Emergency medicine residency training began over lunch.

In 1969, at Cincinnati General Hospital, Bruce Janiak, MD, FACEP, sat down at a small cafeteria table where a group of physicians were debating the possibility of a new specialty: emergency medicine. At the time, the emergency department (ED) belonged to everyone and, in practice, to no one. Medical students were routinely sent across the Ohio River to Kentucky, where they served as the only “doctor” in a small ED. On Dr. Janiak’s first such shift, he was greeted by a nurse and a patient in cardiac arrest. The resuscitation failed. Stirred by what he had experienced, Dr. Janiak went home and read everything he could find about emergency care, which foreshadowed lunch.

Dr. Janiak

Dr. Janiak had planned on training in family medicine. At lunch, he asked if he could instead train in emergency medicine. Dr. Gordon Margolin, an internist, and Dr. Herbert Flessa, an intensivist, agreed, but on one condition:  Dr. Janiak would help create the curriculum during his rotating internship. What followed was the birth of emergency medicine, and in 1970, Dr. Janiak became the first emergency medicine resident in the United States.

Dr. Janiak did not set out to make history. He simply wanted to be, in his words, “where the action was,” and for him, the ED was it. He never regretted the decision. Emergency medicine demanded adaptability, decisiveness, and comfort with uncertainty. It required physicians who could care for anyone, at any hour, with whatever resources were available.  Dr. Janiak thrived in that environment.

Building Emergency Medicine

A small group of mentors helped guide the early formation of emergency medicine at Cincinnati General Hospital. Initially, the head of outpatient medicine, Dr. Jim Agna, was asked to oversee the ED because it was viewed as an extension of outpatient care. Together, they built rotations that allowed Dr. Janiak to function as an emergency physician in all but name. He completed a rotating internship through internal medicine, surgery, pediatrics, cardiology, and other specialties.

Dr. Janiak (seated, far left) at the 55th Anniversary of Department of Emergency Medicine Residency at University of Cincinnati, 2025.

A year later, Dr. Tom Blum, an internist, was formally named head of the emergency medicine residency program, giving the program its first official footing.

Dr. Janiak’s first co-resident, Dr. Bill Teufel, joined in 1971 after leaving California, where he had planned to pursue surgery. He chose instead to train alongside Dr. Janiak in this new and uncertain path. For the first time, emergency medicine felt like a shared effort.

Residency at the University of Cincinnati

During residency, there were no faculty members physically present in the emergency department.  Dr. Janiak recalled seeing an attending physician in the ED only once during his three years of training. Most of his mentoring came from senior residents in other specialties. Some were generous teachers; others less so. The absence of structure left room for innovation and self-reliance.

There was no playbook. Learning happened in real time and often under extreme pressure.

During his intern-year surgery rotation, the chief resident sought Dr. Janiak’s help during a Whipple procedure. In a thick southern drawl, the resident promised Dr. Janiak he was about to witness the best operation in the world. Suddenly, Dr. Janiak found himself nowhere near the surgical site holding a retractor for hours. When the resident turned his head to take a sip of juice, Dr. Janiak dropped the retractor and quietly fled the operating room, never to return.

He also recalled a tornado striking an RV park outside of Cincinnati. Victims flooded the ED. Dr. Janiak spent nearly 20 hours suturing.

Later in residency, Dr. Janiak was given a small office in the emergency department, which became a gathering place for house staff across the hospital where a refrigerator, occasionally stocked with adult beverages, helped the hours pass. One Saturday, Dr. Janiak hosted members of the Pittsburgh Steelers who were in town for a game.  Dr. Janiak made sure they were well hydrated and smiled gleefully the next day when his beloved Cincinnati Bengals won easily.

There were also painful lessons. A senior internal medicine resident wanted to demonstrate the dramatic effect of a newly released drug, Lasix, and inadvertently administered more than 200 mg; The patient died moments later. Dr. Janiak never forgot it. From that point forward, he double-checked every medication dose, a habit that lasted throughout his career.

Another patient, an obese adolescent taking a new weight loss medication, arrived agitated, grabbing at objects and hiding under the stretcher.  Dr. Janiak filed a Food and Drug Administration adverse drug report. Within a week, a pharmaceutical company representative took him to an extravagant dinner and asked whether he really wanted to submit the report.  Dr. Janiak made it clear that he did. The experience reinforced his belief that advocating for patients sometimes requires pushing back against powerful interests.

At the end of his pioneering residency, emergency medicine still lacked board certification. With no alternative, Dr. Janiak became certified in family medicine. In 1980, he was grandfathered into the American Board of Emergency Medicine (ABEM), finally receiving formal recognition for a specialty he had helped create.

Post-Residency Career

Dr. Janiak with patients during his years in the U.S. Navy. (Click to enlarge.)

Dr. Janiak with patients during his years in the U.S. Navy.

After residency, Dr. Janiak served in the U.S. Navy from 1972 to 1974 as head of emergency medicine at the Naval Hospital in Pensacola, Fla. There, he met the love of his life, Michele, an emergency nurse, and they fought immediately. They married only nine weeks later. His career later took him to the Toledo (Ohio) Hospital (1974-2002), Fayetteville Memorial Hospital near Atlanta (2002-2004), and eventually to the Medical College of Georgia in Augusta (2004-2019), where he found deep fulfillment in teaching. He gave back to the specialty by serving as President of both ACEP and ABEM.

Beyond teaching, Dr. Janiak’s favorite moments on shift were spent sitting down with patients and talking about their lives, not just their illnesses. “My home,” he said, “was taking care of patients in the emergency department.”

For Dr. Janiak, patients always came first. Once, before fax machines or email, an administrator arrived in the emergency department and instructed him to implement a change because the Joint Commission required it.  Dr. Janiak knew it was not good patient care and, through his ACEP connections, also knew it was not an actual Joint Commission policy. He called a friend at the Joint Commission, signed out of the ED, flew to Chicago, walked into the Joint Commission office, obtained a letter clarifying the policy, and flew home to hand it to the administrator. It may not have been politically wise, but Janiak always chose his patients.

Emergency medicine was, in Dr. Janiak’s words, “just plain fun.” Every day was different. There was a thrill in pulling patients back from the brink of death and satisfaction in making the right diagnosis at the right moment.

Dr. Janiak never measured success by income. He started moonlighting during residency at $7.50 an hour. What mattered were the people. He believed emergency medicine only worked when physicians, nurses, and technicians functioned as a true team. At Toledo Hospital, he personally funded Christmas parties, raffles, and even cruise giveaways for nurses, not as extravagance, but as gratitude.

That team philosophy extended to difficult moments. When an emergency nurse struggling with opioid addiction was identified, Dr. Janiak sent her to rehabilitation and later rehired her in a tailored role to help screen patients for substance use and connect them with care.

He carried the same mindset into the creation of the Emergency Department Benchmarking Alliance (EDBA) in 1994. That, too, was the result of an administrator asking him to justify ED throughput times.  Dr. Janiak realized he had no meaningful way to compare his department’s performance to others. He called colleagues, learning that no one else knew how to compare themselves against their peers either.

The EDBA was built around one simple question: How do I know I am doing a good job? Dr. Janiak insisted that physicians, nurses, and administrators all be involved. Redacted patient charts were shared. Care was reviewed at the patient level. Every administrative decision required a clinical endpoint. Improvement was never abstract. It was always tied back to patient care. The organization has since grown to include more than 1,500 EDs and continues Dr. Janiak’s original mission of using data in a positive manner to support frontline staff and managers.

Although he never wanted to leave the ED, Dr. Janiak retired in 2019 to care for his wife. She passed away in 2025 after 52 years together and 14 children.

Janiak’s Words of Wisdom

Dr. Janiak said he believes that emergency medicine must take care of its people. Janiak cautions against letting money drive decisions and warns that graduating physicians without job opportunities represent a failure of stewardship. He takes pride in emergency medicine, a specialty born in the United States now practiced around the world.

To new emergency physicians, his message is simple: Enjoy your patients, be proud of your work, and remember that you are the only clinical specialists available 24 hours a day, 365 days a year. And if you feel overwhelmed or discouraged, he still offers himself as just an email away.

Thank You Dr. Janiak!

Bruce, this article is our way of saying congratulations and thank you. Thank you for helping create the specialty we love. Thank you for building emergency medicine around patients, teamwork, and joy in the work itself.

We are sorry it took so long after your retirement to write this. We know Michele would have loved sitting beside you, listening as you read it, and seeing you recognized for the extraordinary and lasting impact you have had on the field she also loved.

You will be missed in the emergency department but never forgotten.

Dr. Canellas is an associate chief medical officer at UMass Memorial Health, an assistant professor of emergency medicine at UMass Chan Medical School, and a research affiliate at the Massachusetts Institute of Technology’s Sloan’s Operations Research Center in health care AI. She serves on the board of directors for the Emergency Department Benchmarking Alliance, where she focuses on advancing data-driven strategies and innovations to improve emergency department and hospital operations nationwide.

Bruce would love to hear from former students, colleagues, or anyone else at bdjaniak@aol.com.