I'm retired now, but I trained at one of the oldest emergency medicine programs in the early 1980s. The faculty at my medical school advised me to train in internal medicine or general surgery so I could be a real doctor after I burned out of emergency medicine.
Dr. Chesney Fowler's article made me think: Looking at the root cause of any disease and correcting it yields the best results. (“The Emergency Medicine Staffing Death Spiral,” EMN 2016;38:32; http://bit.ly/2hVXVCh.) I trained before EMTALA when the ER was not the open door to any and all health care 24/7. Sure, we had non-ER patients, but they were a minority.
Do we ask neurosurgeons, orthopods, or dermatologists to see any patient who walks in their door? Can we walk into any hotel or restaurant, any time, demand a room or meal, quickly, and then walk out? Do we ask for Italian food in a French restaurant? Do we demand a swimming pool in winter?
There is no specialty-driven filter at the door. We could take all comers, then triage them to FP, STD, chronic pain, drug rehab, prescription refill, sports physical, legal second opinion, psychiatry, or emergency if we had the resources to build and staff all of these facilities 24/7 with the appropriate, non-EM specialists. Any other business would be thrilled to have an ever-increasing number of customers at the door, but they make a profit. ObamaFunds? TrumpFunds? ER doesn't stand for EveRything.
We chose a specialty for a reason. We're forced to be GPs when we don't want to be. Communist countries pick the careers (and specialties for physicians) for the highest-educated citizens. (My wife grew up under communist rule. She and her first husband were thus directed.) I thought we chose our own here.
Scribes are definitely a boon to charting. No CEO writes his own letters or memos; neither should we. My group resisted this for many years. We can easily see more patients in less time with their help.
For the 25 years I practiced in the ER, I heard many promises; none materialized. That's the main reason I am among those who didn't recommend health care as a career to the next generation (having several MDs in the prior generations). We're a dedicated, patient group, well versed in delayed gratification, but I was sick of being lied to and taken advantage of.
Paul Mele, MD