Be part of the “medical neighborhood.” Emergency physicians have a clear opportunity to insert themselves in the newest healthcare structures, still in their infancy in both structure and evolving function, but it is necessary to insure someone else does not pre-empt the decisions and define the role of the emergency physicians.

A specific parameter that cannot be overlooked is the fact that emergency physicians exert a substantial amount of influence over the revenue stream of every hospital, every time they make the critical decision to admit their patients. Schur and Venkatesh have just reported “the number of hospital admissions increased by 15.0% from 34.3 million in 1993 to 39.5 million in 2006; admissions from the ED increased by 50.4% from 11.5 million to 17.3 million. The proportion of all inpatient stays initiated by admission from the ED increased from 33.5 to 43.8%.” Over and above the scrutiny given patient satisfaction scores attained by emergency physicians, this particular issue warrants a great deal more attention.

The veritable life blood of every hospital is affected by the clinical expertise and decision-making skills of emergency physicians. As hospitals continue to struggle with short-stay admissions and reimbursement reversals, emergency physicians are presenting creative solutions to their hospitals through observation services. New York Medicaid, a payer that has certainly never been considered particularly friendly toward emergency physicians in terms of payment rates, in April 2011 effectively designated the ED as the focal center for observation services.

It is certainly reasonable to assume and expect this recognition of the specialty to become a trend, but emergency physicians must leverage these industry moves and seize the moment.

It is estimated that 136 million patients will be seen in US emergency departments this year. The CDC Report released in May 2012 notes 79.7 percent of adults visited the ED due to lack of access to other providers, significantly more than the 66.0 percent who visited due to seriousness of the medical condition.

As noted above it will take years for the supply of primary care practitioners to catch up to the present need. Even when the remaining 50 million, currently uninsured individuals receive coverage, it will remain to be seen how effective the primary care network will be in keeping patients out of EDs, for routine, non-emergent care.

Until those issues are resolved, emergency physicians will continue to provide service to these millions of patients, another indication and confirmation of the critical role fulfilled today by emergency medicine.