Gateway

Although some people say primary care is the gateway into the health care system, I think the emergency department is really the entry-point into the medical care system today. Many of the people we see do not regularly see their family doctor; when they are well, they don't make the time, and when they are sick, they go to emergency. Furthermore, primary care is stretched incredibly thin as it is, and although emergency medicine is equally taxed, laws such as EMTALA require ED's to see everyone whereas a primary care practice can simply say they are not taking new patients. This is a problem. Emergency medicine is designed to treat emergencies; there is a physician trained in critical care medicine, nursing ratios that allow procedures under conscious sedation, 24 hour access to CT scans, surgical, obstetric, medical, and anesthetic consultants, and more. In the emergency department, we should not be seeing chronic stable problems or minor injuries that don't utilize such high-level services. Urgent cares are designed to decompress the emergency department, and they do to some extent, but the truth is, there are too many patients and there is only one destination for them to get their care right now.

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