"What's in a name?," "Moonlighting for fun and profit": reflections on the state of emergency medicine--a goal for 2000 and beyond.

We are perhaps America's greatest source of unquestioned and unquestioning care for the poor. The acutely ill and injured need us desperately, every hour of every day. No one who comes to the door of any ED needing our services fails to receive our best efforts. Emergency physicians freely place themselves at risk from violence and the deadliest of diseases. We should be at the pinnacle of public and professional admiration and respect. Yet parents are told their children are at risk, no one knows our names, and hospital administrators and medical staffs watch us come and go with equanimity. Our work is occasionally thrilling, often repetitive, quite frequently sad, sometimes dangerous, generally described as stressful, and on occasion incredibly rewarding. Both one's individual job satisfaction and the collective survival of our specialty depend on the mix of these factors being satisfying enough to justify going to work every day. Some of that job satisfaction must come from outside ourselves, the perception that what we do is valued by others. How much "burnout" derives from a growing awareness of how negatively we are viewed and how little that perception has changed. To the extent that organized emergency medicine wishes to keep the specialty alive and healthy, it must address this image crisis in emergency medicine. What is the purpose of looking past the year 2000 with lofty goals and aspirations if, through the eyes of our peers and patients, we have come such a little way? As much as I appreciate the opportunity to write this editorial, we in emergency medicine need to do more than preach to ourselves. A little at a time, in every way we can, in academic centers or 40-bed hospitals, as members of the medical staffs and hospital committees, and in our day-to-day interactions with our peers, students, and the public, we must demand our name and demand the recognition we have won for our (apparently) still fledgling specialty. Our organizations must represent us in these areas by forcefully directing their public relations efforts away from ourselves and toward the public and our colleagues.