Emergency departments (EDs) absorb most acute unscheduled care (AUC) in the United States. Routing all of this care through one high-intensity system serves no one well: crowding delays care for time-critical patients; visits that turn on evaluation and coordination, and routine and chronic care defined by longitudinal needs, are delivered episodically and at high cost in a setting built for resuscitation and stabilization; and clinicians trained for emergencies spend much of their time on work the category does not fit. I argue that this is not only a capacity or workflow problem but a conceptual one. In practice, "emergency care" is defined by arrival: crossing the ED threshold, not clinical risk, triggers the legal duties, insurance protections, and workflows attached to the label. This was no one's mistake; routing everything through the one door always open was a rational adaptation to a fragmented system. But the adaptation no longer merely persists; it forecloses alternatives. Using conceptual engineering, I trace how history, regulation, payment, public scripts, and lexical entrenchment stabilize this system, and situate it against the social drivers that make ED-as-default ethically necessary and operationally costly. I then propose an ameliorated concept of emergency care: a risk- and time-sensitive, expert-mediated, priority-conferring subset of AUC, determined by structured triage wherever it occurs. Because a definition changes nothing by itself, I outline a phased implementation pathway, show how it applies across delivery settings, including rural and safety-net systems where the ED should remain the local acute care hub, and describe the workforce implications for emergency medicine. The choice posed to the specialty is whether to keep treating crowding, mismatched care, and clinician dissonance as operational problems to optimize within the ED, or to recognize them as properties of what we mean by emergency care and of the system that enacts it.

Gender disparities in academic promotion persist despite decades of research documenting their scope. Women remain underrepresented at senior academic ranks in Emergency Medicine, with only 19% of full professors identifying as women. Existing literature has largely cataloged the barriers driving this gap-disproportionate clinical workloads, non-promotable labor burden, sponsorship deficits, and caregiving responsibilities-but has devoted comparatively little attention to the strategies women use to successfully navigate these barriers. This commentary proposes a shift in research focus: From documenting the problem to systematically studying the hidden determinants of advancement among women who have achieved promotion. We introduce PROMOTED-EM, a qualitative research framework organized across 14 domains of academic career life, designed to elicit the tactical, behavioral, and relational strategies that enabled promotion. By centering the experiences of successfully promoted women in Emergency Medicine while explicitly attending to intersectionality and the limitations of survivor bias, this agenda aims to generate actionable, evidence-based guidance for women faculty, department leaders, and institutions committed to closing the promotion gap.

Patients frequently present to the emergency department (ED) with pain, swelling, or erythema in the early period following total joint arthroplasty (TJA). Differentiating normal postoperative inflammation from superficial surgical site infection (S-SSI) or early periprosthetic joint infection (PJI) can be difficult due to overlapping clinical and laboratory features, particularly within the first 30 days after surgery. We seek to provide emergency providers with an efficient and evidence-based framework for differentiating normal healing from early infection following TJA. We accomplish this by reviewing postoperative physiology, temporal response of inflammatory markers and synovial fluid analysis, and existing diagnostic criteria for infection. Normal healing after TJA produces predictable inflammatory responses that commonly exceed thresholds established for chronic PJI diagnosis. Therefore, early PJI diagnosis should utilize a time-dependent interpretation of synovial fluid, while S-SSIs remain primarily clinical diagnoses. A structured diagnostic algorithm can safely reduce unnecessary testing and costs, protect against medicolegal pressures, and provide evidence-based practices for effectively detecting early infection following TJA. This is crucial in the setting of the new Transforming Episode Accountability Model (TEAM) that bundles TJA payment.