This futuristic thought experiment highlights two unique business models: micro-hospitals and hyper-acute specialty hospitals. In the emergency medicine of tomorrow, the latter, generally one every 100 miles, have been formed because in addition to the economies of scale within larger centers, a growing body of evidence had shown that high-volume centers, whether they be performing coronary artery bypass grafting or delivering ICU care, perform far better than lower-volume centers in terms of patient outcomes. A mix of large academic centers and corporations raced to consolidate the hospital market in the 2030s and created these 5,000-bed megaplexes of health care, just as Walmart and Amazon had done in the retail space during the early 2000s. Americans still needed access to acute care within a reasonable distance from their homes, and so the micro-hospital was born. Part freestanding emergency department with resuscitation bays and imaging in-house, part observation unit, and part heliport to efficiently ferry critical patients in specially made ICU drones to the specialty hyper-acute hospitals, these centers have proliferated, with emergency physicians at the helm.

While our specialty will evolve dramatically over the next 50 years, we believe the need for emergency physicians will only continue to grow. Tomorrow’s emergency physicians will build upon the giants who founded emergency medicine by being diagnosticians who can make sense of all the noise generated from enhanced triaging and remote patient monitoring, availabalists who see patients 24-7-365, resuscitationists who bring people back from death’s doorstep, and dispositionists who quarterback care in an increasingly hyper-specialized system. Most important, in an ever-virtualized world, they’ll serve as the humanists who actually take a few minutes to sit down and talk to their patients, bringing an element of sanity to the chaos of 2068.

NOTE: The views represented in this futuristic thought experiment solely belong to the authors and do not represent those of EMRA.

Dr. Maniya is the President of EMRA and a resident at The Mount Sinai Hospital in New York.

Dr. Jarou is the immediate Past President of EMRA and an administration fellow at the University of Chicago.

Dr. Hughes is the President-Elect of EMRA and a resident at the University of Cincinnati.