Mission over margin: a community ER doctor’s discipline

The May 2, 2026, New England Journal of Medicine (NEJM) Perspective, “From Mission to Margin in Academic Medicine,” articulates an internal struggle I feel frequently. All physicians recognize the formative environment Dr. Vyas describes as something that must be fiercely protected, and his call to action against the commodification of training resonates deeply. As an emergency department physician practicing outside of this setting, I recognize that when we succumb …

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Mission over margin: a community ER doctor’s discipline