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.