The Specialty of Correctional Medicine

Society of Correctional Physicians

I just returned from this year’s NCCHC convention.  It was excellent, as always.  A very important announcement was made at the Society of Correctional Physicians’ meeting on Sunday that deserves more publicity than it is getting.

The American Osteopathic Association (AOA) has officially recognized Correctional Medicine as a Medical Specialty.  You can read the resolution here. This is a huge step for those of us who practice the Specialty of Correctional Medicine.  This is the first step in getting our specialty fully recognized and legitimized within the bigger world of medical practice.

We do not now have the recognition and respect that we deserve.  As an example, if you are registering to join the physician community at Medscape, you are asked to list your specialty and you are given a drop-down list of sixty-nine (69!) possibilities including “Nutrition” and “Genomics” (what the heck is that?) but not Correctional Medicine.   What is the closest alternative?  Internal Medicine?  That’s not right.  General Practice?  Doesn’t fit.  In fact, there is no other comparable specialty.  And Correctional Medicine is, in fact, a specialty practice of its own.

I learned this the hard way when I segued into correctional medicine from my original specialty of emergency medicine.  It took me several years until I really felt comfortable with the practice of medicine in my jails.  And I am still learning!  I am making changes to several of my protocols based on things I learned at the SCP conference and the NCCHC conference this last week.  A couple of them were real head-slappers, “How could I have never thought of this?”  Those I will write about eventually.

Correctional Medicine’s tentative acceptance as a recognized specialty reminds me of the early days of emergency medicine.  “Back in the day,” meaning the 1940s and 1950s, emergency rooms (nobody called them “Emergency Departments” back then.  They were literally rooms.) were staffed by various members of the medical staff as part of their obligation to the hospital.  There would be an orthopedist there one day, a pediatrician the next day and an anesthesiologist the next.  If you worked in the ER full-time, other doctors looked at you askance.  They were thinking, “What’s wrong with you that you’re not working as a ‘real’ doctor, with a ‘real’ practice?”

That began to change in the 1960’s as full-time emergency physicians began to get organized and set the standards of their fledgling specialty.  The American College of Emergency Physicians was established in 1968. The Journal of the American College of Emergency Physicians (now the Annals of Emergency Medicine) was first published in 1972.  Later the same year, the first emergency medicine residency program was established. Emergency Medicine was finally officially recognized as an independent medical specialty in 1978 by the American Medical Association.  The first official certification exam was given by the American Board of Emergency Medicine in 1980.

When I entered my Emergency Medicine residency in 1985, there was still a little of the old attitude still around: “If you work in the ER, there must be something wrong with you.”  But I believe that attitude nowadays is finally gone.  Emergency Medicine nowadays is a fully integrated, well-respected specialty.

Correctional Medicine is well on the way along the same path.  We have the NCCHC, established in the 1980s.  We have The Society of Correctional Physicians, established in 1992.  The first issue of the Journal of Correctional Health Care was published in 1994.  And now we have the American Osteopathic Association recognizing our discipline.

There are two other organizations besides the AOA that certify medical specialties in the United States.  The first is, of course, the AMA.  The other is the American Association of Physician Specialists.  But since the AOA has already recognized Correctional Medicine, there is momentum for recognition by the other two organizations.

Note that the first Emergency Medicine residency program was established in Cincinnati a full six years before Emergency Medicine became an official specialty.  Where in the country will the first Correctional Medicine residency program be established?  It’s coming!

18 thoughts on “The Specialty of Correctional Medicine

  1. Nancy Wolf

    Thanks Jeff, it’s difficult enough to be a nurse practitioner in corrections, my colleagues elsewhere cannot understand what the heck I do, but to now have support of larger, te established organizations is a real boom.
    Exposure to our ‘craft’ is essential for the change that is so greatly needed in our correctional/prisons systems. Knowing you are out there sifting through the info and bringing it to the attention of those of us that may not be able to attend all the offerings is a Godsend,
    Thanks for your passion to treach, mine has difficulty sometimes getting “outside the walls”!

    Reply
  2. Ryan

    Hi Dr. Keller. I am a third year Physician Assistant student at the Rochester Institute of Technology. I am beginning to write a research paper, for which I have chosen to write about Correctional Medicine. Your blog appears to be an excellent resource, especially because there are so few publications on Jail Medicine. I was wondering if you or any of your colleagues would be willing to answer a few questions for my paper. If so, please contact me at RJP4380@RIT.edu, I would really appreciate it!

    Reply
  3. Taryn Parks

    Hi! Thank you so much for posting all this great information! Are there any updates regarding correctional medicine residencies? I am a third year medical student who wants to get into correctional medicine. I am actually a D.O student, and seeing as how the AOA has recognized the field as a speciality, an AOA residency would work perfect for me! I’d love to discuss becoming a correctional medicine doctor if anyone is interested in helping me get there! I’ve already been able to work behind bars at San Quentin as a medical student, and I absolutely loved it. Any help would be greatly appreciated! Thank you!

    Reply
    1. Jeffrey Keller MD Post author

      Hi Taryn! To my knowledge, there is not yet an established residency in correctional medicine. Do not let that discourage you! I personally would recommend that you do a residency in internal medicine with as much side training in psychiatry as you can get, and then you can pick where you want to practice. Give me first shot! I’ll hire you!

      Reply
      1. Taryn Parks

        Having a job offer as a third year medical student — you just made my day! Thank you! I have heard that having a residency in IM is definitely the way to go. I’m hoping to find a program that allows me to do both IM & Psych. That would be ideal! My interests are IM, psych, infectious disease, and addiction medicine. There simply is no other population that fits that mold so perfectly. Plus, I have no problem working behind prison walls, and absolutely believe that everyone deserves care, regardless of their past. After the IM/psych residency, there is also a correctional medicine fellowship that is offered in Florida, and I would love to do that. They take fourth year students for rotations, so I am going to rotate there and hopefully be back in a few years for the fellowship. So exciting to find a group of people that are supportive! I have had many think that I was crazy for wanting to go this route, but I think it can be uniquely rewarding if you are open to the idea of this work!

        Reply
        1. Aubrey Jones

          Hi Taryn! I just came across this article and your posts. I’m actually interested in taking the same route that you describe here; I’ll be entering my first year of medical school in two weeks! I’m wondering if you could update me on your journey. I’d love to hear where you are today!

          Reply
    1. Jeffrey Keller MD Post author

      No, I do not, Taryn, but thanks for asking. I’m sure I could point you in the right direction to set up a medical school rotation in a correctional facility if you are interested.

      Reply
  4. Merrian

    Hi Dr. Keller,

    I was wondering if I can touch base with you regarding supplemental education for someone interested in correctional medicine. I am going into an adolescent medicine fellowship in july and would like for it to be ‘correction centered’ but am not sure what resources I should be reading or conferences aside from the NCCHC conferences.

    Reply
  5. Dr. Calkins

    I too am an Emergency Physician turned correctional medicine doctor. I wonder if ACEP has a section for correctional medicine? They have every other section imaginable, including “Cruise Ship Medicine” and Hyperbaric sections…why not correctional med section? This would be a great first step!

    Reply
    1. Jeffrey Keller MD Post author

      Thanks for the comment, Dr. Calkins! ACEP does not have a Correctional Medicine section. My vote is for you to be the driving factor to set one up! I will join!

      Reply
  6. G Williams

    Correctional medicine can be thought of a sub-type of the above mentioned medical fields. Of note, I am a physiatrist working in correctional medicine. In addition to ob-gyn, we can also provide this type of medical care. Because the bulk of the correctional medical care comes from the primary specialty, this field in itself cannot be a specialty, but a sub-specialty at best. In the future, a certificate of knowledge in the field should probably suffice, as the field is in its infancy and it will likely grow in knowledge in a limited fashion. Let me be more specific, because of medico-ethical limitations on the captive population, the field will never achieve scientific knowledge needed to give the evidence needed to support its development and be competitive as a full field such as ABIM, ABPMR or AAFP.

    Reply
  7. Kate M

    Hello! I just found your post! I’m interested in Correctional Medicine and I would like to do a rotation in a prison, but am having a hard time finding where to look or how to set it up! I would greatly appreciate any advice or direction you might have.

    Thank you

    Reply

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