When we think about taking a trip to the hospital, one of the first questions that runs through most of our minds is, “I wonder how long the wait will be?”
The wait times for patients continue to increase as many hospitals struggle with the increasing use of their emergency rooms. Patients rush to the ER for all kinds of conditions, both life-threatening and non life-threatening.
This poses a major problem for hospitals that are operating at or above capacity. With the influx of patients to the ER, we’re seeing more and more people waiting for unacceptably long periods of time to be seen by a physician. Some patients are waiting to the point of near death before they are seen.
What is Causing the Long Lines?
There are many reasons why the wait for care has continued to grow, many of which will be too complicated to explain here. However, we’ll try to cover some of the main reasons behind the overcrowding of hospital waiting rooms below.
Large Number of Uninsured Individuals
One of the primary drivers behind long wait times is the fact that many individuals do not have health insurance. As you may already know, ERs will see patients regardless of their insurance status.
One of the hopes for the Affordable Care Act is that by making health insurance more readily available, we’ll be able to decrease the crowding in emergency rooms. The goal is to push many of the less critical patients out to the primary or “ambulatory” care areas of the health system rather than having them funnel into the ER. It remains to be seen whether this will pan out as expected.
One caveat to this idea is that even insured individuals will show up in the ER for conditions that don’t need immediate treatment. Again, this could throw a stick in the spokes of the plan to reduce wait times by improving insurance coverage.
Lack of Primary Care Physicians
You may have read in the news that there is an incredible shortage or primary care physicians in the United States. If we had more primary care docs that were able to take on patients, it would be much easier to push lower acuity patients out into the primary care setting and away from ERs.
Unfortunately, the problem is not likely to improve any time soon. With the expansion of insurance to a larger number of individuals, primary care docs are going to be even more over-burdened than they already are. This poses a serious problem in terms of finding alternate care opportunities to help people avoid ER visits.
With long work hours, and lower pay when compared to specialists, it’s easy to see why fewer medical students are choosing to go into primary care. It’s hard to blame them when you consider the fact that, according to the AAMC, the average medical school education costs $278,455 and $207,868 at private and public schools, respectively.
Patients Are Triaged in the ER
When a patient arrives in the ER they go through what is referred to as triage. The basic idea behind this term is that nurses and physicians will give each patient an initial evaluation and rank them on the severity of their illness.
Patients who have more severe conditions will be seen right away, while those who are less severe will wait until a physician is available to see them. This makes sense, but if you’re one of the less severe patients it can be extremely frustrating to have to wait for, potentially, hours to be seen.
Can Wait Times be Fixed?
This is actually a difficult question to answer. While we’re going through a phase of pretty strict cost cutting, it’s unlikely that reimbursement levels for primary care physicians, or any other physician, are going to rise in the near future.
This adds to the issue of a lack of primary care docs. Without the monetary incentive to jump into this line of work, medical students will continue to head toward the specialty areas.
The primary care doctor shortage also poses a problem for the plan to move insured patients out of the ER and into the primary care setting. When patients find that there are no PC doctors to see them, where will they go? Back to the ER.
One of the best options to help alleviate the wait time issue is to increase the autonomy of physicians assistants and nurse practitioners. At a minimum, NPs and PAs should be given the authority to see low acuity (less severe) patients in order to take some of the pressure off of the ER doctors. This would allow those patients with less severe issues to move through the system more quickly.
In addition, it’s going to take a big effort on the education side of things to teach patients that the ER should not be used for conditions unless they are an absolute emergency. However, this can get a bit murky when you try to answer the question of what specifically constitutes an emergency and what does not.
Overall, I think wait times can be reduced, but I’m not sure that they can be eliminated. It would take a herculean effort on the part of hospitals and their staff to improve efficiency to the point where wait times are eliminated. On top of that, generating incentive for medical students to go into primary care would take major restructuring of both reimbursement models and medical school tuition payments. I don’t see either of those things happening any time soon.