But despite the challenges, emergency physicians continue to find deep meaning in their work. At Johns Hopkins, many doctors choose to work in the emergency department specifically because they want to work with underserved populations and provide them with world-class care, Dr. Kelen said.

For Dr. Oman, the rewards come from helping patients navigate an increasingly complex health care system. “Actually being able to get the person the right kind of help that they need, trying to find resources for people, trying to get them where they need to be, that’s challenging, but at the end of the day, it is also rewarding.”

The Corporate Challenge

With roughly one-quarter of emergency medicine visits now staffed by private equity-controlled groups and some companies staffing hundreds of emergency departments nationwide, emergency physicians face new pressures from corporate employment models. Contract arrangements can make it difficult for physicians to advocate for better patient care, and hospital sales or mergers can leave entire physician groups suddenly seeking new positions. However, the specialty’s inherent flexibility helps mitigate these risks, as physicians can often find new opportunities that better align with their values.

Innovation and Adaptation

Emergency physicians have consistently demonstrated their ability to adapt to changing health care needs. During the COVID-19 pandemic, emergency departments quickly reorganized to handle patient surges, setting up tents and creating new care areas. This adaptability extends to embracing new technologies and care models while maintaining the core mission of providing immediate, high-quality care to anyone who needs it.

The specialty continues to innovate in areas like EM research, out-of-hospital care, and disaster preparedness. Dr. Prescott noted how emergency physicians have been instrumental in developing programs like the American College of Surgeons’ “Stop the Bleed,” which has made a major difference on a national level.

Looking Forward

Despite challenges in the field, leaders remain optimistic about emergency medicine’s future.

The key, according to Dr. Kelen, may be reconnecting with the specialty’s core mission while adapting to modern health care realities. “If we all got together and started trying to reach real solutions to these many issues, that other part — the heroic part and the nobility of what we do — will shine through,” Dr. Kelen said.

Although emergency medicine is not an easy job and one never knows who is going to walk into their department, for medical students considering the specialty, Dr. Oman’s message is clear: “It’s still the best specialty, even with all its drawbacks and challenges, because you can make it into almost anything you want.”