Much adieu about ’22?

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From pandemic strife to burnout, the EPM board predicts what awaits this year.

COVID-19 continued to roar through 2021 with vaccinations providing yet another divisive arena. Social media remained a battleground on COVID treatments and deterrents as ERs saw fluxes with the Delta and Omnicron variants. Staffing was reduced then increased to deal with the virus while physician burnout became more than a talking point.


With 2022 poised to present new problems as the world continues to get a hold on COVID, the Emergency Physicians Monthly board brought back their predictive technology and crystal balls to predict what’s in store for this New Year.

Vaccinations will be key

Despite increasing scientific evidence that shows the safety and effectiveness of COVID vaccines, the US will continue to get to “pandemic ending” vaccinations levels. Despite multiple waves of the current and future COVID variants, ED volumes will rise to pre-COVID levels.


EM will continue to build roads into “non-emergency department” treatment spaces, whether online or in-person. Online CME will continue to innovate for those who choose to obtain CME credit from the comfort of their homes.

-Andy Little, DO


Variants will continue to proliferate. I’ll bet recommendations for repeat interval booster shots will be recommended (as just reported from Israel), and heartily used in the vaccinated population.


ED Volumes and Workforce projections

Anticipate return to pre-COVID volumes. Use of APPs will continue to grow. Vigorous efforts are needed by our key organizations to make sure APPs do not threaten our roles and practice. Let’s band together and improve our message as trained emergency physicians: Who are we? Why are we important? What is our role?

We need better APP training and strong requirements for integration into the fast-moving world of changing medical practice.  We’re all in this together, so let’s teach, administer and practice that way!

The ZOOMers

Virtual conferencing for local, regional and international meetings will continue as a standard. And that’s not just because of COVID, but because it is cost and time effective for so many.


It’s here to stay. Good for patients, great for EPs.  Let’s make sure that emergency medicine stays a leader in telemed.  We need strategies to help our EDs and healthcare institutions make telemed a part of the regular clinical practice of EM.  Let’s get our EM residents involved in the practice of telemed so they can lead us forward.

-Judith E. Tintinalli, MD, MS

No more predictions

At this point, I think it’s best to refrain from predicting 2022 after this past year turned out to be much different and more challenging than expected. Both medicine and humanity seemed to have met their match with a virus that despite having no intelligence, has proven much smarter than us.

My hope is that is 2022 we can all take a deep breath and find some harmony to work together through what remains of this pandemic and stop the senseless bitter divide it has caused. Only then can we start to move the needle forward in other realms of medicine. Alas, that would be akin to a New Year’s miracle, as even we as EM providers can’t seem to find common place.

-Andrew Kalnow, DO

Beware the burnout

Emergency Departments are unlikely to have relief from the overwhelming burden for another year whether or not the pandemic comes under control (I will also refrain from making any predictions on what seems unpredictable).

Burnout and stress will continue to increase leading to more resignation and calls for more action on how to change the healthcare system.

To that end, there will be a focus on creative technological solutions— more innovative strategies and investments in home care including RPM, home observation and virtual triaging. Telehealth will have a broader definition to include clinical, patient and health system experience not just use of technology.  Emergency medicine is already part of these changes with ACEP and SAEM having discussions on telehealth, the expanded workforce and how to prepare for the broader scope of practice for emergency medicine.

Unlike previous years, the divide between healthcare systems, academic centers and private industry will start to close as there is more cross collaboration due to the needs of quick change and the ever expanding definition of the front lines. There will be barriers as regulatory parameters will be limited and investing will decrease but that will allow for a more thoughtful approach that changes EM drastically in the next five years.

-Aditi Joshi, MD, MSC

COVID to continue taking a toll

  1. COVID-19 will continue to increase the emotional, physical and mental strain on the workforce.  Healthcare workers will start to retire and look into other careers.  Human capital will become a constraint.
  2. Healthcare will continue to increase its use of technology. Telemedicine will become a fixture in healthcare. This will become a staple as the new front door for healthcare.
  3. More focus on health equity and social determinants of health.  There could be a future where remote monitoring systems at home improve diagnosis and delivery of preventive and acute care to populations at need.

-Salim R. Rezaie, MD

More boosters on the horizon

Over/under on number of vaccinations necessary to be considered “fully vaccinated” by end of 2022: FIVE. Those with only two boosters will be accused of harboring disease and causing variants to develop. When media finally catches on that dogs and cats also harbor coronaviruses, there will be a public outcry to vaccinate house pets.

There will be at least three new COVID “variants” discovered.

Litigation involving COVID will increase. Hospitals and providers will be sued for EMTALA violations when they fail to accept transfer of severely ill patients or fail to provide appropriate medical treatment for COVID patients … and possibly even for vaccine-related injuries.

To increase profits, venture capital firms that own physician staffing groups will continue to decrease emergency physician pay and decrease emergency department physician coverage – sometimes to dangerous levels. Due to an alleged shortage of physicians (and other factors), more states will license midlevel providers for independent practice and venture capital firms will use those providers to supplant emergency physicians.

Attempts to combat “surprise billing” legislation will fall flat. We let insurance companies paint emergency physicians as “greedy” in the media and did little to combat the image.

We lost that battle. Now watch as insurers start imposing retrospective denials of coverage with impunity which will result in emergency physicians getting paid nothing for their services because it is now against the law to balance bill. I not holding out hope that we’ll fight that battle any better.

Completely agree with Judy on telemedicine. Don’t know that it WILL be added to emergency medicine curricula next year, but it NEEDS to be added to emergency medicine curricula.

Random predictions on economy: Inflation will reach double-digits. Those numbers may be artificially depressed. Lock in rates on home loans while you still can. Precious metals up by 20%. I think crypto has some bad juju, but sentiment about it is too volatile to bet against it.

-William Sullivan, DO, JD

More Division

Unfortunately, the virus, as well as social and political forces will continue to the polarization of humanity, and people will gravitate toward those who think as they do, neglecting to listen to those who think, look or believe differently. We will continue to witness a deterioration of tolerance and patience.

The forces that build walls will also create many opportunities for us to show grace, kindness and tolerance.  Every person’s true colors will show even brighter against the backdrop of a world in crisis.

-Evie Marcolini, MD, FACEP, FCCM

Deja Vu

  • COVID continues to be our major headline throughout 2022.  It will impact our acuity, staffing and wearing masks at work.
  • Volume will continue to return and likely exceed our pre-pandemic levels, but with a higher admission rate
  • The job market will be strong.  This is likely tied to a combination of expansion of responsibilities outside of the ED (telemedicine and expanding our footprint around the hospital in places like observation services and procedures) and unfortunately, we’ll also likely see an increase of early retirements among more experienced docs who are just tired of working in the COVID environment.

-Mike Silverman, MD


Andy Little, DO specializes in Emergency Medicine at AdventHealth East in Orlando Florida.

EDITOR-IN-CHIEF Dr. Rezaie is founder and editor of R.E.B.E.L EM.

Andrew Kalnow is an emergency medicine physician and associate program director at OhioHealth Doctors Hospital in Columbus, OH.  He is also a co-host for EM Over Easy, a podcast focusing on #MoreThanMedicine.

Dr. Joshi is the Medical Director of JeffConnect On Demand.

Dr. Tintinalli is currently a professor and Chair Emeritus of Emergency Medicine at the University of North Carolina. In addition to teaching in the emergency medicine department, she is an adjunct professor at the UNC Gillings School of Global Public, and a frequent lecturer in the School of Journalism and Mass Communication. Dr. Tintinalli is double boarded in emergency medicine and internal medicine. She was the founder and first president of the Council of Emergency Medicine Residency Directors. She is a former president of ABEM as well as the Association of Academic Chairs in Emergency Medicine. She is a past winner of ACEP's James Mills award as well as ACEP's National Education Award. And of course, she is the Editor-in-Chief of 7 editions of her eponymous textbook, which is arguably the best-known EM text in the world.

SENIOR EDITOR DR. SULLIVAN, an emergency physician and clinical assistant professor at Midwestern University in Illinois, is EPM’s resident legal expert. As a health law attorney, Dr. Sullivan represents medical providers and has published many articles on legal issues in medicine. He is a past president of the Illinois College of Emergency Physicians and a past chair and current member of the American College of Emergency Physicians’ Medical Legal Committee. He can be reached at his legal web site

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  1. My 1.5 cents… Medicine, science and their representatives (us) will continue being targets of misguided attacks. Gone are the days people cheered and thanked healthcare workers in early days of the pandemic. That gratitude and support have been replaced by distrust, hostility and in many cases rage & violence. The knife of disinformation is cutting deep in the fibers of society. Unfortunately, I don’t see things getting better any time soon, not even if the pandemic ended tomorrow. The damage has been done, the cat is out of bag, and it will take a new generation of leaders to bring back the good in society, and for the good of society it self.

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