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In 1966 the NAS‐NRC document stated, regarding emergency care, “No longer can responsibility be assigned to the least experienced member of the medical staff, or solely to specialists, who, by the nature of their training and experience, cannot render adequate care without the support of other staff members” [16]. Thus the importance of physician leadership and training in EMS was identified early. During the 25 years following World War II, increasing demands for care were placed on hospital emergency departments. As a result, groups of physicians began focusing on exclusively practicing and improving emergency care. They identified the academic discipline and scientific rigor necessary to define a separate medical specialty: emergency medicine.

In 1968, ACEP was founded by those physicians interested in the organization and delivery of emergency medical care. In 1970, the first emergency medicine residency was established at the University of Cincinnati, and the first academic department of emergency medicine in a medical school was formed at the University of Southern California. Soon the directors of medical school hospital emergency departments founded the University Association for Emergency Medicine. Between 1972 and 1980, more than 740 residents completed training at 51 emergency medicine residencies throughout the country [35–37]. The first major step toward designation as a medical specialty occurred in 1973 when the AMA authorized a provisional Section of Emergency Medicine. In 1974, a Committee on Board Establishment was appointed, and a liaison Residency Endorsement Committee was formed [37]. Further impetus toward expansion of residency training in emergency medicine occurred with the formation of the American Board of Emergency Medicine (ABEM) in 1976 [38]. Before that time there was some hesitancy to create additional residency programs that might not lead to board certification.

In September 1979, emergency medicine was formally recognized as a specialty by the AMA Committee on Medical Education and the American Board of Medical Specialties. One of the strongest arguments in favor of the new specialty was that emergency physicians had a unique role in the oversight of prehospital medicine. ABEM gave its first certifying examination in 1980, which incidentally did not examine on any areas of prehospital care.

Although emergency medicine, emergency nursing, and prehospital care were all nourished by the funds distributed between 1973 and 1982, the first full‐time EMS medical director was not appointed until April 1981 in New York City. Previously, all had been part‐time, and many had been simply functionaries. Shortly thereafter, cities like Salt Lake City and Houston followed New York’s lead, and appointed full‐time EMS medical directors. Even then, EMS as a physician career choice was perceived by many as perhaps a risky career undertaking.