Synapse: April 17, 1980

Wednesday, April 15, 2015

From 35 Years Ago:
Vol. 24, No. 23, April 17, 1980:

Today, emergency medicine (EM) seems a solidly entrenched and respectable medical specialty. Compared to many specialties, however, it is a latecomer. The first emergency rooms were staffed in an ad hoc fashion by internal medicine and surgery residents. The first dedicated training program in EM was begun at the University of Cincinnati in 1970, and board certification in EM was first offered in 1979.

It was in those years of rapidly burgeoning but still nascent field that Synapse ran the article “The rise and fall of emergency medicine” by Susan Stern. The first SFGH-based EM residency had begun in the middle of 1979. Less than two years later, before its first residents had even graduated, a group of UCSF school of medicine administrators and SFGH department chairs decided to end the residency. “None of the emergency medicine faculty or residents, however, were present at the decisive meeting,” reported Stern. H. Barrio Fairley, associate dean of the UCSF school of medicine, attributed the decision to shutter the program to the departure of its director and associate director.

Some provisions were made for the residents, including allowing the third-year residents to complete their programs as scheduled, helping interns transfer to other residencies, and cobbling together a mixture of SFGH and Highland rotations to get the second-year residents through their remaining year and a half. It was those second-year residents that felt particularly exposed. One of them, Nancy Gorham, was paraphrased as wondering “whether after this fragmented training they will ultimately be considered board eligible in their specialty and graduates of an accredited program.” She also lamented that she and her fellow residents “are being treated, ‘as if we are less competent, less intelligent, less astute, less dedicated. . .  like second-class doctors’” by some other UCSF residents.

Although the inciting event for ending the residency may have been the loss of two critical faculty members, Storm’s article made clear that there was significant skepticism of the specialty itself. Donald Trunkey, chair of surgery at SFGH, “says that the country needs fewer emergency physicians -- and emergency rooms -- than emergency medicine proponents claim. He also claims that surgeons are better qualified than emergency physicians, who he calls ‘glorified paramedics,’ to handle trauma cases.” Conversely, Melvin Cheitlin, acting chair of medicine at SFGH, “says that most internists, including Dr. Sande, who will soon become chief of medicine at SFGH, feels that internists are better qualified than emergency physicians to take care of primary care patients.”

Today, the UCSF-SFGH EM residency is substantial, with 36 full-time faculty and 14 residents per year, according to its website. To get that there, however, required some resuscitation.