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Western University of Health Sciences
AAEM/RSA Education Committee
As aspiring emergency medicine (EM) physicians, what is it that motivates us? Perhaps it was from working as a first responder or in emergency medical services? Or maybe even from shadowing at a busy trauma center or watching a TV show come to life as the ED team rush to diagnose a complex pediatric poisoning? Or maybe, it was a poignant personal experience with serious disease or injury? While these challenging and adrenaline-rush cases provide variety and excitement to the profession, one must always remember that the core of EM is often times primary care medicine. According to the 2014 CDC data, while there were 141.4 million ED visits in the year, only 7.9% of those were critical cases requiring hospital admission. As many as one-third of ED visits are thought to be for primary care complaints. Although there is not a set definition, most of these are defined as non-urgent ED visits, conditions in which a delay of several hours of care would not increase the likelihood of adverse outcomes. In retrospective medical record reviews, non-urgent visits were defined by diagnoses, whether hospital admission was an endpoint, symptoms, and vital signs to name a few. However perceived seriousness of condition by the patient may also be a subjective factor. With changing healthcare policies of our new era, it is inevitable that access to healthcare, especially primary care, will be a significant concern for the younger uninsured and Medicaid population. It is evident that the greatest increase in ED visits between 2006 and 2014 were from the Medicaid population. In that time period, with the exception of injury as the first-listed diagnosis, there has been an increased percentage in medical, mental health/substance abuse, and maternal/neonatal conditions that were managed on an outpatient disposition. From the EM profession’s standpoint, the questions arises: should there be more policy changes and interventions to decrease use of the already overextended ED’s? Or should the EM profession embrace this inevitable change and adapt to care for primary care issues?