A few years back, I embarked on a journalistic journey, chronicling the lives of several intrepid physicians who’d traded their scrubs and stethoscopes between the United States and far-flung locales like Australia, New Zealand, the Netherlands, and even the cradle of humanity, Ethiopia. These weren’t just travelogues; they were glimpses into the diverse tapestry of global health care, each thread woven with different financing models and delivery systems. But those four stories, as compelling as they were, merely scratched the surface. The world of medicine, and particularly the high-octane realm of emergency medicine, pulsates with a myriad of approaches, each shaped by unique cultural, economic, and geographical forces.

Recently, my intellectual curiosity was piqued by the ACEP ambassador program—a brilliant initiative fostering a vital exchange of knowledge and experience through the participation of international colleagues in fostering the development of emergency medicine around the world.¹ Ambassadors cross-pollinate ideas, sharing triumphs and tribulations whispered across continents!

The findings of a recent article in JACEP Open shed a revealing light on this global landscape.² These researchers interviewed ambassadors from a staggering 69 out of 77 countries. A resounding 91 percent (that’s 63 out of 69 nations, for those keeping score at home) officially recognize emergency medicine as the distinct, high-stakes specialty it is.

Think about that for a moment. We’ve clawed our way from the nascent days of 1962, when Ireland bravely stood alone as the first nation to acknowledge our tribe as independent within the vast House of Medicine. The U.K. and the U.S. followed suit a decade later in 1972, and a steady drumbeat of progress has echoed across the globe, culminating in El Salvador’s recent embrace of our critical field. Today, an astounding five out of every six countries interviewed boast a national society dedicated to emergency medicine, a testament to our growing global solidarity. And mirroring that impressive statistic, approximately 87 percent have established residency training programs within their borders, nurturing the next generation of frontline heroes. Our specialty isn’t just expanding, it’s exploding, poised to equip more and more dedicated individuals to tackle the unpredictable onslaught of acute, unscheduled care that walks, wheels, or sometimes flies through our doors.

Interestingly, the vast majority—a hefty 83 percent—adhere to the Anglo-American emergency medical system, the very model we know (and sometimes love to critique) here in the United States. The remaining nations operate under a Franco-German model, a system in which the physician, the ultimate decision-maker, races directly to the scene of the emergency, a stark contrast to our more tiered approach. On the surface, it might seem like our way of handling the chaotic dance of emergencies is representative of a significant chunk of the planet. Indeed, the authors of this insightful study estimate the countries responding to their survey encompass a staggering 6 billion souls—roughly three-quarters of humanity.

But here’s where the comfortable assumptions start to fray. How many emergency medicine residency-trained physicians does a country actually need? How many residency slots are essential to keep pace with the relentless march of population growth and the ever-present specter of unforeseen crises? These are the billion-dollar questions that remain stubbornly unanswered, the kind that keep data-driven minds like mine buzzing late into the night.

However, even a cursory glance at the data reveals a stark disparity. The median number of emergency medicine residency-trained physicians working in a country stands at a mere one per 100,000 population. Now, hold onto your hats: in the United States, that figure skyrockets to 19 per 100,000! And yet, despite this seemingly higher concentration, we still grapple with staffing challenges in our emergency departments, particularly in the often-forgotten outposts of rural America (a crisis we’ve dissected in previous reports).³ The disparity in residency programs is equally eye opening, with a global median of just 0.4 programs per million population, while the U.S. boasts more than double that number.

Globally, the picture that emerges suggests a significant amount of ground to be covered, a race to build capacity and expertise in the face of universal human vulnerability.

But the questions that truly ignite my passion, the ones that keep me curious after a particularly brutal shift, delve far deeper than simple headcounts of doctors, emergency departments, and residency programs per capita. Which countries truly excel in the care of the very conditions that bring patients crashing through our ED doors—the sinister march of sepsis, the brutal aftermath of trauma, or the sudden devastation of strokes and heart attacks? These are the metrics that truly matter, the ones that reflect the real-world impact of our systems.

We’ve seen countless books dissecting the “best” health care systems in the world, often focusing on macro-level indicators like maternal and infant mortality rates, the sheer number of hospital beds, or the dollars spent per patient.⁴ While these metrics offer a broad overview, they often bypass the gritty reality of the emergency department, that critical juncture where seconds count and expert intervention can mean the difference between life and death. They rarely delve into the nuanced dance of diagnosis and treatment that unfolds on the knife’s edge.

Perhaps you are one of those unsung heroes, a physician who has witnessed firsthand how one country navigates these critical emergencies compared to another, and crucially, compared to our own system here in the United States. Are there hidden lessons embedded in these international experiences, pearls of wisdom we’ve overlooked in our own often-insular approach? If so, I implore you to reach out. Share your stories, your insights, your observations on how we can collectively raise the bar, providing better, more equitable care for all our patients, both within our borders and across the vast expanse of the globe. The conversation has just begun, and the world is waiting to hear what you have to say.

Dr. Dark (@RealCedricDark) is associate professor of emergency medicine at Baylor College of Medicine and the Medical Editor-in-Chief of ACEP Now.

References

1. American College of Emergency Physicians. Ambassador Program | International Emergency Medicine Section. Available at: https://www.acep.org/intl/ambassador-program/.
2. Lee JA, Friedman B, Alberts H, et al. Emergency Medicine Around the World: Updates from the 2023 American College of Emergency Physicians International Ambassador Country Reports. J Am Coll Emerg Physicians Open. 2025;6(3):e100108.
3. February 2025 News from the College. ACEP Now. Published February 11, 2025. Accessed May 23, 2025.
4. Emanuel EJ. Which Country Has the World’s Best Health Care? New York, NY: Hachette Book Group; 2020.