Recently several administrators, wealthy donors, and prominent politicians gathered to cut the red velvet ribbon on a freshly renovated emergency department complete with gold plated scissors. Beyond the façade of cherry accents and brushed glass placards embossed with the names of well-connected members of the community was a crew of nurses, techs, nurse practitioners, physician assistants, and emergency physicians who, for the past several years, have toiled away in obscurity, only visible to the patients crowded into repurposed “care spaces” with whom we have daily contact.

Whether it’s due to the great resignation of nurses on the floors or sicker seniors necessitating more hospital admissions, the boarding of inpatients has crushed emergency departments across the country. Still reeling from the pandemic, blood splattering on our floors, we have been unable to catch our collective breath. Yet, those in the c-suites looking at sterile spreadsheets suggest “the numbers have never been better.” They say we’re seeing more patients and seeing them quicker. Those in government feel we can do our work even cheaper—recently cutting Medicare reimbursement even though, inflation adjusted, Medicare is paying us 26 percent less than a generation ago!¹

And yet we fight on.

We are the most burnt out specialty in back-to-back years, suffering from declining interest in our specialty from medical students. Those of us left in emergency departments hold the line, converting new single-patient rooms adorned with faux wood paneling and glass doors into internal waiting rooms. We conduct interviews in a manner dangerously close to killing the mandate of patient privacy to which we swore an oath and examine patients in reclining chairs (if we’re lucky). All this as we sift through the haystack of patients to find the needle whose life dangles dangerously close to the precipice.

This is modern day emergency medicine.

As researchers in this issue note on the cover, hallway medicine is not equal to the medicine we should be practicing. Boarding is getting worse, but ACEP and others are working to solve the problem. Let’s hope the administrators, our government leaders, and the public will heed our siren call from “in the trenches”—as one of the higher ups recently praised my team while touring the emergency department on a quiet Monday morning. Upon reflection, it must have been nice to tour our emergency department before the blitz of patients the rest of us knew would soon arrive.

Dr. Dark (@RealCedricDark) is associate professor of emergency medicine at Baylor College of Medicine and the medical editor in chief of ACEP Now.

References

1. Medicare physician payment is NOT keeping up with inflation. American Medical Association. Available at: https://www.ama-assn.org/system/files/medicare-updates-inflation-chart.pdf. Accessed Nov. 10, 2023.