The Case Against Calling It ‘Emergency Medicine’

Names matter. They shape expectations, guide behavior, and in medicine, determine how systems are built, how resources are allocated, and how clinicians practice. The name “emergency medicine” is one of the most consequential misnomers in American healthcare. It implies a discipline defined by urgency and life-threatening conditions. The reality, borne out by decades of data, is considerably more complicated, and the gap between the name and the reality has quietly become a crisis of its own.

This is not an indictment of emergency physicians. This is a challenge to the institutional mythology that has calcified around a specialty name, one that legitimizes overutilization and may be doing patients and the system a quiet, compounding harm.

Are Most Emergency Department Visits Actually Emergencies?

The data on how “emergent” most emergency department (ED) visits are is consistent, voluminous, and largely ignored. The U.S. logs approximately 155 million ED visits annually — at a cost that reached $76.3 billion in 2020 alone. If these were primarily emergencies, such spending might be justified. But the acuity data tell a different story.

A 2025 analysis from Texas A&M’s School of Public Health found that nearly 40% of ED visits involved conditions that physicians viewed as non-urgent or issues better suited for primary care. Other research suggests the U.S. sustains an estimated 18 million avoidable ED visits each year, adding $32 billion in costs to our healthcare system annually.

The ED has become a primary care safety net, a walk-in clinic for the underinsured, a behavioral health intake system, and, occasionally, a place where someone arrives dying and a clinician saves their life. To name the whole enterprise after that last function is to let the exceptional eclipse the ordinary.

Does the Name Itself Make Things Worse?

The name “emergency department” gets us into trouble because the word “emergency” does something powerful. It confers urgency on every visit. It implies that every diagnostic question is a crisis requiring full investigation before discharge. It shifts the default position from restraint to action — clinically appropriate for a small fraction of patients, but a systematic mismatch for the majority who actually need triage, reassurance, a referral, and perhaps a conversation with a social worker.

When a patient goes to a place called an “emergency department,” they arrive expecting emergency-level evaluation. When that evaluation includes a CT scan, a battery of labs, and a 4-hour stay for a sore throat, they are not being managed to their actual need. They are being processed to satisfy a label.

Nowhere is the mismatch between name and practice more consequential than in diagnostic imaging. Emergency physicians have among the highest CT scan rates in medicine, and a substantial body of evidence suggests much of it is clinically unnecessary.

A systematic review in the Annals of Emergency Medicine found that unnecessary ED imaging costs the healthcare system close to a billion dollars annually. A 5-year study at one ED in an urban academic medical center found a 67% increase in CT angiography for headache and dizziness, while the rate of findings of acute pathology fell by 38% over the same period. More scans, but no greater pathology.

The driver is not clinical uncertainty alone; it is fear. A survey of 435 emergency physicians found that 97% acknowledged ordering at least some medically unnecessary imaging, with fear of missing a low-probability diagnosis and fear of litigation as the primary drivers. That fear is not irrational: more than 75% of emergency physicians will be named in a malpractice claim at some point in their career.

But here’s the uncomfortable data point: a landmark study in the New England Journal of Medicine tested malpractice tort reform in three states and found it produced no reduction in imaging rates, hospitalization rates, or per-visit costs. The ordering culture runs deeper than fear of litigation. It is embedded in professional identity, and that identity is shaped, in part, by the name and the responsibility it construes.

All this unnecessary testing is also counter-intuitive to emergency medicine, a field where clinical decisions should be based on available history and exam findings, not working up chronic ailments, benign diseases, and morphing into a center for incidental findings.

Time for a Rebrand

So, what should we call it?

What happens inside EDs is better described as acute unscheduled care: care that is unplanned, time-sensitive from the patient’s perspective, and distributed across a wide spectrum, from the trivially minor to the immediately life-threatening.

“Department of Medical Access” would be a more accurate name. The reconceptualization invites a redesign: acuity-stratified care pathways, embedded primary care and behavioral health clinicians, and a culture of diagnostic stewardship rather than diagnostic maximalism. This may controversially eliminate the need for emergency medicine specialists in favor of triage specialists who triage patients to the appropriate care. It creates the political and cultural space for imaging and laboratory stewardship programs that currently struggle against the gravitational pull of a specialty’s self-conception.

It also resets patient expectations on both sides of the gurney, which may be the highest-leverage intervention available.

The ED is considered one of the most important institutions in American medicine. It is also one of the most misnamed. Renaming is not a retreat. It is a reckoning and the beginning of a more honest conversation about what acute unscheduled care actually requires, who is best positioned to provide it, and how the genuinely emergent can receive the concentrated brilliance it deserves without being diluted across a hundred ankle sprains and a thousand sore throats.

Call it what it is. Then build what it needs.

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