Written by: Tony Thrasher, DO, MBA, CPE, DFAPA
Re: Opinion letter pursuant to recent Focused Practice Designation in EBH
In February 2025, the American Board of Medical Specialties (ABMS) Board of Directors approved the request from the American Board of Emergency Medicine (ABEM) to recognize expertise in Emergency Behavioral Health (EBH) through a Focused Practice Designation (FPD).
This endeavor was the result of ABEM and the ABPN (American Board of Psychiatry and Neurology) collaborating on this initiative to offer this FPD to interested emergency physicians and psychiatrists! An Emergency Behavioral Health Task Force was established to bring forward this opportunity, and it had robust participation from ABEM, ABPN, AAEP (American Association for Emergency Psychiatry), and ABFP.
This project has a fascinating history tied to the AAEP and their longitudinal interest in pursuing certification and/or fellowship in the specialty overlap between psychiatry and emergency medicine. This came to a tipping point when the AAEP was tasked by a formal action statement from the APA Assembly to investigate all possible options in this educational enhancement.
That journey led AAEP leaders to speak to a multitude of psychiatric stakeholders (APA, ACLP, ABPN, AADPRT, NAMI, etc…) about possible options prior to combining forces with our emergency medicine colleagues. This led to synergy and the creation of a formal task force that would aim for said certification that would be chaired by ABEM with significant inputs from ABPN and AAEP. After deliberation on the above, the decision was made to examine a Focused Practice Designation (FPD) as opposed to a traditional fellowship.
While the field of psychiatry has not utilized FPDs in the past, our EM colleagues were familiar with it as they’ve used it on such items such as ultrasound specification. Immediate advantages to the FPD include the ability to include multiple specialties (both psychiatry and emergency medicine have clear interest in this) as well as the ability to recognize physicians at different stages in their career.
Another unique feature of this FPD is the fact that fund of knowledge will not be evaluated by a traditional examination. In fact, expertise in this FPD will now be assessed through a portfolio approach (also being developed by our ABEM task force). The portfolio truly manifests the myriad of ways in which physicians demonstrate their professional skill set. In fact, during the initial presentation to the ABMS subcommittee known as COCERT (the Committee on Certification), their expert panelists noted their extensive interest in not only the portfolio approach but also that this effort includes multiple medical specialties working in tandem.
So, when looking at how this can positively affect those we care for, we are having impact at two levels. We are supporting the psychiatrists that have dedicated their career to this challenging milieu….while also making sure that psychiatric subject matter experts can train emergency medicine physicians who are markedly likely to see these emergencies regardless of where they practice nationwide!
The ABEM is starting the actual process/details as we speak, and the expectation is that physicians may start applying by 2026. From a practical standpoint, there will be many advantages to having the FPD in terms of recognition, tenure, professional advancement, compensation, and competitive differentiation when looking at desirable positions.
Respectfully submitted……..
Tony Thrasher, DO, MBA, CPE, DFAPA
Past President – American Association for Emergency Psychiatry
Immediate Past President – Wisconsin Psychiatric Association
Medical Director – Milwaukee County Crisis Services
tony.thrasher@milwaukeeecountywi.gov
Resources:
https://www.abem.org/news/new-emergency-behavioral-health-focused-practice-designation-approved-for-abem/
https://www.prnewswire.com/news-releases/new-emergency-behavioral-health-focused-practice-designation-approved-for-american-board-of-emergency-medicine-302387719.html
https://www.beckersbehavioralhealth.com/behavioral-health-news/emergency-behavioral-medicine-granted-focused-practice-designation.html
