Primary care shortage may lead to ever-increasing rates of emergency department visits

A shortage of primary care may lead to ever-increasing rates of emergency department use, even for people who have health insurance, according to a new study released today by the Archives of Internal Medicine.  

"Coverage does not equal access," said Sandra Schneider, M.D., FACEP, president of the American College of Emergency Physicians.  "People come to the ER because it's the only place they are guaranteed to get the help they need.  It's time to recognize the tremendous value that people place on having access to emergency care.  And that it's not a realistic objective to prevent emergency visits -- at least for the foreseeable future -- not only because of physician shortages, but because of the nation's growing elderly population.  It's time to start focusing on new ways of providing medical care in the United States.  For example, emergency departments are fully staffed 24/7, and the marginal costs of caring for a non-urgent patient are actually the same as a visit to a primary care physician."

Researchers analyzed National Health Interview Survey data of approximately 317,000 adults across the United States from 1999 to 2009.  They found that people with one or more barriers to primary care are more likely to visit the emergency department and that barriers to primary care have doubled over the past decade. Those barriers include: limited physician office hours, wait times for appointments, difficulty in getting in touch with a primary care physician's office to make an appointment and transportation issues.

In 1999, 6.3 percent of adults reported at least one barrier to primary care.  By 2009, that number had risen to 12.5 percent.  Among adults with at least one emergency department visit, the prevalence of having at least one barrier to primary care increased from 12 percent to 18.9 percent during that decade.

"Emergency medical care consumes just two percent of all health care spending in this country while treating an ever-growing population of patients," said Dr. Schneider.  "Emergency medicine is critical at any hour of the day.  It must be there when you need it."