Summary of the “Emergency Medicine Present, Past and Future” Webinar

Fred Dennis, MD, FACEP

This ACEP webinar, held February 5 and hosted by immediate past president Alison Haddock, convened emergency physicians from across the career spectrum to have an honest conversation about where emergency medicine has been, where it stands today, and where it's headed. Panelists included early career physicians Laurel Barr (Chair, Early Career Physician Section) and Amanda Irish (Councilor, Early Career Physician Section), alongside veterans Fred Dennis (PGY-53, Vice-Chair, Exploring Retirement Section) and Stephen Anderson (PGY-44, Chair, Exploring Retirement Section and former ACEP Board chair).

The Early Career Landscape

Early career physicians are entering a field burdened by financial and structural pressures unlike anything prior generations faced. The average graduating resident now carries approximately $265,000 in student loan debt - a figure that often grows during residency, because income-based repayment payments don't keep pace with interest. Laurel described graduating with $160,000 in debt that ballooned to $250,000 by the time she finished residency. She and her husband paid $7,000 per month toward loans for their first five years of practice, leaving little room to save for a home or invest in a business. Amanda added that uncertainty around the Public Service Loan Forgiveness (PSLF) - a program that influenced many physicians' career decisions - has added another layer of financial anxiety, with some seeing their monthly payments quadruple with no clear resolution in sight.

Beyond finances, the job market itself has transformed. The small democratic physician groups that prior generations expected to join have largely been replaced by large, consolidated employers. Residents are warned that high signing bonuses often signal hidden tradeoffs in autonomy or working conditions. Even when physicians find a group they like, contracts get acquired and conditions change. The result is a generation of doctors who feel like employees rather than practitioners, with little control over their work environment and limited pathways for career advancement, as senior physicians continue occupying leadership roles longer than in previous generations.

The COVID Inflection Point

Every panelist identified the COVID-19 pandemic as a breaking point that exposed and accelerated existing fault lines in emergency medicine. Amanda, who was an intern when the pandemic hit, described going from seeing 28 patients a shift to two - then suddenly intubating everyone who walked in, with patients stacked in hallways and attendings afraid to enter rooms. Laurel described bringing COVID home to her family while watching her institution prioritize appearances over staff safety, receiving one reused mask with instructions to make it look like a fresh one. What broke her spirit wasn't just the danger - it was the realization that when push came to shove, the system would not protect her.

Both early career physicians described a lasting shift in their relationship to the work. Laurel went from saying "I love my job" on her commute to saying "I hate my job" - at first occasionally, then three times a shift. Amanda described the added trauma of going home and seeing people on social media deny that what she had just lived through was real, eroding her trust in the public she was sacrificing to serve. Stephen described losing close ACEP colleagues to COVID and watching the pandemic lay bare every smoldering problem in the system - boarding, mental health crises, critical care backups - all igniting at once.

Lessons from Experience

Veteran physicians acknowledged candidly that emergency medicine is measurably harder today than when they entered the field, and that they likely could not sustain the pace current physicians are expected to maintain. Fred emphasized that networking - through ACEP and professional relationships - has been the single greatest career accelerator, noting that the best jobs are rarely advertised. He also credited renewed patient connection with re-energizing his career at a point of near-burnout, finding purpose in listening to what patients were truly afraid of rather than just treating their presenting complaint.

Stephen shared his overarching philosophy: family first, whatever makes you whole second, job third. Both veterans stressed the importance of diversifying professional identity - through advocacy, administrative roles, dual degrees, or outside passions - as essential to long-term sustainability. Fred noted that physicians who pursue MBAs or administrative roles can serve as translators between clinical and business interests, multiplying their positive impact across entire physician groups and patient populations.

Corporatization and the Road Ahead

Panelists expressed concern about the ongoing corporatization of emergency medicine, which has shifted power away from physicians and toward administrators several layers removed from clinical realities. Laurel captured the disconnect vividly: during the pandemic, administrative staff received paid time off while pit doctors continued getting coughed on. Metrics driven by corporate priorities - door-to-disposition times, RVU generation - fail to capture the actual quality and effort of clinical care, leaving physicians feeling unseen and undervalued.

There were notes of cautious optimism. Private equity involvement in emergency medicine, which rose sharply from 2010 to 2020, has been declining and flattening since. ACEP has responded with resources including a democratic group bootcamp, an emergency physician empowerment course, and programming around unionization for those interested in that path.

Closing Call to Action

Laurel closed with a marathon analogy that resonated across the room. Emergency physicians, she said, are running on a treadmill controlled by someone else - the speed constantly increasing, while standardized metrics fail to reflect the effort being expended. Her call to action was clear: slow the treadmill together, have honest conversations about the pressures driving burnout, and support one another before exhaustion forces people to stop entirely. Because once someone steps off the treadmill, they may not get back on — and emergency medicine, now more than ever, cannot afford to lose the people who chose it as a calling.