Merit Badge Certifications and CME

…or, death by a thousand CME’s…

The Big Trend at my joint is Chasing Certifications. Yes, we’re a Trauma Center, and those that were here during that pursuit recall the extraordinary efforts (and monies) expended in that effort. Trauma Center Accreditation requires, inexplicably, ATLS certification of all the Trauma docs and EM docs who work in the hospital, plus semiannual ‘Trauma CME’. The ONLY thing that makes this even semi-tolerable is that the pain is pretty agnostic – the Trauma Surgeons have to jump through the same hoops, but it’s still terrifically annoying. (Why is it annoying? Because ATLS wasn’t meant for Board Certified EM docs working in Trauma Centers, it was meant for those practitioners who see trauma infrequently, and for whom it is a frightening novelty. Also, there hasn’t been anything significantly new in the EM practice of Trauma since RSI.) Finally, I had this training in residency, as did every residency trained, board certified EM doc.

Now, we’re being treated to the latest, a ‘Chest Pain Center Certification’. They want a set number of CME hours entailing Cardiac topics, and it’s Time to Draw the Line. Not that I’m against cardiac treatment or education, and if there’s a specialty that has an active journal set, it’s Cardiology. Unfortunately, this is a slippery slope, and it’s truly insulting to professionals in EM. Cards wants 10 hours a year of Cardiology CME (Trauma wants about 7 a year), so now 17 of my 25 state-required CME hours would be claimed. Nevermind I’m about to go to ACEP and would have a heck of a time finding 10 hours of cardiology specific programs to attend, and what would I miss while trying to attend cards CME primarily? The Trauma CME?

This isn’t a straw dog, this is reality, and here’s where the dog bites: our joint wants A Lot Of Certifications, and next is Stroke Center. Now add in another 7 – 10 hours of Required CME for Neurology, and you can see where this is headed: I’m going to have to quit my job to go all to the conferences to keep my job. This would be in addition to the EMCC required by my Board. And, what’s to keep every single specialty from laying on a requirement on the ED for all the docs to have ‘CME in our field’? None, at this rate.

So, here’s how I see it, and how I think it should be presented: I’m a professional, I am well trained and keep up with the literature (my board makes sure of it, yearly). I have to have 25 hours a year (minimum) of CME to keep my State licensure, just like every Physician on staff, and there’s the every two year Medical Staff reappointments to make sure we’re keeping up our end of the bargain. That should be plenty of assurance, and all the numbers required to fulfill any medical staff obligation.

Merit Badges make sense for Boy Scouts, but not for EM Professionals. Before you balk, consider your specialty and a requirement for 10 hours of EM CME a year…

AAEM statement on ACLS
AAEM statement on ATLS
Update 2-27: (via commenter Darren)
ACEP Statement on merit badges and specified CME