Doc-to-Doc Series: Is Emergency Medicine in the US Stable? Insights from the RAND Study

By Jamie Shoemaker, MD, FACEP

Emergency medicine has long been a cornerstone of the American healthcare system—offering immediate, life-saving care to anyone who walks through the doors. But behind the scenes, the stability of this vital specialty has come under increasing scrutiny. A recent comprehensive study by the RAND Corporation sheds light on the evolving landscape of emergency medicine in the United States, raising critical questions about workforce trends, reimbursement pressures and the sustainability of emergency care delivery.

Background: Why The RAND Study Matters

Commissioned in the wake of mounting concerns about emergency department (ED) overcrowding, workforce oversupply and economic volatility, the RAND study sought to assess the overall stability of emergency medicine as a specialty. It was supported by stakeholders, including professional associations like the American College of Emergency Physicians (ACEP) and the Emergency Department Practice Management Association (EDPMA), and aimed to inform policy and strategic planning.

Emergency departments care for more than 150 million patients annually and often act as the safety net for the entire healthcare system. Yet, the specialty is now facing a perfect storm: declining reimbursement, increasing operational costs, shifts in care delivery models and predictions of a surplus of emergency physicians in the coming years.

Key Findings of the RAND Study

The RAND study offers a multidimensional view of the current and future challenges facing emergency medicine. Here are some of the most important findings:

• Workforce Imbalance on the Horizon
  One of the study’s most discussed projections is the anticipated oversupply of emergency physicians. According to RAND, by 2030 there could be a surplus of board-certified emergency physicians. This is driven by a combination of increasing residency slots, flat or declining ED volumes per capita and broader use of advanced practice providers (APPs) such as nurse practitioners and physician assistants.

• Economic Pressures Are Mounting
  The financial viability of emergency medicine practice groups is under strain. The study found that declining reimbursement rates—particularly from commercial insurers—and a rise in uninsured or underinsured patients have eroded revenue stability. In many cases, EDs are operating at a loss or surviving due to hospital subsidies.  Strikingly, the study found that over 20% of care delivered in the Emergency department goes completely uncompensated.

• EDs Are Becoming the Front Door of the Health System
  Despite financial challenges, the RAND study affirmed that emergency departments remain the entry point for nearly two-thirds of hospital admissions. However, the role of the ED is shifting: there is growing emphasis on patient throughput, efficiency metrics and integrating value-based care. This can create tension with the traditional mission of emergency medicine to provide unscheduled, high-acuity care 24/7/365.

• Burnout and Workforce Morale Are Critical Concerns
  The study highlighted significant stress among emergency physicians, exacerbated by the COVID-19 pandemic. High rates of burnout, moral injury and administrative burden are threatening the long-term sustainability of the workforce. These human factors are just as important as economic models when considering the future of the specialty.

• Consolidation and Corporate Practice Trends Are Reshaping the Landscape
  Another important trend identified is the increasing consolidation of emergency medicine groups, many of which are now backed by private equity or large corporate entities. While this can bring efficiencies and resources, it has also raised concerns about autonomy, transparency and alignment of priorities between clinicians and business interests.

What Does This Mean for the Future of Emergency Medicine?

The RAND study doesn’t just identify problems—it provides a foundation for dialogue and solutions. Here are a few takeaways for policymakers, hospital administrators and physicians:

• Workforce Planning Is Essential: Training pipelines must be adjusted in coordination with projected demand, and creative solutions are needed to address geographic maldistribution—especially in rural and underserved areas.
• Payment Reform Is Critical: Emergency medicine must advocate for fair reimbursement models that recognize the unique role and value of ED care, including uncompensated care and 24/7 readiness.
• Physician Well-Being Cannot Be Ignored: Addressing burnout and fostering a culture of wellness is a moral and practical imperative for retaining a resilient, committed workforce.
• Innovation Is Inevitable: Emergency medicine leaders must engage with the evolution of care models, including telehealth, alternative destinations and team-based care—ensuring that quality and access remain central.

A Call for Leadership and Advocacy

The RAND study is a sobering yet necessary mirror for the emergency medicine community. It underscores that while emergency departments remain indispensable, the system that supports them is not inherently stable – the ED safety net is in jeopardy of collapse. Deliberate action is needed—through advocacy, policy change, innovation and leadership—to ensure that emergency medicine remains a sustainable, fulfilling and patient-centered specialty.

This moment calls for unity, strategic foresight and a recommitment to the mission that defines emergency medicine: care for all, at any time, no matter what walks through the door.  Ventra Health stands ready to advocate for our clients and their patients to sustain the financial vibrancy of the specialty and access to acute, unscheduled care for all.

Ventra Health: A Partner in Advocacy and Stability

Amid the challenges outlined in the RAND study, Ventra is stepping forward not just as revenue cycle management experts, but as a committed partner in safeguarding the future of emergency medicine. Ventra understands that preserving the ED safety net requires more than operational efficiency—it demands bold, coordinated advocacy at every level of the healthcare system. Through its physician-led strategic advisory team and deep engagement with legislative and policy efforts, Ventra is ready to help drive the systemic changes needed to ensure that emergency departments remain accessible, financially viable and able to deliver high-quality care. By championing fair reimbursement, transparency, and sustainable practice models, Ventra stands alongside clinicians and organizations working to protect the front line of American healthcare.

Are you an emergency physician, hospital leader, or policymaker concerned about the future of emergency medicine? Let’s keep the conversation going—stability is possible, but only if we work toward it together.