The Disaster of Emergency Medicine

I was walking through the emergency room a few days ago and saw a patient sitting on a gurney in the hallway drinking pop and eating a sandwich.

Nothing is more irritating than seeing the emergency department being used for non emergent medicine.

If you can breath, walk, and talk….. It’s not an emergency! Call your doctor’s office and get an appointment.

Unfortunately, the non-emergent use of emergency departments is more common than you think. It’s unclear why people abuse emergency rooms, but it happens a lot.

Sometimes it’s because the patient does not have insurance and doesn’t have a doctor. And patients know that the ER is not allowed to turn them away. So they just go to the ER and get their primary care there.

Sometimes it’s because patients don’t know any better. They think that they can just go to the ER for all their problems, and that that is normal. Someone please educate these people.

Sometimes they say that their doctor is “booked and can’t see me for 2 weeks”. So they stroll into the ER to get their urinary incontinence medication refilled.

ER physicians should not be allowed to prescribe medications for on-going problems. Then patients won’t go to them. An ER doctor should not have to deal with refilling Viagra or Flomax for a patient.

How do we fix this problem?

Pay primary care physicians more! What? Why? There really isn’t a primary care shortage in this country. There is a shortage of pay for primary care. If primary care physicians were paid appropriately, they would have enough office hours and time to accommodate all their patients.

Instead, more and more primary care physicians are leaving primary care, moonlighting as ER physicians, and sub specializing to try and make more money for their time. They want to be efficient.

If a primary care physician can get paid upfront $130 dollars an hour for working in the ER, why would he bother seeing 4 patients an hour, some of which have no insurance, some have insurance, but he has to hire 3 employees to chase down insurance companies, so that he can maybe make $30 an hour, but get paid 90 days later?

It does not make sense.

So he cuts his office hours down to 10-20 hours a week, and goes and moonlights at an urgent care facility, an ER, or as a hospitalist.

With President Obama touting health care reform, he needs to attack the core of the problem. Fix primary care medicine! Pay the primary care doctors for their time, effort, thought process, and care.

The worst thing that Obama can do is to hire cheaper “providers”. Not physicians, but “providers”.

A provider can be anyone, a nurse, a physician’s assistant, a dentist or even a chiropracter. Sure, hiring nurses and PAs to take over primary care medicine may look cheaper, but the long term consequences are more expensive.

When you have a lesser trained “provider” trying to care for people, you get tons and tons of useless consults. We have seen this in hospitals as well as clinics. Over utilization of consultants costs the system more. While a good primary care physician can work up most problems and only consult for difficult cases, a lesser trained provider will consult more often and cost the patient, as well as the system, more on the aggregate. That is bad medicine.

A patient will not get appropriate care until further down the line from a random consultant. Bad medicine!

My advice to Obama: Pay the primary care physicians what they are worth, and you will not have a primary care shortage. You will save patients lives, ensure better outcomes, as well as have a healthier population in general. Stop short-changing the physicians that are on the front lines.

This will also relieve the emergency departments, to handle “emergencies”. The vast majority of ER doctors did not go into ER because they want to see sniffles, fungal toe infections, and a thinning hairline. Nor do they want to refill your Viagra.