• When the emergency room is your only option

    While I was focused on malpractice, Ezra Klein picked up on another study showing that more than a quarter of acute care visits were made to the emergency department.  While a fair amount of those were by patients without insurance, a significant number were by insured people.  Why?

    One of the big problems here is time: Primary care doctors don’t have much of it, and what they have is generally between 9 a.m. and 5 p.m., Monday to Friday. Patients also don’t have much time, but what little time they do have is between 5 p.m. and 9 a.m., Monday to Friday, and then the weekends. Emergency rooms have long waits, but at least you can schedule when you’re waiting for a time when you’re not supposed to be working.

    Indeed.  While we love to think that we can see doctors much faster in the US, that’s really not always the case.  One of the reasons for so many ED visits is that there are many times during the week that you just can’t see your doctor.  In 2009, the Commonwealth Fund published their survey of primary care physicians in 11 countries.  Here’s one of their findings:


    As you can see, fewer than 30% of practices in the US reported that they had arrangements for patients to see doctors or nurses after hours.  Where else are people supposed to go?  Not to beat a dead horse, but this chart also shows that we rank last among those 11 countries in our ability to provide after-hours care.  People aren’t necessarily going to the emergency department because they are lazy or can’t be bothered to go to the doctor.  Sometimes, that is their only choice.


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    • Has anyone looked at this for specialty care? I would bet, based on trying to contact people, that it is even worse for specialists.

      Steve

    • The Commonwealth Fund Survey was on Primary Care. I’m not sure, but I will look.

    • Thought about it some more, and I am not sure how you account for call coverage. A surgeon may not have official late hours, but be available on call and is seeing a patient in the ER as it is closer to the OR and allows for further testing as needed.

      Steve