Pessimism Seen on Health Reform

ACEP News
July 2010

By Alicia Ault
Elsevier Global Medical News

Washington — Emergency physicians are not optimistic about health reform's impact on the conditions in the nation's emergency departments, according to a survey conducted by the American College of Emergency Physicians.

The survey, conducted in the spring, found that 71% said that despite the widening of access to care and increased insurance coverage for Americans, emergency visits will increase.

"The nation's emergency physicians absolutely support reforming our nation's health care system and expanding health insurance coverage to all Americans," ACEP President Dr. Angela Gardner said. "However, health insurance coverage does not equal access to medical care, especially with an aging population and physician shortages. You also can't prevent most emergencies."

About half of the survey's 1,822 respondents said that, with health reform, more people will seek emergency care, while 38% said they expected no change.

When asked whether the Affordable Care Act would effectively address the problem of uncompensated care in the emergency department, 61% of surveyed emergency physicians said no.

Almost half of the respondents said they expected no change in conditions in the ED. Among those conditions: overcrowding, boarding, and the ability to find specialists to take call. Only 15% said that the reforms were a step in the right direction.

In the survey, overcrowding was listed as a problem by all respondents, with a quarter saying it was overcrowded in their ED every day. A quarter had overcrowding 5 days a week or more, and another 26% said their EDs were overcrowded 3 or 4 days a week.

Overcrowding levels have stayed about the same in the last year for a third of respondents, but they rose slightly for 36% of respondents—and increased significantly for 28% of those surveyed. A total of 15% of respondents said that boarding occurred every day, and 56% said that it was an issue 1-5 days a week.

With health reform, 54% of emergency physicians said that the number of specialists willing to take call will decrease. The response in part may be due to their pessimistic outlook on what impact reform will have on the number of specialists in the United States. Forty-four percent of survey respondents said the ranks of specialists would decrease, while a quarter predicted no change. Another 26% said they weren't sure of the impact.

Finally, the emergency physicians who responded were not optimistic about the future of medicine, with 35% predicting that health reform would mean that fewer people would choose to become physicians. One third said that physicians would retire or change careers before age 60. When it came to their own careers, however, 66% said they intended to continue practicing. Twenty-three percent said they were undecided, and 11% said they planned to stop practicing.

The survey "should send lawmakers a clear message that emergency departments, which are a critical, life-or-death part of our health care system, need help now," Dr. Gardner concluded.

To conduct the survey, ACEP sent emails to 17,361 emergency physicians and received responses from 1,822. The poll has a margin of error of plus or minus 2.2%.

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