For nearly half a century, James R. Roberts, MD, helped steer the helm of emergency medicine—and EMN. His scholarism, ingenuity, and convictions brought our specialty from its rocky infancy to our stormy present. When faced with obstacles and challenges, he let a dogged dedication to patient care guide the way, a foundation that went on to define modern-day emergency medicine.
In Jim's early years, fledgling EM programs began to build the emergency care system as we now know it. Titans—Jim among them—collated and created a body of knowledge that would grow to standardize and enhance the medicine practiced in emergency departments across the country. Over the next several decades, the specialty grew alongside and as a fundamental component of the evolving health care infrastructure as well as its intersection with the public support system.
Out of necessity, the burgeoning EM skill set ballooned to serve a patient base in need, and matured to synthesize the many unique operational and patient-centered considerations of emergency care. In large part due to Dr. Roberts and his contemporaries, emergency departments are now responsible for nearly half of hospital-associated medical care delivered in the United States. (Int J Health Serv. 2018;48:267.)
But with emergency medicine's adolescence have come some growing pains.
After years of a pandemic with battles fought at the bedside and beyond, emergency physicians have been stretched thin. The financial landscape wrought by declining reimbursement rates and increasing payor complexity has resulted in challenging practice environments across the United States. Domestic and international political upheaval has had a real impact on what crosses the ED threshold and how it's handled. Emerging infectious threats and rising public health problems continue to present themselves to our doors, all while emergency physicians parry the challenges of increasingly complex chronic illnesses and a broadening scope and responsibility of practice.
The truth is we find ourselves at a precipice in emergency medicine.
Critical issues facing the specialty today will define the coming generation. In the coming years, we'll litigate the controversial landscape of postgraduate medical education, the role of nonphysician providers in the emergency department, and the influence of private equity. We'll see post-COVID public and private sector regulatory change, and we'll lead an incorporation of technology into clinical practice that will force constant practice evolution.
Fortunately, a diverse and historic workforce faces the task. EPs hold roles across academia, operations, government, and more, bringing insight and a perspective perennially missing from critical conversations. At the bedside, EPs continue to master a growing sphere of knowledge and responsibility, synthesizing a vibrant evidence base with clinical practice.
As emergency medicine confronts the defining issues of our day, I am humbled to have a chance to continue Dr. Roberts' tradition and service of knowledge and narrative sharing. A few years (and a few more gray hairs) into a career that I can only hope holds a candle to Jim's shining example, I've learned enough to know that the breadth and depth of our specialty are ever-expanding, ever-evolving, and impossibly varied and vast—and I know the value of the information sharing and conversational connectivity that Emergency Medicine News has fostered.
In his letter to the newly graduated emergency physician (EMN. 2013;35:27; https://bit.ly/3Nwl5jb), Dr. Roberts looked back on 42 years in the ED and remarked upon “the bizarre and macabre milieu” that defines our days and the isolationism it can bring. (After all, who truly can understand the daily experience of the EP other than someone who's worn those blood-splattered sneakers before?) EMN allows a community of more than 40,000 emergency physicians to share experiences, learn from one another, and remain reliably informed on issues that impact us every day.
Jim was a giant. In the times I was lucky enough to sit by his side, he would impart lesson after lesson, all borne from a career that defined the shape and scope of emergency medicine. He always relished the chance to spread knowledge and enhance excellence in our field, and for decades he helped cultivate conversations in departments across the country alongside the many talented and resourceful writers of EMN.
But even the longest shifts come to an end, and Dr. Roberts has signed out the board.
Thanks, Jim. We've got it from here.
A New Era for EMN
Dr. Pescatore, in his first article as board chair, writes about his predecessor's shining example and his vision for emergency medicine. Page 3
Dr. Pescatoreis clinical faculty and an attending emergency physician at Einstein Healthcare Network in Philadelphia. Follow him on Twitter@Rick_Pescatore.