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25th Anniversary Reflection: The Founding of ACMT

As part of our 25th anniversary, founding members are sharing interesting tidbits from the past. ACMT's first president, William Banner, MD, PhD, FACMT, offers a look at the beginning of ACMT.

Leslie Dye invited me to wax philosophical as a former President of ACMT. Given that I was Chairman of the American Board of Medical Toxicology (ABMT) at the time that we transitioned to ACMT, I guess that makes me the first official president of this organization. I think to understand the more humble position I was in, you need to understand a little bit of prehistory, and since I am somewhat prehistoric it will come fairly easily.

I was one of a long line of officers serving the ABMT, the first certifying board in the field of medical toxicology. In those days the responsibility of all of the members was to submit questions for the annual exam. The Vice Chairman of the ABMT coordinated collating the questions for the written exam and the questions and exhibits for the oral examination component. These were then distributed back to the Board of Directors to vet, agree upon, and form the content for the final examination. In addition to determining the content of the exam, the Board gathered and proctored the exam prior to each annual meeting. The one-day, written examination, was followed by two challenging days of oral examination, where poor supplicants were subjected to a two—on—one grilling process.

I remember when I took the exam in 1982 sitting in front of two of the legends of toxicology with a sense of impending doom. Drs. Rumack and Goldfrank were always gentlemen and, while the process was still somewhat proctoscopic, I survived and never held it against them (maybe just a little). At the end of both examinations, the Board members sat in a room and argued the placement of the cut point for passing by examining the blinded score results. It was always a difficult process. So it was with some sense of responsibility that I became a Board member and participated in this process.

Having been on other boards, this position was clearly the most demanding of time and the most intense. When I became the Vice Chairman of the Board, I literally spent most of my nonclinical time reading through questions, editing, sorting, and mailing in a laborious process that was done in the pre-Internet age, using actual paper and snail mail. It was during my vice-chairmanship that we did analytics of the board scores and compared the oral exam to the written. I found such a high degree of correlation that the board agreed to terminate the oral exam process and rely instead upon the much less labor-intensive and less costly process of a written examination only. I considered that a minor victory for the oppressed.

When I became Chairman I gladly delegated the written examination process to my Vice Chairman. The principal task ahead of me at that time was to follow in the footsteps of Drs. Becker, Goldfrank, Rumack and many others who were pushing for our board to be subsumed by the primary boards and turn over the examination process to the American Board of Medical Specialties. The yeoman’s work had been done by others, but I had the honor of pounding the gavel that relinquished the examination process of the ABMT to the American Board of Medical Specialties, therefore dissolving the ABMT.

For approximately 30 seconds we did not exist. There was a faction that felt “mission accomplished” and that we should eliminate the board and report to the American Academy of Clinical Toxicology that we had finished our work. Others felt the need for a professional organization that was able to bestow fellowship on individuals who had passed the board examination process, allowing additional recognition in the manner of other organizations. Still, a third group wanted to have a professional advocacy organization that could lobby Congress for reimbursement and provide more aggressive advocacy for medical toxicology practices and billing. I don’t think at that moment we resolved anything other than the need to continue as a group to accomplish the latter two missions in some fashion.

In that way ACMT was born with a joint mission to bestow the honors of fellowship and act as a professional organization to promote the practice of medical toxicology. I believed at the time and still believe that there is ample room for the three organizations: ACMT, AACT, and the American Association of Poison Control Centers. We all coexist with the missions of clinical practice, research, and public health. While at times it seems that we have bumped into one another on these missions, I think the past 25 years have shown that the overlapping memberships in these three organizations and the collegial spirit of the officers of the three groups have always prevailed to work together and that the organizations continue to sponsor excellent educational activities at all levels and all promote research activities.

As the current President of the Board for the American Association of Poison Control Centers I have had recent opportunities to work with the officers of ACMT and AACT, Dr. Charles McKay and Dr. Robert Palme. I’m proud to say that these two good friends maintain the goodwill and joint efforts that continue to hold us together in our mission of improving care for those exposed to toxic substances at all levels. I was proud to be the first President of ACMT and continue to be proud of all that it has accomplished in the 25 years of its existence.

William Banner, MD, PhD, FACMT, FAACT