM by-laws was required from the other sponsoring boards by the end of December. In these days, before faxing, email, and PDFs, penned signatures were required on the document. Wiegenstein decided to make the push to get the signatures by flying around the continent as Christmas approached. He went to Oregon where the internal medicine representative signed the document in the airport, then to a surgeon in Vermont, and then to Canada where a representative was visiting family.

Wiegenstein arrived home “totally exhausted”, and then went out in the Michigan snowstorm for groceries. On the way back he collapsed. A couple months earlier he had “put an endotracheal tube down a jaundiced person and cut my finger.” His exhaustion was related to evolving viral hepatitis. Wiegenstein “laid there for 10 to 15 minutes and I decided I didn’t want to die there in the snow.”  He trudged home and “looked in the mirror and saw my yellow sclera and noticed the urine was dark.” His SGOT was 6,000. Wiegenstein was out of work for three months.

As it turned out, Wiegenstein’s efforts to get all the signatures were not enough to get the ABEM vote teed up in ABMS for March 1979. The vote was delayed, but all the sacrifices and hard work paid off. In September 1979, emergency medicine was overwhelmingly approved by ABMS as the 23rd US medical specialty.

Quotes from John Wiegenstein are from an oral history interview conducted by Brian Zink in Naples, Florida in 2002.

ABOUT THE AUTHOR

Brian J. Zink, MD is a Professor and Chair in the Department of Emergency Medicine at Alpert Medical School of Brown University. Dr. Zink is also the author of Anyone, Anything, Anytime- a History of Emergency Medicine (Mosby Elsevier, 2006)

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