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January 31, 2008

The Myth Behind Emergency Room Delays

Jill Stoddard
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We talked today with Professor Linda Green and asked her to clarify a common misconception about emergency room delays. Below are excerpts from our conversation:

“Whenever journalists write about emergency room delays, they tend to oversimplify the problem, and they usually connect the increase in emergency room wait times to the increased percentage of uninsured patients. It’s true that the percentage of the uninsured is increasing, but all the research I’ve seen shows that the percentage growth in visits to emergency rooms is greater for insured patients than uninsured patients.

“So it’s not about uninsured people, it’s about people in general. And the reason more people are going to the emergency room is that the wait time to get an appointment with a primary care physician has gone up to an average of three and a half weeks. There are just are not enough primary care physicians, and there’s no financial incentive to become a primary care physician when other specialties are much more high-paying.

“And while the growing difficulty in access to primary care is certainly a factor in the growth of emergency department visits, it’s likely not the only cause. We are also experiencing increased numbers of people with diabetes, heart disease and other serious chronic diseases, and these also contribute to the increase in visits.

“There is also a growing number of patients being ‘boarded’ in emergency departments while waiting for an inpatient bed. These require the attention of the emergency department physicians, which results in the physicians having less time available for the new arrivals into the department.

“Hospitals do try to adjust the number of physicians that are on call to accommodate patient flow — for example, they realize more patients show up at noon than at two in the morning. They just don’t do it very well because they don’t know how to do it very well. Most hospitals are not run by MBAs. They are run by physicians, and physicians aren’t familiar with management techniques that are used in other industries. Banks, supermarkets, airlines and call centers all use mathematical models. Hospitals don’t use these mathematical models so it’s not surprising that they don’t operate efficiently.

“It does take up a lot of time and energy from the hospital managers to keep the hospital afloat. Most hospitals are in financial straits — one third of them operate in the red, and they don’t focus on emergency rooms because it’s not where they make money.”


by Henry Walther, MD | January 04, 2009 at 3:21 AM

Professor Green is misinformed or ignorant. Hospitals are not run by physicians; they are in fact run by people with business backgrounds (MBA or Masters in Hospital Administration) or RNs who have chosen to be administrators, with or wothout business degrees. The days when the business aspect of hospitals were run by MDs, at least in California urban settings, lay about 20 years in the past.

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