Yes, ERs are in crisis. A favorite topic here. A major part of the problem can be traced to poor primary care access and “defensive medicine”. Let me elaborate:

1) Lack of access
Lack of primary care incentives for medical students and providers = dwindling primary care access = patients going to the ER for “routine” or non-emergent care = ER overcrowding = eventual collapse. Simple.

2) “Defensive medicine”
Sending patients to the ER is how office providers practice defensive medicine. Any patient who presents to the office with RLQ abdominal pain or chest pain gets immediately sent to the ER to rule out appendicitis or heart attack. Imagine the outrage if a PCP “missed” an appy or heart attack. As the defensive medicine mentality continues to run rampant, the threshold for sending people defensively to the ER continues to lower.

The same goes for overnight and weekend calls. As the perceived threat of malpractice rises, no doctor would be willing to give any advice over the phone. The liability exposure for telephone medicine is too great. Hence, “go to the ER” will soon be universal telemedicine advice.

Argue about the sense of this if you must, but hey, I just tell it like it is.

The solution? Fix primary care access and reform the malpractice system. These two issues are direct causes of the ER crisis and their resolution will go a long way to healing the broken system.

Update:
Medrants chimes in.