It was 2 p.m. on a sunny and humid day, 1 hour before my 8-hour shift was over in the emergency department at the community hospital that I was rotating through. It was part of my fourth-year emergency medicine (EM) clerkship. Not that I would have noticed the weather, save for the few seconds the sliding door to the ED would open periodically, as if on its own cadence, with the sounds of stomping boots and a rolling gurney making its way through.
We were busy. At this particular hospital, I was told, EM volume is already up 35% this year compared with the previous year, and bed holds had been hitting new highs each week.
One more hour until my shift is over and a poor soul will take over my computer, seat, and the chaos.
I took a glance at the electronic health record again, seeing whether there was anything I could do to discharge any of the patients to relieve some of the strain. Knee pain, toe pain, headache/migraine, shoulder pain, elevated blood pressure. Although it’s true that any of these listed complaints could have emergent etiologies, the truth was that all of these patients were here owing to exacerbations of chronic issues. And yet most, if not all, of these patients had been here for nearly 8 hours, some even longer, waiting for treatment and exacerbating an already busy ED.
“I don’t understand. Couldn’t these patients have sought care outpatient with their PCP [primary care physician]? It would have been a lot cheaper and faster.” I asked. A seasoned ED physician, bald, graying, and whom I had just met today and hadn’t spoken to much until this very moment, turned to me and said: “We have become the dumping ground for primary care complaints.”
‘Go to the ED’
“PCPs are already too busy,” the physician continued. “It’s just easier to say: ‘Go to the ED. They’ll take care of it.’ ”
He continued: “In my 30 years of practicing, emergency medicine has changed so much. When I first started in the 1980s, I was only seeing emergencies, and it was fun. Now, 80% of my patients are primary care complaints. These days, I am more of a primary care physician than an emergency physician.”
Hmmm, I thought. Was this physician burned out and jaded? Quite possibly. Was this change the physician experienced throughout his career more likely attributed to a capitalist-run, profit-driven health care system and its cohort of underinsured and noninsured citizens? Certainly. I’m only a fourth-year medical student, so my view of the situation is no doubt limited.
But something he said definitely rang my bell: I’m more of a primary care physician than an emergency physician. That is an argument I can consider. Whether it is caused by poorly designed reimbursement schedules or the state of America’s profit-driven health care system, which effectively makes these physicians double as PCPs on a daily basis.
I let this thought ruminate on my drive home, along with how there’s a such a huge demand for PCPs, resulting in it taking up to 3 months to get an appointment with one. That’s crazy, and I understand the need to come to the ED where you’ll (hopefully) be seen the same day.
I also ruminated on how emergency physicians have the highest rate of burnout among all the specialties, with no career recourse afterward. Either you’re part of the hospital machine complex, or you’re out. Practicing EM for nearly 30 years is apparently a rarity these days. Most emergency physicians last 5 years, 10 years tops, and then are so burned out that they retire to pursue a life outside of medicine (real estate seems to be popular). But this is a shame.