Emergency rooms visits up year over year on clarkhoward.com

The latest stats from the Center for Disease Control show emergency rooms visits are up. Some 120 million of us visited the ER in 2006 -- the last year for which records are available.

Historically, the ER has been for uninsured people. But today, a very large numbers of insured individuals are making the trek -- even for non-emergency conditions in the middle of the day.

What's going on? Well, many people no longer have primary care doctors. So they just go to the hospital. Not a good idea. The wait is very long and you have to be assessed in triage; there's no "first come, first serve" service. The visits are also massively expensive even with insurance.

If you do have insurance, you'd be better off taking the time to pick a primary care doctor. This also allows for continuity of care and easy follow-up visits.

But most people won't get around to selecting a primary care doc. That's why there are alternatives like "nurse-in-a-boxes," which can be found at supermarkets, drug stores, Wal-Marts, etc. Nurse-in-a-boxes usually have a price list so you know how much you'll pay to be seen by a nurse practitioner.

Another alternative comes in the form of Doctor of Nursing Practice programs being offered at some 200 schools. These doctoral-level programs require nurses to take the same qualifying exam as a doctor. Clark loves that the marketplace is developing an answer to the primary care crunch.

What others are saying

Emergency care
I went to the emergency room for chest & stomach pains, was diagnosed with a severe case of fibroids that are life threatening because I have almost no oxygen, iron or blood. I told the Doctor I had no insurance, job or money, the Doctor told me it was Georgia Law, they could not refuse to see me at a clinic he himself referred me to, and that I had to contact the clinic immediately after being discharged. I did so and I am being refused service unless I have money at the Doctor's office he referred me to. I could literally die from this illness if I do not get the attention I need.i am suffering every single day that I wake up. They are refusing service without giving me an excuse. It may be because of my last name (Muhammad). What should I do?
Thank you.
Respectfully,
L.M.
By L.M. @ 09/17/09 12:35:13 PMreport abuse
response
As a physician, I think this is NOT a good idea since although these nurse practicioners make take the same test they certainly do not have the same clinical training as a physician (ie 3 year residency with 80 hours a week of clinical training) that you would see in an internal medicine physician. REALLY think about that when you put your life and health in their hands!
By RB @ 05/18/09 03:08:38 AMreport abuse
ER for the uninsured
The statement "Historically, the ER has been for uninsured people" is just not accurate. Historically, the ER has been for people with serious or life-threatening illnesses or injuries which require immediate attention in order to save lives and/or avoid further complications. An insured person would be foolish to use the ER for non-emergency care because the usual ER visit co-pay is $50., and when the claim for their ER visit is reviewed by the insurer it will be denied if the patient's condition was not a true emergency. In that case the patient will be responsible for the entire bill.

Most health insurers require their members to choose a primary care provider, or one will be chosen for them. If a patient calls his physician with a problem and is advised to go to the ER, that bill will almost always be paid by the insurer.

The high usage of the ER by uninsured people with non-emergency health problems has contributed significantly to the difficulties experienced by most hospital ERs and the closure of many. These people tie up physicians, nursing staff, and exam rooms, which result in these resources not being available to the true emergencies such as stroke, heart attack, fractures, etc. Also, care for the uninsured is usually not reimbursed, which then requires the hospital to absorb the loss or pass it on to the paying patients.
By Elizabeth @ 11/26/08 05:52:11 PMreport abuse
Doctor of Nursing Practice
A Nurse Practitioner with a DNP may be called Doctor based on earning the DNP or PhD degree, but she or he is not a medical doctor. The DNP is Doctor of Nursing Practice and this professional may be a Board Certified Nurse Practitioner (may be a generalist or specialist) or an Advanced Nurse Clinician such as a Certified Nurse Midwife, a Certified Nurse Anesthetist,or a Certified Psych-Mental Health Nurse Therapist. All are RNs, licensed by their state regulatory agencies if they are in clinical practice.
To the medical student, a nurse with an earned doctorate is also a 'real' doctor, and the nurse with the DNP title may introduce(depending on state regs) herself/himself as Dr XXX, Nurse Practitioner (this must be clear to patient). Generally, the nurse with a PhD uses the title 'Doctor' in non-clinical situations.
By Paula Sumner MSN, FNP-BC @ 10/09/08 10:14:24 PMreport abuse
Doctor of Nursing Misinformation
A nurse with a Doctor of Nursing Practice Degree is still a nurse, not a physician. They do not take the same board exam as a physician. In fact, without a degree in medicine, they would be ineligible to sit for any such exam. Medicine and Nursing are quite different fields of study.I previously enjoyed your radio show and valued your advice; however, I now question whether there are other topics, where you are also providing misinformation to your listeners.
By Robert Dhein, M.D. @ 09/08/08 06:03:25 PMreport abuse
no choice except ER
I recently lost my job and insurance. I've tried free clinics to no avail and no DR will see me w/o money. I went to ER because my BP was at stroke level one day. Do I deserve to die just because I have no money?
By rita @ 08/17/08 11:33:45 AMreport abuse
junk E.R. visits
In my opinion, a medical emergency is 'a sudden unexpected occurance hazardess to life or limb'. A snotty nose, a common headache, or a skin rash for 3 weeks is NOT an emergency. Almost all over-the-counter medicines WERE PRECRIPTION at one time. They STILL WORK, and are LESS expensive. Keep out of E.R.s! E.R.s have some of the worst germs because of all the sick people there. In my 30 yrs. experiance as a M.D. many of my patients who went to an E.R. at nite didn't even get their prescriptions filled!!!!!! Now that's a real wasted visit.
By m podobnikar @ 08/16/08 02:37:30 PMreport abuse
Stop getting it WRONG, Clark!
You posted a prior article saying that the DNP's (Dr of Nurse Practitioners) take the same qualifying exam. That's completely and utterly wrong! The same ORGANIZATION makes up both sets of exams, but they are hardly the same. Real doctors have to take 3 exams lasting a total of 4 days (darn expensive exams, I might add). That's to even be eligible for a medical license. A board-certified doc has to sit for another expensive exam usually 1-2 days long. NURSE PRACTITIONERS DO NOT TAKE THE SAME EXAMS!
By Medical Student @ 08/14/08 04:08:40 PMreport abuse
primary care
RJ makes an excellent point. When I was a kid you could call a doctor and they would make a house visit. Now you get an answering service with a recorded message telling you to go to the ER. And, if you do try to make an appointment with your primary care doctor you might have to wait a week or more to get in. If they say you can't wait, they again direct you to the ER. The ER is just a dumping ground.
By Ben @ 08/14/08 09:29:43 AMreport abuse
primary care?
Most of us have a primary care doctor, and when we call for a quick appointment we are advised by the automatic answering device to call 911.
Keep in touch !!
By Rj @ 08/14/08 08:32:50 AMreport abuse

Emergency care

I went to the emergency room for chest & stomach pains, was diagnosed with a severe case of fibroids that are life threatening because I have almost no oxygen, iron or blood. I told the Doctor I had no insurance, job or money, the Doctor told me it was Georgia Law, they could not refuse to see me at a clinic he himself referred me to, and that I had to contact the clinic immediately after being discharged. I did so and I am being refused service unless I have money at the Doctor's office he referred me to. I could literally die from this illness if I do not get the attention I need.i am suffering every single day that I wake up. They are refusing service without giving me an excuse. It may be because of my last name (Muhammad). What should I do?
Thank you.
Respectfully,
L.M.

By L.M. @ 09/17/09 12:35:13 PMreport abuse

response

As a physician, I think this is NOT a good idea since although these nurse practicioners make take the same test they certainly do not have the same clinical training as a physician (ie 3 year residency with 80 hours a week of clinical training) that you would see in an internal medicine physician. REALLY think about that when you put your life and health in their hands!

By RB @ 05/18/09 03:08:38 AMreport abuse

ER for the uninsured

The statement "Historically, the ER has been for uninsured people" is just not accurate. Historically, the ER has been for people with serious or life-threatening illnesses or injuries which require immediate attention in order to save lives and/or avoid further complications. An insured person would be foolish to use the ER for non-emergency care because the usual ER visit co-pay is $50., and when the claim for their ER visit is reviewed by the insurer it will be denied if the patient's condition was not a true emergency. In that case the patient will be responsible for the entire bill.

Most health insurers require their members to choose a primary care provider, or one will be chosen for them. If a patient calls his physician with a problem and is advised to go to the ER, that bill will almost always be paid by the insurer.

The high usage of the ER by uninsured people with non-emergency health problems has contributed significantly to the difficulties experienced by most hospital ERs and the closure of many. These people tie up physicians, nursing staff, and exam rooms, which result in these resources not being available to the true emergencies such as stroke, heart attack, fractures, etc. Also, care for the uninsured is usually not reimbursed, which then requires the hospital to absorb the loss or pass it on to the paying patients.

By Elizabeth @ 11/26/08 05:52:11 PMreport abuse

Doctor of Nursing Practice

A Nurse Practitioner with a DNP may be called Doctor based on earning the DNP or PhD degree, but she or he is not a medical doctor. The DNP is Doctor of Nursing Practice and this professional may be a Board Certified Nurse Practitioner (may be a generalist or specialist) or an Advanced Nurse Clinician such as a Certified Nurse Midwife, a Certified Nurse Anesthetist,or a Certified Psych-Mental Health Nurse Therapist. All are RNs, licensed by their state regulatory agencies if they are in clinical practice.
To the medical student, a nurse with an earned doctorate is also a 'real' doctor, and the nurse with the DNP title may introduce(depending on state regs) herself/himself as Dr XXX, Nurse Practitioner (this must be clear to patient). Generally, the nurse with a PhD uses the title 'Doctor' in non-clinical situations.

By Paula Sumner MSN, FNP-BC @ 10/09/08 10:14:24 PMreport abuse

Doctor of Nursing Misinformation

A nurse with a Doctor of Nursing Practice Degree is still a nurse, not a physician. They do not take the same board exam as a physician. In fact, without a degree in medicine, they would be ineligible to sit for any such exam. Medicine and Nursing are quite different fields of study.I previously enjoyed your radio show and valued your advice; however, I now question whether there are other topics, where you are also providing misinformation to your listeners.

By Robert Dhein, M.D. @ 09/08/08 06:03:25 PMreport abuse

no choice except ER

I recently lost my job and insurance. I've tried free clinics to no avail and no DR will see me w/o money. I went to ER because my BP was at stroke level one day. Do I deserve to die just because I have no money?

By rita @ 08/17/08 11:33:45 AMreport abuse

junk E.R. visits

In my opinion, a medical emergency is 'a sudden unexpected occurance hazardess to life or limb'. A snotty nose, a common headache, or a skin rash for 3 weeks is NOT an emergency. Almost all over-the-counter medicines WERE PRECRIPTION at one time. They STILL WORK, and are LESS expensive. Keep out of E.R.s! E.R.s have some of the worst germs because of all the sick people there. In my 30 yrs. experiance as a M.D. many of my patients who went to an E.R. at nite didn't even get their prescriptions filled!!!!!! Now that's a real wasted visit.

By m podobnikar @ 08/16/08 02:37:30 PMreport abuse

Stop getting it WRONG, Clark!

You posted a prior article saying that the DNP's (Dr of Nurse Practitioners) take the same qualifying exam. That's completely and utterly wrong! The same ORGANIZATION makes up both sets of exams, but they are hardly the same. Real doctors have to take 3 exams lasting a total of 4 days (darn expensive exams, I might add). That's to even be eligible for a medical license. A board-certified doc has to sit for another expensive exam usually 1-2 days long. NURSE PRACTITIONERS DO NOT TAKE THE SAME EXAMS!

By Medical Student @ 08/14/08 04:08:40 PMreport abuse

primary care

RJ makes an excellent point. When I was a kid you could call a doctor and they would make a house visit. Now you get an answering service with a recorded message telling you to go to the ER. And, if you do try to make an appointment with your primary care doctor you might have to wait a week or more to get in. If they say you can't wait, they again direct you to the ER. The ER is just a dumping ground.

By Ben @ 08/14/08 09:29:43 AMreport abuse

primary care?

Most of us have a primary care doctor, and when we call for a quick appointment we are advised by the automatic answering device to call 911.
Keep in touch !!

By Rj @ 08/14/08 08:32:50 AMreport abuse

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Aug 13, 2008 -- Emergency rooms visits up year over year

What others are saying