Opinions expressed in the Correspondence section are those of the authors, and not necessarily of the editors, ACER or SAEM. The editor reserves the right to edit and publish letters as space permits. Letters not meeting submission criteria will not be considered for publication. See "Instructions for Authors."
CORRESPONDENCE The Past & Future of Academic Emergency Medicine To the Editor: I feel compelled to respond to Dr Becker's editorial "Cellular Resuscitation, Basic Science, and the Future of Emergency Medicine" [August 1989;18:896-897], as I believe the basic premises on which his argument is based are incorrect. Dr Becket believes that emergency medicine has "lost sight of its origins"; he identifies these origins as the treatment of shock and hypotension and bemoans the fact that academic emergency medicine has failed to honor its origins by pursuing resuscitation research to the exclusion" of all 8ther research. Specifically, he seems to take issue with research that focuses on "clinical delivery and patient care services." As evidence for his thesis, he cites the 18th Annual University Association for Emergency Medicine meeting program. He believes that only by identifying and pursuing basic science research within a specialized clinical focus can e m e r g e n c y medicine emerge as a recognized and, therefore, legitimate specialty.
R o b e r t J Rothstein, MD, FACEP - - S e c t i o n E d i t o r Bethesda, Maryland
As a physician who trained in one of the older emergency medicine residency programs, under the direction of one of the founders of our specialty, my understanding of the origins of emergency medicine differs significantly from that of Dr Becker. I believe that emergency medicine originated from a perceived need to provide quality care to acutely ill and injured patients and out of recognition of the unique fund of knowledge that is required of those delivering emergency care. This fund of knowledge is distingnished not so much by its depth as by its breadth, and its recognition of the common pathophysiology of acute illness and injury. It is this common pathophysiology that Dr Becker correctly identifies as important and of significant concern to emergency medicine research, but to cite it as the origin and focus of our specialty ignores the true mission of emergency medicine - the provision of quality emergency care to patients and the teaching of these skills to physicians. Research is of value only insofar as it advances our scientific knowledge and improves our patient care and physician education. Basic science research accomplishes these goals, but no more or less effectively than does good quality clinical and health services research. That these efforts have gone unrewarded in academic medicine should serve as an indictment of the evaluation and promotion system, rather than as justification of the unique value of basic science research. Academic emergency medicine is ideally suited to significantly impact all of academic medicine in the 1990s and beyond. As the academic medical center learns to "function in a new world of cost containment, managed 19:5 May 1990
care delivery systems, utilization review, reduced lengths of stay, competition for market share, and external intervention, ''1 emergency physicians can become models for future academic medical practice. Cost control requires a shift from inpatient to ambulatory patient care and education.~ Emergency medicine is already meeting this need and furthering our ability to control costs with clinical and health services research. As academic emergency physicians, we are able to balance significantly greater clinical c o m m i t m e n t s (compared with other specialties) with teaching and administrative responsibilities and still conduct quality research, much of which addresses important clinical and practice management questions. Recognition of the value of this type of research has been slow, but there is evidence that the recognition is occurring. In the 1988 chairman's address to the Association of American Medical Colleges, John W Colloton spoke on "Academic Medicine's Changing Covenant with Society." In his address, he appealed for the establishment "within academic medicine [of] a national agenda that places a substantial priority on the scientific analysis of our entire health care system, analogous to that which presently supports the biomedical research dimension of our enterprise ... the time is past when such research could be dismissed as unscientific and unworthy of our attention ... the reward system, academic stature, financing, and other inducements essential to the alleviation of this shortage must be put in place so that faculty members appropriate in numbers and quality to address society's present concerns with our system of health care can be mobilized. ''2 Perhaps rather than attempting to adhere to the timehonored model of an academic specialty, emergency medicine should view itself as a model of the future academic specialty, effectively balancing the triad of patient care, teaching, and research while maintaining its focus on the delivery of cost-effective, quality care to patients. To the extent that we can accomplish this, we shall fulfill academic medicine's "covenant with society" and remain true to our origins as well. Robert A Schwab, MD Emergency Medical Services University of Virginia Health Sciences Center Charlottesville i. Ross RS, Johns ME: Changingenvironment and the academic medical center: The Johns Hopkins Schoolof Medicine. Acad Med 1989;64:1-6. 2. Colloton JW: Academicmedicine's changing covenant with society. Acad Med 1989;64:55-60.
In Reply: I appreciate Dr Schwab's interest in my editorial. While he and I disagree on several points, we share a recognition of current problems and a deep concern for the future growth and development of emergency medicine.
Annals of Emergency Medicine
612/171
CORRESPONDENCE The Past & Future of Academic Emergency Medicine To the Editor: I feel compelled to respond to Dr Becker's editorial "Cellular Resuscitation, Basic Science, and the Future of Emergency Medicine" [August 1989;18:896-897], as I believe the basic premises on which his argument is based are incorrect. Dr Becket believes that emergency medicine has "lost sight of its origins"; he identifies these origins as the treatment of shock and hypotension and bemoans the fact that academic emergency medicine has failed to honor its origins by pursuing resuscitation research to the exclusion" of all 8ther research. Specifically, he seems to take issue with research that focuses on "clinical delivery and patient care services." As evidence for his thesis, he cites the 18th Annual University Association for Emergency Medicine meeting program. He believes that only by identifying and pursuing basic science research within a specialized clinical focus can e m e r g e n c y medicine emerge as a recognized and, therefore, legitimate specialty.
R o b e r t J Rothstein, MD, FACEP - - S e c t i o n E d i t o r Bethesda, Maryland
As a physician who trained in one of the older emergency medicine residency programs, under the direction of one of the founders of our specialty, my understanding of the origins of emergency medicine differs significantly from that of Dr Becker. I believe that emergency medicine originated from a perceived need to provide quality care to acutely ill and injured patients and out of recognition of the unique fund of knowledge that is required of those delivering emergency care. This fund of knowledge is distingnished not so much by its depth as by its breadth, and its recognition of the common pathophysiology of acute illness and injury. It is this common pathophysiology that Dr Becker correctly identifies as important and of significant concern to emergency medicine research, but to cite it as the origin and focus of our specialty ignores the true mission of emergency medicine - the provision of quality emergency care to patients and the teaching of these skills to physicians. Research is of value only insofar as it advances our scientific knowledge and improves our patient care and physician education. Basic science research accomplishes these goals, but no more or less effectively than does good quality clinical and health services research. That these efforts have gone unrewarded in academic medicine should serve as an indictment of the evaluation and promotion system, rather than as justification of the unique value of basic science research. Academic emergency medicine is ideally suited to significantly impact all of academic medicine in the 1990s and beyond. As the academic medical center learns to "function in a new world of cost containment, managed 19:5 May 1990
care delivery systems, utilization review, reduced lengths of stay, competition for market share, and external intervention, ''1 emergency physicians can become models for future academic medical practice. Cost control requires a shift from inpatient to ambulatory patient care and education.~ Emergency medicine is already meeting this need and furthering our ability to control costs with clinical and health services research. As academic emergency physicians, we are able to balance significantly greater clinical c o m m i t m e n t s (compared with other specialties) with teaching and administrative responsibilities and still conduct quality research, much of which addresses important clinical and practice management questions. Recognition of the value of this type of research has been slow, but there is evidence that the recognition is occurring. In the 1988 chairman's address to the Association of American Medical Colleges, John W Colloton spoke on "Academic Medicine's Changing Covenant with Society." In his address, he appealed for the establishment "within academic medicine [of] a national agenda that places a substantial priority on the scientific analysis of our entire health care system, analogous to that which presently supports the biomedical research dimension of our enterprise ... the time is past when such research could be dismissed as unscientific and unworthy of our attention ... the reward system, academic stature, financing, and other inducements essential to the alleviation of this shortage must be put in place so that faculty members appropriate in numbers and quality to address society's present concerns with our system of health care can be mobilized. ''2 Perhaps rather than attempting to adhere to the timehonored model of an academic specialty, emergency medicine should view itself as a model of the future academic specialty, effectively balancing the triad of patient care, teaching, and research while maintaining its focus on the delivery of cost-effective, quality care to patients. To the extent that we can accomplish this, we shall fulfill academic medicine's "covenant with society" and remain true to our origins as well. Robert A Schwab, MD Emergency Medical Services University of Virginia Health Sciences Center Charlottesville i. Ross RS, Johns ME: Changingenvironment and the academic medical center: The Johns Hopkins Schoolof Medicine. Acad Med 1989;64:1-6. 2. Colloton JW: Academicmedicine's changing covenant with society. Acad Med 1989;64:55-60.
In Reply: I appreciate Dr Schwab's interest in my editorial. While he and I disagree on several points, we share a recognition of current problems and a deep concern for the future growth and development of emergency medicine.
Annals of Emergency Medicine
612/171
