Future of the emergency physician: subject or citizen?

Seventy-seven percent of emergency physicians (EPs) work as either employees or independent contractors (ICs). In contrast, other hospital-based physicians such as radiologists and anesthesiologists have a much higher percentage of ownership in their medical practices. The development of a high percentage of nonownership arrangements among EPs finds a useful historical comparison in the industrialization of nonhealth care workers over the past 100 years. Unless significant changes occur in emergency medicine (EM) organization and practice structures, EPs will have less self-determination over their practice compared with other specialties. This will inevitably result in less self-determination for their future. Combined with the great strides EM has achieved as a specialty, EPs' brightest future lies in being citizens of a broader, more expansive, all encompassing EM practice.