Med School may make emergency training optional

The potential change is just one of many the Medical School is looking at to cut costs.

Facing serious financial issues, the University of Minnesota Medical School is considering shifting emergency medicine training from being a mandatory to elective rotation. The potential change is just one of many the school is looking at to cut costs. “The state has taken $20 million out of the Medical School and over the next few years will probably take another $20 million,” Medical School Dean Frank Cerra said. “The issue is: How does the Medical School deal with that?” The suggestion to make emergency medicine training optional came partially from within the department, the dean’s office and from student feedback, Cerra said. Mandatory rotations are more expensive to maintain because they require more time and energy on the part of the faculty members who teach them. Making the rotation optional would free up additional money to be used elsewhere. “It really doesn’t change anything if it ever gets approved, because the students can still elect to take it,” Cerra said. “Nobody’s going to interfere with that.” Since all patients will access emergency care at some point in their lives, it’s important that future physicians have basic training in emergency medicine, said Cherri Hobgood, vice chair of emergency medicine at the University of North Carolina School of Medicine. “Emergency medicine is part of an integrated health care delivery system,” she said. “Without at least a basic working knowledge of that from a student’s perspective, I think they are not well-prepared to move forward into practice.” Second-year medical student and Emergency Medicine Interest Group President Noah Sugerman said he worries that if students don’t have to take the training as part of their required coursework, fewer will be exposed to emergency medicine and fewer will then choose it as their specialty. Emergency medicine trains students in areas like surgery, radiology, internal medicine, anesthesiology and OB/GYN. It also trains students to be comfortable in the face of acute medical trauma, Sugerman said. “I think it’s important for anyone who is going to be a doctor to have at least some experience with that,” he said. The Medical School is one of about 25 percent of medical schools in the country that require students to take emergency medicine training, although the trend is toward making it mandatory, said Robert Hockberger, chair of the Department of Emergency Medicine at Harbor-UCLA Medical Center in Los Angeles. “The University of Minnesota was one of the pioneers in being one of the first medical centers to require this experience,” he said. Emergency physicians leave the workforce, either because they resign or retire and are not replaced, at an annual rate of 1.7 percent, according to a 2009 report by the American College of Emergency Physicians. When applied to the 26,826 emergency physicians practicing in the United States in 2009, the report found that about 450 will leave the workforce each year and will be replaced by about 1,350 new emergency medicine residency graduates. Despite the positive attrition rates, the ACEP concluded that with the increasing demand for emergency physicians, it will be decades before there are enough board-certified, residency-trained emergency physicians in the workforce. If students get experience with emergency medicine in medical school, that exposure might make them more likely to choose it as their career path — a phenomenon that’s likely been happening at the University, Hockberger said. “My guess is that that foresight they had has resulted in top students going into emergency medicine,” he said, “and those residents graduating and staying in Minnesota and providing high quality emergency medical care for the people of the state.” Balancing the school’s budget will occur on a department-by-department basis over the next few years and will involve administration, department heads and faculty, Cerra said. Meetings to decide where cuts will be made begin in February, he said. “Over the next two years we will end up smaller and we will end up with fewer programs,” Cerra said. “But right now I don’t know what those are.”