Individuals experiencing homelessness in the United States bear a disproportionate burden of morbidity and mortality, driven in part by significant structural barriers to timely and ongoing healthcare. Limited access to primary care, high healthcare costs, and perceived societal stigma contribute to frequent reliance on emergency departments (EDs). To date, little work has examined how emergency physicians’ emotional responses during encounters with homeless patients may influence clinical decision-making and patient outcomes.

This project consisted of two studies. Study 1 investigated emergency physicians’ emotional experiences, physiological stress, and care delivery during ED encounters. 20 physicians were shadowed across three clinical shifts each (480 total hours). Self-reported emotions, observational data from physician-patient interactions, physiological arousal, and electronic health record (EHR) metrics were collected across 895 ED encounters, with EHR data currently extracted for 331 encounters. Results from Study 1 indicated that encounters with homeless patients elicited significantly greater negative emotions (e.g., frustration, indifference), fewer positive emotions (e.g., empathy, compassion), and higher physiological arousal among physicians (all p < 0.05), alongside longer disposition times (p = 0.04) and fewer diagnostic tests ordered (p = 0.01). 

Study 2, a narrative review of homelessness in the ED, contextualized these findings by identifying patterns of stigma, implicit bias, and structural barriers that shape clinician attitudes and patient experiences. Together, these studies suggest that physician emotional strain and systemic inequities may jointly influence ED care of this highly vulnerable patient population,

highlighting the need for interventions that address bias, support clinician well-being, and promote equitable emergency care.