The ER isn’t as big of a money drain as you think for most hospitals, though. The department may show a loss, but net of downstream revenue (ancillaries ordered in the ER, admits, etc.), the situation can be quite profitable.

Don’t believe the hype from the management team.

Because of the medico-legal environment we’ve got, ER docs will be more likely to admit.

Soft admits are the most profitable admits of all.

I agree that there’s a point at which the amount of charity care provided eventually depletes these additional margins.

ER docs, however, don’t stand to lose nearly as much as the primary care docs. Not to mention the fact that there are often additional subsidies to ER physician groups precisely to offset this impact–fees for being a subcontracted group.

Forgive me (or not…I don’t really care)–but the ER is still a relatively sheltered economic environment compared to the rest of us (esp. primary care, where we’re not talking about just reimbursement cuts affecting income, but rather our immediate viability).

(P.S.–Anesthesia and Radiology have the same complaints. Metastatic effects post-admission. And no sympathy from the rest of us.)