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 As reported in last month’s ACLP News, C-L psychiatrists are among professionals eligible for a new certification in emergency behavioral health. Here Tony Thrasher, DO, MBA, CPE, DFAPA, medical director of crisis services, Milwaukee County Behavioral Health Division, and past president of the American Association for Emergency Psychiatry, describes the opportunity. |
Recognition to be offered to physicians at different levels in their career
In February 2025, the American Board of Medical Specialties (ABMS) Board approved a 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, a multi-disciplinary representation across the House of Medicine, was established to bring forward this opportunity, and it had robust participation from ABEM, ABPN, AAEP (American Association for Emergency Psychiatry), and ABFP (American Board of Family Medicine).
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. Consequently, we began further conversations with ABEM who had also been examining these possibilities. 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.
This task force began with years of effort including but not limited to: stakeholder engagement, curriculum development, application consolidation, and examination of parallels already being utilized in medical education. 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 emergency medicine colleagues were familiar with it as they’ve used it on such items 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 levels in their career.
More specifically, the FPD has multiple pathways to enter for recognition. For instance, there are ways to enter through a possible fellowship training while also including past practice items such as a career spent working in said fields. All of these pathways will now be worked upon by the ABEM task force, given the ABMS approval.
Another unique feature of this FPD is the fact that fund of knowledge will not be deferred to a traditional examination. In fact, expertise in this FPD will now be evaluated 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 skillset. In fact, during the initial presentation to the ABMS subcommittee known as COCERT (the Committee on Certification), their subject matter panelists noted their extensive interest in not only the portfolio approach but also that this effort includes multiple specialties working in tandem.
So, all that being said, a fair question would be…now what? Given the fact that the ACLP formally supported this project (thank you!), how does this affect your members now?
Purely from a pertinence standpoint, our AAEP leadership has always noted that the ACLP has a great deal of interest in emergency psychiatry (as evidenced by the very talented special interest group). Hence, there are likely many ACLP members who not only have interest in this FPD but who also have a strong portfolio for consideration!
The ABEM is starting the actual process/details as we speak, and the expectation is that physicians may start applying by 2026. Given the subject matter expertise present in ACLP, I’m guessing that there will be many experienced professionals who already have given a great deal of their career to the field of emergency psychiatry. Consequently, they will have the ability to utilize the portfolio approach to enter through the ‘practice pathway.’ Additionally, there will be coordination/collaborations with pre-existing fellowship programs that are doing wonderful work, despite not being fully ACGME-recognized per se.
From a practical standpoint, there are likely to be advantages to having the FPD in terms of recognition, tenure, professional advancement, compensation, and competitive differentiation when looking at desirable positions.
From a systems standpoint, while my comments above reflect on those who are already doing the work, there is likely even more to gain from those who will be new to the field—and engage more due to the FPD.
During our development stages, I often commented to interested stakeholders that while some psychiatrists have interest in this field, ALL emergency medicine physicians have interest in this overlap between our two fields.
So, when looking at how this can positively affect those we care for, we are having impact at two levels. We are supporting psychiatrists who 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!
From a personal standpoint, I am a psychiatrist who has spent the majority of my career within the world of ER psych and psychiatric emergencies. As such, I am so proud of the advancements that groups such as the AAEP and ACLP have accomplished. The addition of this FPD signals to the greater medical world that this is not only an important section of our work, but it also deserves investment. This includes clinical, research, and academic support towards our mission and those we serve!
I am grateful for your attention to this short read. More info will come as 2026 approaches, but I wanted to make your membership aware of this phenomenal development. I welcome any questions or further commentary you may have as we move into the next stages.
