Emergency Medicine History and Expansion Into the Future

A Narrative Review

Martin R. Huecker, MD; Jacob Shreffler, PhD; Melissa Platt, MD; Dan O'Brien, MD; Ryan Stanton, MD; Terrence Mulligan, DO, MPH; Jeremy Thomas, MD


Western J Emerg Med. 2022;23(3):418-423. 

In This Article

Abstract and Introduction


Emergency medicine (EM) has advanced profoundly since its specialty recognition in 1979. As diagnosis and treatment changes, payment restructures and best practices evolve.[1] We drive these changes, impacting hospital throughput and revenue to ensure quality emergency care. Our impact on the practice of medicine depends on a body of knowledge, the "biology" of emergency medicine.[2] From 2000 to 2010 the number of emergency physicians (EP) increased more than in any other specialty.[3] With estimates of over 48,000 EPs practicing in the United States currently and continued opening of new residency programs, multiple sources expect a 20–30% surplus of board-certified emergency physicians by 2030.[4,5] Presciently, a 1997 paper by Holliman et al predicted that the supply of emergency doctors would equal demand in about 2020.[6]

In 2020, multiple EM organizations created a taskforce to study the projected EM workforce oversupply.[4] The considerations address issues related to who practices emergency medicine (advanced practice providers, non-board-certified physicians) and who manages emergency clinicians (contract management groups, academic and hospital systems). Only two offer non-zero sum approaches: broaden the umbrella to expand emergency physician scope of practice and expand the reach of emergency medicine to ensure that no community is left behind.[4] This review aims to provide context for the workforce dilemma by describing the evolution of the scope of EM and possible future directions.