The future of the private practice of emergency medicine.

No specialty better personifies the changes occurring throughout the health care delivery system than emergency medicine. It was just a short 25 years ago that the specialty of emergency medicine, as it is known today, emerged. The full-time staffing of EDs arose out of a need by patients who were presenting in ever-increasing numbers to hospital EDs that were staffed by a nurse or part-time physician. The specialty has continued to be responsive to the changing health care system throughout the past 25 years with innovations such as fast track units, observation units, and chest pain treatment center. To develop a vision for the future of the specialty, it is important to first evaluate the current trends in health care and their influences on the specialty. Three significant areas stand out in the current health care landscape: consolidation of hospital systems, emergence of publicly traded physician practice management companies, and the increasing penetration of managed care.