Yale’s Head of Emergency Medicine Discusses Health Challenges, and ‘The Pitt’

In 2004, Arjun Venkatesh faced a tough choice: accept a lucrative job on Wall Street or follow his long-held dream of going to medical school. He already had his MBA, but he hadn’t fully shut the door on practicing medicine.

When he asked physicians across specialties for advice, most told him he was crazy to pursue a career as a doctor, citing frustrations with HMOs and endless paperwork.

So he reframed the question: “If you hadn’t become a doctor, what would you be doing instead?” All of them, Dr. Venkatesh says, responded, “I’d still be a doctor.”

Now chair of emergency medicine at Yale Medicine and chief of emergency medicine at Yale New Haven Hospital, Dr. Venkatesh understands why.

“It’s the grass-is-greener phenomenon, especially in emergency medicine,” he says. “Many people are watching the TV show ‘The Pitt,’ which takes place in an emergency room. It’s accurate, and it shows how hard this work really is. But most of us would choose it again in a heartbeat.”

For Dr. Venkatesh, who has led the department since 2023, the role combines his passion for treating patients with his interests in business and leadership. Along the way, he even added a master of health science degree to complement his research in health care systems—becoming one of the architects of the Overall Hospital Quality Star Ratings system, used nationwide to measure a hospital’s quality of care.

“There's almost no job in health care where you get this type of life experience at solving puzzles and diagnoses. I’ve never had a shift where I didn't see something new,” he says. “I’ve also never left a shift without knowing I made a significant impact on somebody's life and health. It’s pretty special to find a job that has all that.”

In the Q&A below, Dr. Venkatesh talks more about his career path, how Yale’s Department of Emergency Medicine is leading the country in research, and more on what he thinks of “The Pitt” and other TV hospital dramas.

My mom is a neurologist. When I was a kid in Dayton, Ohio, it was the early days of using thrombolytic therapy, or TPA, for stroke care. She would be on call all night and sometimes take me along so she didn’t have to drive alone. I’d hang out in the physician lounge or in the medical records office.

I got accustomed to being around hospitals and hearing about emergencies like strokes. And it's amazing how far we've come from then to now. We live in a world where that type of stroke care is very routine and delivered in our emergency departments at Yale several times a day.

In high school, I volunteered in a hospital. My favorite job was supply distribution. I’d push a cart filled with gauze pads or bags of saline or whatever else and take it throughout the hospital, which gave me a behind-the-scenes look at how hospitals function. It got me interested in health care delivery—not just taking care of patients but how we manage these systems to help people at their greatest time of need.

I was pre-med as an undergraduate, but an internship with a health care consulting company turned into a full-time job. I went to class at night and loved learning about the business side of health care and how health systems work.

I went on to business school and got my MBA. I worked in finance and decided to go to medical school. I had this background in business and this real appreciation and love for numbers and science, but I didn’t know what specialty to choose.

I wanted to do something with my hands, but also wanted to use diagnostic reasoning. I didn't know much about emergency medicine, but I was fortunate that I had a mentor my second year of medical school who was an emergency medicine physician. He was tasked with teaching me how to use a stethoscope and do a neurology exam and everything else. We did it all in the emergency department and I loved being there.

It was the place where you got to make a diagnosis. At the time, the TV show “House” was on the air showing their department of diagnostic medicine. But in real hospitals, that’s what we call the emergency department.

I love the diagnostic puzzle the ED offers, as well as the ability to do procedures and the exciting parts like taking care of people with strokes and heart attacks and trauma and sepsis. I also love being part of the safety net and always feel like my moral compass is straight at work. We take care of everyone anytime, regardless of whether they're insured or not, homeless, or a CEO. Plus, Yale New Haven Hospital has the fifth-largest ED in the country. I wear that as a badge of honor.

They're all real, and I don't want to discount any of them. The hours are hard because they're at odd times. Most patients seek emergency care during the evenings, nights, and on weekends. On the other hand, you also have a lot of job flexibility. You can work shifts. There are a lot of people in emergency medicine who pursue academic interests in research or medical education or more atypical pursuits like ski or tactical medicine. It allows for diversity in work that keeps you from getting burned out by doing the same thing again and again.

Emotionally, yes, it can be difficult because you don't have a relationship with your patient like other specialties. No one talks about their emergency physician, except the one they saw once. And you're dealing with them on the hardest day of their lives. But that's also what makes it the most fulfilling.

What I love about academic medicine is that you get more than one job. You can be a clinical emergency physician. You can be a scientist. You can be an educator and work with residents and students. Being chair is all of that but on steroids. It’s a wonderful mix.

I take pride in the success of the people in our department. We’ve been the No. 1 NIH-funded emergency department in the country for four straight years. The average academic department in emergency medicine has 1.2 people with NIH funding. By my last count, we have 17 or 18.

If we are not conducting research, we are at least taking part in most major clinical trials in emergency medicine. Our faculty are writing the guidelines for emergency medicine, not just here in New Haven, but for the 5,000 EDs across the country.

I may be biased—my sister-in-law is one of the show’s creative executives—but I believe it is the most accurate depiction on TV of our health care system and some of its challenges.

Each episode is one hour in one day. So in one episode, it starts with a patient in the ED waiting room, which is full, and there are patients in the hallway. This is true across the whole country.

Normally, on a TV show and in real life, people get upset when they’ve been waiting for a while. They’re unwell. They’re in pain. But we just don’t have enough people, places, or resources to take care of everybody immediately.

In the show, you see people patiently waiting in the beginning. They understand there are other people who were in a car crash or have some other trauma. But after they’ve waited six hours, it explodes. I don’t think any TV show has ever depicted one of the biggest patient safety issues and vexing problems we have today in health care.

The broad answer is that it’s a mix of economics, policy incentives, and demographics that have gotten us to where we are today. People are living longer, with more complex conditions such as cancer and heart disease, and these people need access to acute care.

We also have health care disparities and more vulnerable populations, particularly with older adults. The problem is we have roughly 5% to 10% fewer hospitals and hospital beds today than we did 30 years ago. And if emergency department visits have grown by 30% to 40% in the last decade, it's a simple supply and demand mismatch.

We are struggling across the nation in caring for people outside of the hospital as well. People need to be able to see their doctors and get timely services. What we see in the ED is sometimes a symptom of a broken health care system.

I have two little boys, 8 and 6, and they have a lot of energy. I love spending time with them and traveling with them and my wife, Pooja Agrawal, MD, MPH, who is on faculty at Yale and is a powerhouse in academic emergency medicine as a member of the Society of Academic Emergency Medicine Board of Directors and an internationally recognized expert in refugee and immigrant health.

I love playing tennis, which I did competitively growing up and recently got back into. Even if it’s just five times a month now, that’s a start and I have audacious goals for it to grow just as I do for the Department of Emergency Medicine.