News Upload with Howard Kim: Mind the Gender Gap


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Mind the Gender Gap
Women comprise nearly 50% of medical students, yet the percentage of women in EM, particularly in leadership, continues to lag
Lansing, Mich. – While the proportion of female medical school graduates has increased steadily over time nearing 50 percent of all graduates in 2007 the number entering EM is trailing, according to a report by the Society for Academic Emergency Medicine. SAEM convened a task force in 2005 to study the unique recruitment, retention and advancement needs of women in EM.

Although other medical specialties have achieved or exceeded gender parity, women comprised 35.5% of all 4,259 EM residents in 2005 – up slightly from 26% in 1995, according to the report. Advancement for the decreasing number of doctors who choose to practice EM post-residency is also a concern: women represent 26% of  faculty in EM at the assistant and associate professor levels, but only 12% at the Full Professor level. According to the American College of Emergency Physicians, less than one in four of its members is a woman. 


The task force, led by researchers at Wayne State University in Detroit, said the shortage of female administrators and faculty members is exacerbating– and may even be responsible for —the problem. Research shows that having women in leadership positions attracts other women to the department, the SAEM said. “It will be more difficult to recruit the best women trainees if they aren’t exposed to, and mentored by successful senior women in academia,” said the SAEM report’s lead author Gloria Kuhn, DO, PhD, who is also a professor of medicine at WSU.

Some fear that unless the trend is reversed, the pool of talented women who might be attracted to EM will shrink to the point where it could  hurt EM’s competitiveness as a specialty.

To improve women’s status in EM, the task force made recommendations for individuals at four levels of leadership and accountability: leadership of national EM organizations, medical school deans, department chairs and individual faculty members.


The multi-level strategy includes: better data collection and reporting on gender equity; establishment of a high-level leadership position at each medical school to oversee advancement of women faculty; and development of professional best practices for women faculty members. SAEM also encouraged national groups to strengthen programs for women in academic EM, including creating a structured academy to integrate and enhance current faculty development initiatives. 

Some strategies appear to be working: this year, the top-elected officials of six national emergency medicine organizations are women.

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Yielding to concerns, CMS backs off from proposed changes to EMTALA
Changes would have affected patient transfers and on-call physician lists

Washington D.C.–Bowing to pressure from healthcare providers, the Centers for Medicare and Medicaid Services has retreated from implementing specific rules that would have imposed narrower definitions to two key provisions of the Emergency Medical Treatment and Labor Act (EMTALA).


CMS withdrew proposals to amend final rules that would have significantly affected EM providers in areas involving the transfer of unstable patients previously admitted to a receiving hospital’s ED, and the maintenance of physician call lists.

CMS said it was reversing its original intent on these rules based on comments from health care providers who argued the changes would have a negative impact on the delivery of ED services and unnecessarily burden the emergency medical system.
Regarding changes to the unstable patient transfer rule, CMS had originally intended to revise existing EMTALA regulations concerning the responsibilities of the receiving hospital. The intended revision would have required the receiving hospital accept the unstable patient “so long as the transfer was appropriate and the receiving hospital has the capacity to treat the individual.”

In reversing its decision, CMS said it would leave the rule unchanged. “CMS confirmed in the final rule that when an individual with an unstable emergency medical condition is admitted in good faith to a hospital as an inpatient [and then transferred], the EMTALA obligation for that admitting hospital ends,” said Sandra DiVarco, a Medicare attorney with the Washington, DC-based law firm McDermott, Will, and Emery.

In effect, the receiving hospital is under no EMTALA requirement to accept the patient.
Furthermore, DiVarco said, even if the patient’s condition remains unstable and the patient later requires a transfer to a higher level of care at another hospital, the receiving hospital doesn’t have an EMTALA obligation to accept the patient either.

Addressing the on-call list rule, CMS deleted language from its final rule that would have tied the maintenance of a physician call list to a patient’s immediate medical needs, in effect, linking the call list more directly to a patient’s potential outcome.

The existing language requires that EDs maintain an on-call list “in accordance with the resources available to the hospital.” In deleting the new language, CMS said the rule’s current language provides sufficient guidance for hospitals.

But according to DiVarco, CMS also cautioned that providers should not “perceive the change as confirmation that they can limit their on-call availability.” CMS also removed the regulations on on-call lists from EMTALA to separate statutes involving provider agreements. The agency did not address providers’ concerns about compensation for being included on an on-call list.

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A year after ABEM established FP/EM certification track, controversy lingers.
Most combined programs located in rural, under-served regions

Knoxville, Tenn. – A year after the American Board of Emergency Medicine and the American Board of Family Medicine announced a joint, five-year certification program, providers continue to clash over the legitimacy of granting family practitioners and other specialists the right to practice in the ED.

“It is a very controversial subject,” said Amy Keenum, DO, a family practitioner who directs a   one-year fellowship in EM at the University of Tennessee Medical Center. “Until recently there were no EM [residency] programs in Tennessee. Our local rural hospitals are still struggling to staff their departments. We fill an unmet need.”

UTMC is one of a small but growing number of schools around the country that are circumventing the path to board certification. Most are located in regions of unmet need.
“We’ve modeled ourselves after a Canadian system,” which has sped up the certification process without sacrificing quality or experience, Keenum said. The justification for the approach is grounded on existing need, she explained.

“We’re not training people to work in places like New York or Los Angeles where there are a lot of residency programs,” Keenum said. “Our docs are all going to rural hospitals where there are no EPs.” The UTMC program graduates two to four physicians per year.
Many hospitals still insist that their EPs be traditionally board certified and opponents like Bill Durkin, MD, the secretary-treasurer of the American Academy of Emergency Medicine, say that alternative certification essentially gets around the process.

“Multiple studies have shown that board certified, residency-trained physicians are better qualified,” says Durkin.

But proponents of the joint fellowships argue that alternative certification provides a comparable level of training, and that within an institution, the perspectives derived by spanning EM with family or internal medicine have the potential to increase communication and understanding. ABEM said in a news release that one important goal of the combined training is “preparing physicians for practice or academic careers that address the spectrum of patient illness and injury from emergency situations through the total health care of the individual and family.”



  1. Timothy Donnelly, MD FACEP on

    I would appreciate it if Dr. Durkin would provide references for the studies to which he refers. I would like to see documentaion of this oft made comment, especially in reference to rural practices which find it almost impossible to attract
    residency trained applicants.

  2. Please submit a correction:

    Vanderbilt University in Nashville Tennessee has had a long standing residency program in emergency medicine and the University of Tennessee has an emergency medicine residency in Chattanooga Tennessee.

    The question remains, “Will they graduate rural doctors? Who will take care of the citizens of Sneedville TN?”

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