How to train emergency docs
===========================

* Jim Ducharme

The possibility of a 4-year common-track program, as described by Russell MacDonald, has been discussed for more than a decade. Although appealing at first glance, it faces what appear to be insurmountable barriers. The CCFP-EM 1-year program has been popular, producing the majority of emergency-trained clinicians in this country. To maintain the same number of graduates would require a large increase in 4-year residency slots, but such an increase cannot be justified under today's budgetary constraints. On the other hand, the fifth year of the Royal College program was added specifically for subspecialty or nonclinical training that was not available because of a lack of fellowships.1 Reducing the program to 4 years would risk eliminating that aspect of training. 

As is almost always the case, I agree heartily with Alan Drummond's insightful comments. With the closing of acute care beds and inadequate funding for patients needing long-term care, the health care system has been overwhelmed. EDs, rather than being a safety net for the patient, have become the safety net for a fragile system. In my own hospital we have found that to solve overcrowding problems in the ED, we must participate in finding solutions for problems in other hospital departments. Emergency medicine training programs have created expertise. Perhaps the time has come to use our vision and expertise to work with Health Canada and provincial health ministers to develop and implement the approach suggested by Drummond.

**Jim Ducharme** Clinical Director Department of Emergency Medicine Atlantic Health Sciences Corporation Saint John, NB

## Reference

1.  1. Ducharme J. Preparing emergency physicians for the future [editorial]. CMAJ 2003;168 (12): 1548-9.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czoxMToiMTY4LzEyLzE1NDgiO3M6NDoiYXRvbSI7czoyMjoiL2NtYWovMTY5LzUvMzkxLjEuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9)