Bay Path University

Emergency Departments: The Litmus Test for American Healthcare There are many reasons why emergency room visits continue to rise, even though it is one of the most expensive options in healthcare. First, if a primary care doctor or other health practitioner is not available, people turn to EDs. Certainly, when it is midnight or off hours, the ED may be the only option. But there is another underlying problem—there are not enough primary care doctors, physician assistants, and nurse practitioners to take care of the population, regardless if they reside in the cities or rural towns. The ED may be the only place to go. Second, there is a lack of awareness of options. People want the comprehensive care and attention the EDs provide. In the words of Dr. Paul Seward, an emer- gency room doctor for almost 50 years and author of Patient Care: Death and Life in the Emergency Room (Catapult, July 2018), "Using emergency depart- ments to create access to healthcare is like putting a snowplow on a Porsche." Finally, by law, emergency departments cannot turn people away for treatment and are required to admit regardless of a person's ability to pay. It is an incred- ible promise, but one that is taxing the system to capacity. Despite these troubles, EDs provide immediate and lifesaving care. They are in their own unique ways responding to this critical problem. Part of the Solution One of the solutions is the increasing use of physician assistants (PA) on the front line of EDs. Although the intention of EDs is to treat severe and life- threatening injuries, in reality, many patients use EDs for non-life threatening conditions, such as the flu, broken bones, cuts and viral infections. Without a doubt, PAs help shoulder the pressure of patient volume in the ED. Since the first graduating class of Bay Path's MS in Physician Assistant Studies in 2014, several physician assistant alumni have chosen to concentrate in emergency medicine. For Ernest Darkoh G'16, Nathanial Moore G'14, and Carly Muniz G'16, they couldn't imagine being anywhere else but in the ED. When asked what specifically drew them to work in an environment that is a ceaseless hub of activity, their answers were all the same: you see patients at all ages and stages of their lives; you treat cases and situations that cut across the medical spectrum; and, most important, you are part of a supportive team of medical providers with an emphasis on the word team. "Since I was a young boy, I knew I wanted a career in medicine. When I was growing up, my best friend's father was an ED doctor at Mercy Medical Center," states Ernest Darkoh. "I had the opportunity to shadow him, and I saw that the ED was an exciting place to practice medicine. From the moment I entered the PA program, I knew this was my area of focus. As a first-year PA student, www.baypath.edu 13 A Half Century of Emergency Care It was the availability of Medicare and Medicaid in 1965 that ushered in a new era of healthcare in America. Until that time, hospitals were largely community funded and emergency care was limited. For the most part, doctors still visited patients in their home. In the 1970s and 1980s, emergency med- icine became more exact. Professional organizations were formed; best practices established; and examinations and certi- fications within the field were required. Now, decades later, emergency care is at a crossroads as America struggles with the escalating costs of healthcare and the need for more trained medical professionals. Once more, emergency care departments are having to rethink how they deliver services while saving lives. Working in an emergency department has been compared to 'drinking from a fire hydrant' all day.

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