In a recent MedPage Today essay, emergency physician Mary Meyer draws on 25 years of experience to explain how the chaotic ED environment shapes medical decisions. She notes that nearly 50,000 emergency physicians practice in the U.S., with a median age of 50 and about 70% male. Because patients cannot choose their ED doctor, factors like age and gender may matter more than in primary care.
Evidence cited in the essay suggests female emergency physicians order roughly 3% to 5% more tests and hospital admissions than male colleagues, yet mortality rates are no different. Physician age also appears to play a role: one study found mortality rises slightly with doctor age, with physicians over 60 associated with 0.1% higher patient mortality than those under 40. Meyer points out that, unlike other high-stakes professions, emergency medicine has no mandatory retirement age.
Shift timing and workload also affect decision-making. Studies show doctors are more likely to admit patients in the final hour of a shift and order more lab tests as the shift progresses, a pattern consistent with decision fatigue. However, shorter shifts are not clearly safer: an ICU study found more errors on shorter shifts, likely due to higher patient volume and more frequent handoffs, which remain a dangerous point in care. Meyer also notes that weekend staffing reductions may contribute to a "weekend effect" for some conditions, while the "July effect" has been largely debunked. Ultimately, she emphasizes that individual physician variability and ED overcrowding likely have a greater impact on outcomes than when a patient arrives.