Dr. Horne's interest lies in the emerging specialty of Emergency Medicine. He synopsizes its development as a specialty, where before it was covered by general surgeons and specialists.
He introduces us to the earliest surgery, trephaning, in Neolithic times, and continues to the birth of Emergency Medicine, after World War I. The field developed rapidly in following World War II through to the mid-1960's, when the new Medicare and Medicaid programs took available money away from upgrading emergency facilities. Medical schools then received federal grants, but with the stipulation that they produce more physicians, resulting in an overabundance of doctors, the vast majority of which have been specialists.
The public's usage of emergency medical services has changed drastically. Patients now come to the emergency department for routine complaints such as headaches and the flu. Horne believes this trend is justification for emergency medicine becoming a medical specialty. But as emergency medicine becomes a specialty in its own right, issues of payment for services arise as in other areas of medicine.
"Cutting Hospital costs directly" is Horne's first proposal for keeping costs in check in this new atmosphere of increased specialism and inflating healthcare expenses. He also believes that the existing system of "superspecialists" receiving higher fees by virtue of their specialism should be abolished. Emergency departments need to be remodeled toward streamlining care to increase efficiency. Horne is also a proponent of categorization to ensure that patients get to the appropriate treatment facility in a timely manner, a system that reduces the costs of patients getting treatment before they have been categorized.
Appallingly, medical students are not required to graduate with emergency life-support skills, and Dr. Horne calls on his emergency medicine colleagues to teach these skills to students in their departments. Emergency doctors must prove to the medical community "that emergency medicine encompasses an identifiable body of knowledge which has true scientific validity recognized by the profession but not necessarily possessed by all physicians." Certification of emergency medicine as a specialty will "[insure] quality control in emergency medicine."
Dr. Horne looks forward to the 1980's with enthusiasm for the new specialty of Emergency Medicine, eager to see how it fares as its own specialty, how the medical community is affected, and how patients benefit.