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Debra Houry, MD, MPH Headshot

Emergency Rooms Are on Life Support

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As has been widely reported, Mitt Romney's at it again: here's what he had to say about uninsured Americans in his 60 Minutes interview on Sunday:

Well, we do provide care for people who don't have insurance. If someone has a heart attack, they don't sit in their apartment and die. We pick them up in an ambulance, and take them to the hospital, and give them care.

When reporter Scott Pelley pointed that it was the most expensive way to provide care, Romney responded, "Again, different states have different ways of doing that. Some provide that care through clinics. Some provide the care through emergency rooms."

As an emergency physician in Georgia's largest public hospital and as the past president of the Society for Academic Emergency Medicine, I know that not only is it ridiculous to imply that emergency rooms are a replacement for insured health care, but that our already overburdened system can't even go on much longer as it is -- underfunded, overcrowded and little understood. What's more, efforts that could be made to improve the workings of emergency departments are being subverted at every turn. Over the past decade, the National Center for Health Statistics reported that the number of visits to emergency departments (EDs) increased 32% to 136.1 million annual visits. And, although nobody wants to go to the emergency room, with four emergency department visits for every 10 people each year across the country the truth is that many of us -- rich, poor and everyone in between are headed there.


Even if you are lucky enough to have good health care coverage, I will still see you in the ER someday for a heart attack, a bad case of the flu, or for a broken bone after a car crash.

Emergency departments are the frontlines of our health care system, ready to provide care for you, no matter who you are. The Emergency Medical Treatment and Active Labor Act (EMTALA) of 1986 was intended to prevent hospital from turning away uninsured patients and to guarantee that all patients in the U.S. could receive emergency treatment. As an unintended consequence, 55% of emergency care now goes uncompensated, according to the Centers for Medicare & Medicaid Services. In addition, the average emergency physician provides nearly $150,000 a year in uncompensated care due to the mandates of EMTALA. And, since no other medical specialty is under this mandate, other physicians can send uninsured patients to the emergency department for medical treatment that they do not want to provide.

Yet emergency medicine researchers receive less than 1% of National Institutes for Health (NIH) funding -- the largest source of federal funding for research in the US.

The emergency department is the place for groundbreaking research that treats illnesses and injuries that almost certainly will at some point in your lifetime affect you or a family member. Since emergency physicians see heart attacks, pneumonia, and strokes before any other doctor does, we are in a unique position to pave new roads in research in areas such as cardiac arrest, sepsis, and injury prevention.

If Congress can't get its act together and the across the board budget cuts from the Budget Control Act goes through this cold winter, there will be $3.6 billion in cuts for medical research, eliminating more than 2,300 NIH research grants. Cuts in federal research will halt medical advances and slow the search for new treatments for life threatening conditions, a truly chilling outcome.

Almost 10 years ago, the Institute of Medicine recommended increasing the research base for emergency care. Since then, some token steps have been taken towards this goal including the formation of a dedicated Office of Emergency Care Research (OECR) at NIH this past summer, although no budget line was allocated to this office. Although this is a step in the right direction, I think we're all familiar with the adage "put your money where your mouth is." If our country believes that our citizens' health is important then it is imperative to fund innovative research for life threatening conditions. With funding being cut at every turn, Governor Romney's assertion becomes more ridiculous still.

To be sure, the public and even many health care providers still misperceive emergency physicians as shift workers -- "a doc in the box" -- or that we don't have a real niche because we treat all ages and stabilize a myriad of conditions. Although it's true that we do work 24/7, it is precisely because we have a wide breadth of medical knowledge and critical-care treatment skills and experience that we can recognize the complexity and severity of the patient's condition, intervene early and effectively in the course of an injury or critical illness and determine where research is most needed. That said, just as you wouldn't ask a gynecologist to take out a gallbladder, you shouldn't expect an emergency physician to be the best specialist to take care of routine health maintenance concerns or see a patient with surgical complications. But we do and we will until our country has a better solution.

No matter what side of the aisle you sit on, all can agree that our health care system is at the tipping point. Increasing funding for emergency departments will certainly help move our country's medical care forward. But even if the roadblocks to greater funding were to disappear, Governor Romney's "let them eat emergency rooms" stance doesn't begin to get at a way to fix our broken health care system. Ask any emergency room doctor.

This op-ed was written in association with The OpEd Project.