Healthy Frog

In a front page article by the San Francisco Chronicle , they describe a report by the CDC, that reveals what we in Emergency Medicine know all too well.  We have become the primary care providers of the community. To quote the article:

"The likely cause is there are just fewer and fewer primary care physicians," he said. "If you were to get the flu and your doctor says, 'Sure, I'll see you in two weeks,' you may not be able to wait. It's hard for even insured people to get quick appointments and be seen quickly."

The study over 10 years from 1996 to 2006, reveals that the number of uninsured has increased by 5 million in that 10 year time frame, while the number of ED visits has increased by 32% from 90 million to 119 million visits. At the same time the number of emergency departments that have closed dropped by nearly 5%.  This puts added pressure on existing emergency departments and hospital systems.  I would add that those closings also do not necessarily mean more money for hospitals as most hospitals are losing money on nearly every ED visit or admission.

To quote Dr. Billy Mallon, current California ACEP Chapter president:

""The main problem with ER overcrowding is I can't get the admitting patients out. I can't get them to the ICU, to the operating room or to the wards," Mallon said.

He said people who lack access to other care options contribute more to overcrowding than patients who rush to the emergency room in nonemergency situations. "

Ahhh, finally what I have been saying all along. The Obama, McCain camps and all these other state universal health care plans that are being tried have it wrong. It is not about being insured, it is about having access to care.  Insured patients cannot get access to their primary care doctor or their orthopedist or their dermatologist or their gynecologist so they are going to where they know they can get the care they need....the country's emergency departments.

So how can this be solved?

The primary care specialties need incentives to attract students.  Why would a medical student select internal medicine, family practice or pediatrics, put in long hours and hardly make a living , when they can be in a surgical specialty that may pay them 400-500% more and have a better lifestyle.  With the aging population the demand on ED's and hospital admissions will increase, so while it is easy to say we need to cut Medicare programs now, we will pay the price in the future. Hospitals need more dollars to have capital expansion projects in areas of need.  What will Atlanta do if Grady hospital closes?  Will everyone move out of Atlanta?

The state of our health care system is a shambles, to say the least. I would say it is a "crisis".  In as little as 5 years time, I predict the system will completely collapse, meaning every ED and every hospital will be beyond capacity everyday, not just a couple days per week as it is now.  The next presidential administration and congress needs to grab the bull by the horns, and get it fixed or what will develop is a system of the haves and have nots.  Smart industrious healthcare administrators will start cash only hospitals and clinics that those that can afford will go to primarily and the rest will suffer in s system with little access and poor quality care. ( I won't even mention what could happen if there is a major terrorist event or natural disaster.)