Women's Health: Essential Curriculum in Emergency Medicine (2014)

Women's health is an important component of the practice of emergency medicine (EM). The Model of the Clinical Practice of EM recognizes important components of women's health, including obstetrics and gynecology (13.0), patterns of violence/abuse/neglect (14.6), breast cancer (16.8.1), trauma in pregnancy (18.2), and procedures (19.4.8).1 The authors of “Defining a Novel Emergency Medicine Subspecialty: Sex, Gender, and Women's Health” in this issue suggest that women's health be considered as a recognized subspecialty of EM.2 This raises an important philosophical question regarding the value of subspecialty certification compared to a recognized component of the practice of EM. The American Board of Medical Specialties (ABMS) was originally established in 1933 to create uniformity in physician certification and to increase public awareness of the value of specialty certification. Before 1970, ABMS sponsored 10 subspecialty certifications. Since that time, the number of subspecialties has continued to rise, and in 2014, ABMS member boards certify over 145 specialties and subspecialties.3 Currently there are 24 approved ABMS member boards, including the American Board of Emergency Medicine (ABEM), which was approved in 1979. In 2014, ABEM offers subspecialty certification in nine subspecialties: anesthesiology critical care medicine, emergency medical services, hospice and palliative medicine, internal medicine–critical care medicine, medical toxicology, pain medicine, pediatric EM, sports medicine, and undersea and hyperbaric medicine.4 A subspecialty dedicated to women's health might be considered unnecessary and redundant of other postgraduate medical education curriculum. Many specialties include women's health issues as essential curriculum components, including obstetrics and gynecology, EM, family medicine, internal medicine, surgery, pediatrics, and others. For almost a century, the field of obstetrics and gynecology has been entirely dedicated to women's health. The American College of Obstetrics and Gynecology (ACOG) mission statement is in part dedicated to the advancement of women's health care through continuing medical education, practice, and research.5 Another potential concern of another subspecialty might be the diversion of academic resources that are important to the development of women physician scientists. The NIH's Physician-Scientist Workforce Working Group Report from 2014 indicates that only 29% of research grant principal investigators are women, and the rate of growth is relatively flat.6 Although specific evidence is lacking, we hypothesize that a larger female presence in terms of setting the research agenda would ostensibly provide meaningful change in women's health and the way that all physicians understand and care for female patients. At the local level, factors that will encourage women to seek a research career include flexible policies on clinical shift scheduling, an evolved culture that embraces a work-life balance, and access to child care. At the national level, the United States needs a larger pool of mentors with specific interest in mentoring women toward research careers and access to more high-quality, rigorous research-centered training opportunities, which we would opine to include all research fellowships that are approved by the Society for Academic Emergency Medicine's Research Committee. In the spirit of constructive debate, we would offer the opinion that an ever-growing number of subspecialty certifications may dilute the significance of board certification or may dilute the significance of existing subspecialties. While many components of the practice of EM are important to our practice and to residency training, not all warrant subspecialty board certification. We believe that time and resources would be better served to increase the female physician-scientist workforce. However, we remain aligned with McGregor et al. in the idea that we in academic medicine must continue to train residents in issues important to women's health and to practice compassionate and high-quality care for all of our patients, regardless of age, sex, ethnicity, religious beliefs, insurance status, or any other patient characteristic.