Defining the Future of Academic Emergency Medicine

From Department Chair Andra Blomkalns, MD, MBA

Academic emergency medicine emerged roughly 50 years ago with formal training programs and aspirations for an ambitious research agenda. In our early years, emergency departments commanded such desirable locations as underground floors or “found” spaces that no one else claimed. We grew, and we adapted in many significant ways. In the following decades, we fought to gain representation within schools of medicine as departments, not just divisions.

We staked a claim with board certifications, expertise in the emergent airway, sub-specialty pediatric EM training, point-of-care ultrasound, critical care, social emergency medicine, emergency medical services, global emergency medicine, and more. On the horizon, we see our pioneering specialty exploring informatics, pain medicine, climate change in health, and palliative care. 

Now, in this period of our semi-centennial, we can recognize and be proud of how far we have come. At the same time, our specialty remains in a bit of a crisis clinically and academically. One road points toward a struggling reactive approach - a mad scramble in survival mode to continue advocating for our patients trapped in emergency department hallways and for those without access while we also slowly try to climb the academic ladder with decreasing federal funding. At the same time, we see the student pipeline to our incredible discipline degrading. We are sometimes a “backup” match choice, or one chosen because shorter training means students can begin paying off student loans sooner.

Can we forge a better road?

Over the last few years, emergency rooms (ERs) have given way to emergency departments (EDs). In the last decade, even our most stalwart academic institutions finally recognized our specialty as unique and necessary. At Stanford, what was once a 25-bed conglomeration of random spaces is now our 43,000-square-foot adult ED with a wholly separate and specialized pediatric ED. Our faculty of 18 has grown to 86 (and counting), some of whom serve in critical leadership roles in the healthcare system. Like many departments of emergency medicine, we play an essential role and serve as the gateway for care through our trauma centers, stroke centers, geriatric ED, pediatric ED, and many other designations that symbolize the complexity of healthcare and our specialty. 

While our physical spaces, organization charts, and professional designations show progress, we face new challenges. The corporatization of medicine threatens our autonomy and our broader vision. Many of us have the same conversations year after year regarding crowding, boarding, length of stay, and patients leaving without being seen. Yet board meetings rarely have space to explore ways to create new knowledge, save lives, and educate capable, innovative emergency physicians.

As physician-scientists become even more endangered in our specialty, medical students sometimes shy away from emergency medicine pathways because of academic reputational challenges. For those of us already in the field, academic medicine has come under immense stress with insecure federal funding. We know, however, from the last 50 years, that nothing worthwhile comes easily. 

Imagine emergency medicine commanding a proactive and vital leadership role in redefining the continuum of unscheduled or episodic patient care, from birth to death, from all walks of life, in locations regional and remote, across media and technology platforms. Imagine using our extraordinary aptitudes of innovation and dedication to transform healthcare and create new knowledge. If any specialty can do this, I would pick the one with the tenacity and talent to see any patient, anywhere, for anything, all the time, and across all organ systems. 

After years of witnessing patients in crisis on their worst days, emergency medicine physicians are developing tools to prevent a healthcare crisis. Who better to design medical systems than those of us who have a front-row seat to every possible combination of disease, lifestyle, and social driver of health?

We save lives, often daily. This fact alone should elevate our specialty and inspire medical students to join our ranks. We are creating the technology, processes, and channels to diagnose and treat at an individualized level of specificity and speed never seen before. Let us create a reality where emergency medicine is among the most competitive academic specialties for the finest students seeking to change the future. We are moving acute care beyond hospital walls, beyond community clinics, and emergency medical services. We are moving it into kitchens and living rooms through remote care, taking the “anywhere” in our mantra to an entirely new level.

I am optimistic that emergency medicine can continue to emerge as a leader within the broader house of clinical and academic medicine. No other medical discipline is as adept at mastering the dialectical exchange of patients within the complex healthcare system and also seeing science across many fields. Not surprisingly, many emergency medicine colleagues have ascended to leadership positions throughout healthcare, government, and industry. What a great foundation!

What is next? 

During my five years as Chair at Stanford, I have been fortunate to work in a school of medicine and university heavily invested in research and the academic mission. Nevertheless, growing a young emergency medicine department toward academic productivity and innovation has been challenging. The culture shift, the necessary infrastructure and support staff, and the need to create a deep bench of academic physicians who can inspire one another are not overnight projects. However, we are deeply committed to achieving the academic excellence that our field deserves.

The next step lies with creating and supporting pathways and pipelines in undergraduate and medical school education to ensure the sustainability of academicians in our profession. We also need to expand our training to instill a dedication to advancing the science and practice of emergency care. Emergency medicine should never be viewed as just a job or a way to train for a minimum number of years and then enjoy a part-time physician lifestyle. Emergency medicine is a calling. 

Together, we can navigate the challenges ahead, champion the values and integrity of our discipline, and ensure a vibrant and diverse future for academic emergency medicine.

Onward and upward,

Andra L. Blomkalns, MD, MBA 

Redlich Family Professor and Chair 

Department of Emergency Medicine

Stanford University School of Medicine