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EM Organizations Respond to Ranking the Nation's Residency Programs

Posted Monday, September 15th, 2014

Mr. Ben Harder
Managing Editor and Director
Health Care Analysis
US News & World Report
105 Thomas Jefferson Street, NW
Washington, DC 20007

View the PDF of the Letter

Dear Mr. Harder:

As leaders of the top organizations representing emergency medicine, we have been contacted by scores
of emergency physicians from around the country about a survey being conducted by U.S. News & World
Report and Doximity. We appreciate your recognition of emergency medicine as an academic medical
specialty with a unique core of knowledge and robust research agenda.

However, we are concerned about the sampling method chosen for this survey, because we believe it will
fail to achieve your objective for this survey - to identify America's top emergency medicine training
programs. Asking only physicians enrolled in a social media website to nominate their five most
preferred residencies will result in egregious sample bias and is not capable of resulting in a scientifically
valid result. The results will be based solely upon opinions expressed by physicians who have no firsthand
knowledge of any residency training programs other than the ones they attended themselves.

While not a formal ranking of residency programs, the results would convey that some programs provide
better training than others. However, given the limitations, this would not be an accurate - portrayal to
medical students or to the public. It also would not be useful to many medical students, because research
shows that more than 75 percent of emergency physician residents report the number one reason for
selecting a residency program is geography.

More concerning, the results could send a dangerous public health message to people with medical
emergencies. It implies they should consider bypassing hospital emergency departments with residency
programs that fared poorly in the survey. In a medical emergency, people should seek emergency care at
the nearest emergency department, not one that scored better on a highly subjective opinion survey.

Patients need confidence in their physicians in times of crisis, especially since comparison shopping
among doctors is not an option when someone is having a medical emergency. Emergency medicine
residency programs train physicians in the emergent and acute conditions of just about every medical
specialty in health care. As a result, emergency physicians are uniquely qualified to handle a full range of
adult and pediatric emergencies. In addition, they see every kind of human drama imaginable, often
treating multiple patients at a time.

The overall quality of medical care delivered in emergency departments in the United States is excellent,
thanks to the uniformly high standards that govern the accreditation of residency programs in emergency
medicine. Emergency medicine residencies collaborate openly with shared curricular tools built around a
core model of clinical practice, an approach that is fairly unique in medical education. Ranking training
programs above others is contrary to the principles of our specialty, although we recognize that certain
programs are best suited for certain trainees.

Many factors contribute to a successful residency program, not all of which can be measured or
compared. If your target audience is medical students contemplating a career in our field, we would be
happy to work with you to identify objective, measurable factors to help students find the best program
for their individual needs.

Unfortunately, our organizations, which represent more than 40,000 emergency physicians, could not
recommend or encourage participation in the current survey by emergency physicians. We would,
however, be happy to meet with you and help to identify the parameters that might better accomplish that
purpose. If you are interested, please contact Marjorie Geist at 800-798-1822, ext. 3290.

Sincerely,

Alex M. Rosenau, DO CPE FACEP
President, American College of
Emergency Physicians

Mark Reiter MD MBA FAAEM
President, American Academy of
Emergency Medicine

Meaghan Mercer, MD
President, American Academy of Emergency
Medicine Resident and Student Association

Francis L. Counselman, MD
President, American Board of Emergency Medicine

Mark Mitchell, DO FACOEP
President, American College of
Osteopathic Emergency Physicians

Andy S. Jagoda, MD FACEP
President, Association of Academic
Chairs of Emergency Medicine

Jeffrey N. Love, MD MSc
President, Council of Emergency Medicine
Residency Directors

Robert S. Hockberger, MD FACEP
President, Society for Academic Emergency
Medicine

Jordan Celeste, MD
President, Emergency Medicine Residents Association