What I think is that you are very much misinformed, which is a shame given your editorial position (No alms for ACEP, March 2, p. 23).
Contrary to your assertion, this bill is not simply self-serving, it is about preserving access to care for our patients. An underfunded emergency-care safety net translates very directly into unnecessary suffering and death. The fact that you think this is alarmist rhetoric shows that you cannot see this impact from your particular vantage point.
The emergency-care safety net isnt failing in dramatic fashion, like a bridge crashing into a river, it is failing one unavailable consultant at a time, one additional ambulance diversion at a time, one extra patient transfer at a time, one more patient being boarded in the emergency department waiting hours for an inpatient bed at a time, one emergency room waiting-room death at a time, one closed emergency department at a time, one patient at a time. The fact that you cannot perceive this slow-motion, but rapidly expanding, failure does not mean it is not happening; it just means you fail to appreciate it.
There are many ways to solve the problem of emergency department overcrowding, and we are using as many of these options as we can. This legislation is but one option, but that doesnt mean we should not look to legislation to help provide a solution. Deferral of care is certainly an option, but the American College of Emergency Physicians believes it is risky for the patients, providers and community. It is particularly risky when access to alternative-care facilities for the uninsured or underinsured is limited or nonexistent.
Emergency department physicians operate as groups, and the physicians who usually respond to these surveys are the medical directors of their departments, and their response often reflects the experience of the 10 or 15 other physicians working in that department. My own group includes 1,500 emergency department providers in more than 60 emergency departments in six states seeing more than 2 million patients a year. I can assure you the number of uninsured patients in our emergency departments is growing. Is it such a stretch to think that the current economic crisis and loss of millions of jobs is contributing to that burden?>p? I dont know who you or your editors interviewed, but most of the emergency department physicians I know, and most of the literature on this subject, point to the boarding of patients in the emergency department who are waiting for an inpatient bed as the primary cause of overcrowding, not the use of emergency departments by patients who should have been seen in the doctors office. The latter are easily and quickly and often efficiently managed in the emergency department and discharged, and their impact on emergency department resources is relatively minor.
Myles RinerPhysician Greenbrae, Calif.