Each year the ACOEP receives requests from people investigating a career in emergency medicine. In the early 1990's we began gathering information to provide to those seeking information and have dredged up information from sources that have ranged from interviews to online searches. Recently, we found a very comprehensive look at emergency medicine called, Anyone, Anything, Anytime, A History of Emergency Medicine by Brian J. Zink, M.D., a synopsis of what we found in this book and by searching the website this is found below.
Part 1 - The Beginnings of a Specialty
Medical care became a specialty unto itself during the 1800's. Medical Schools were few and most practitioners of the medical arts were trained by physicians who either attended the few medical schools on a preceptor basis or worked for a person considered a 'healer' by society. During this century medical schools of varying quality began to educate and produce medical doctors who completed medical school and went from classroom to practice without the requirement of internship or residency training. This system produced medical doctors who were generalists and could diagnose basic illnesses, deliver babies and do surgery. These General Practitioners (GPs) worked from their offices and provided "emergency care" to patients in the form of house calls. These physicians were considered valuable assets to any community and worked 24 / 7 providing to the needs of their patients. By the early 1900s, change began to invade the world of medicine.
In 1910 the Flexner Report brought changes to the medical profession promoting standardized basic medical education and developing a link between the medical school and hospital. The Report standardized medicine by requiring that practitioners graduate from an accredited school of medicine and promoted at least a one-year training requirement, called an internship. The Report, called for by the medical community and changes in the science of medicine, was further strengthened by the government when a one year internship was required by the Surgeon General for anyone wishing to practice medicine in the Army during World War I and was endorsed by the medical community for anyone wishing to be a GP in the 1920's. At the same time, medical specialties like Surgery, Ophthalmology, Otolaryngology and Internal Medicine began to solidify as specialties requiring advanced training, beyond the internship, to practice in these areas and become a "specialist" in these fields.
With the growth of these medical specialties, a link was forged between specialty physicians and hospitals to provide, not only education, but patient care. As the physician began to establish these links with hospitals and began certification processes to verify training and abilities, they began forming offices outside of their private residences and in areas surrounding hospitals where they were provided practice privileges. General practice was viewed by many a rudimentary education in medicine and was often used as the pre-requisite for training in specialty medicine. However, because GPs were the largest group of physicians in America, most emergency care was still conducted by the GP at patients' homes. The number of house calls dropped significantly after WWI and didn't disappear until the 1960's or later in more rural areas, when more general practitioners were given staff privileges at hospitals.
During the late 1920's through 1955 more specialty practices were established and patients began to seek out specialists for medical care. Prior to this time, over 75% of medical practitioners classified themselves as GPs, after 1955 this decreased to 50% and by the middle of the 1960's only 31% classified themselves as GPs.1
Medical specialists were again given a boost when physicians were classified in the military by their specialty training during World War II and Korea, when it was driven home that the Veterans Administration ranked specialists higher in military rank than general practitioners, spurring thousands of veterans and GPs to seek specialty training after the war.
Part 2 - Early Emergency Care