EDs becoming more and more crowded, emergency physicians say

Nearly all emergency physicians say that every day they care for patients referred to an emergency department by a primary care physician and for Medicaid patients who could not get appointments with physicians when they needed them.

Emergency physicians weighed in on these and other issues in an email survey sent to more than 20,000 doctors by the American College of Emergency Physicians, with 1,768 responding. ACEP conducted the survey from March 3-11.

The poll results find that EDs are becoming increasingly crowded even before the health system reform law's coverage expansion to about 32 million people in 2014. About half will gain access to private health plans through health insurance exchanges and the other half through Medicaid.

"Visits to emergency rooms are going to increase across the country, despite health care reform," said ACEP President Sandra Schneider, MD.

EDs are busier in part because many other EDs have closed and two-thirds of emergency visits happen after normal business hours, when patients have difficulties accessing primary care physicians.

Eighty percent of survey respondents said ED visits had increased significantly or somewhat in the last year. About 90% are expecting similar increases in visits in the next year and as the health reform law is implemented.

Respondents said ED visits are increasing for several reasons. The most popular factor, cited by 28%, was an increase in patients without health coverage. An additional 23% named a growing elderly population as a cause.

Nearly half of poll respondents said diagnostic tests are the biggest expenses on patients' ED bills. Fifty-three percent said fear of lawsuits drives doctors to conduct as many tests as they do.

"Emergency departments need more resources, not fewer, and medical liability reform would help reduce overall costs by reducing the need for defensive medicine," Dr. Schneider said.

Twenty-nine percent of the respondents were hospital employees and 71% were not. The poll is available online (link).