Letter to the Editor: Emergency Care Is More About Primary Care: Emergency Medicine News
The data is hard to refute in the article “Emergency Care Centers Offer Access – At A Cost”, but the researchers’ findings are questionable. (REM. 2021; 43: 1; https://bit.ly/3fn8oan.)
The study claims to show that emergency care can reduce potentially unnecessary emergency room visits, but that it comes at a high cost, with around 37 emergency care visits needed to reduce a low-severity emergency room visit. The underlying assumption is that the sole purpose of emergency care is to replace the emergency department. Sometimes this is the case, but patients also come to the emergency room to fill gaps in primary care when it is not readily available. Lack of easy access to primary care is endemic in a country where, despite ACA, many people have insufficient or no insurance and where overworked primary care physicians cannot see patients on time. .
The study authors looked at diagnoses such as a rash, urinary tract infection, and muscle tension. All of these conditions warrant timely medical attention, and the assumption that patients can see their PCP the next day is, in many cases, simply wrong.
The comparison with other countries is instructive. Americans, on average, go to the doctor about five times a year. That puts them at the bottom of the Organization for Economic Co-operation and Development average, with South Koreans seeing their doctor 16.6 times a year and Germans at a respectable 10. Rather than viewing emergency care visits as mere substitutes for ED visits, they should be viewed as a mixture of “real” urgent visits, with some form of misguided primary care.
In most other countries, patients visit their PCP for emergency care, and PCPs slot their schedules and have revolving doors after hours. Low reimbursement for primary care visits to the United States leads to overbooking, making urgent care visits unavailable. Additionally, the high malpractice rates for minor in-office surgeries, such as laceration repair and abscess drainage, make these procedures unprofitable for PCPs, who refer these patients to emergency or emergency care. .
The current situation in terms of medical access is far from optimal for doctors and patients. We would all be better served by paying attention to the needs of patients – easy access to the right level and type of care.
Eric Lubliner, MD
Brooklyn, New York State