Actually it’s really simple - everyone uses the Emergency Department as their PCP because of EMTALA. No binding obligation to pay and they can’t be turned away. The public has come to look upon the emergency department as the community medical center where anyone can come with any complaint, at any hour of the day or night, and expect prompt and courteous attention.

The scope of emergency medicine is changing in response to this - when ED’s were in their infancy, you had a group of differing specialists that rotated shifts. Depending on what day/time you went in, you could have a cardiologist treating stroke patients, or a surgeon working with respiratory patients. It wasn’t until the late 60’s-70’s that you even had doctors that specialized in emergency care! All this is to say that since then, we have gotten better at saving people’s lives, and now the ED is inundated with patients that have chronic conditions. Med refills, chronic pains, dialysis patients… that’s not what the emergency department was designed for. What I think it’s pretty cool about the whole thing is that the ED is at the forefront of changes within public health care, and I think that it’s obvious that they are morphing into specialized community health clinics. I also think it’s inevitable that healthcare will become subsidized through taxes, but the insurance companies aren’t just going to go away.