Contributor: emergency in emergency medicine

If you have been at an ER lately – or if you’ve watched the television show with concern with concern “The Pitt” – you have seen scenes that look more like field hospitals than advanced medical centers. The waiting rooms have been transformed into makeshift care areas. Chairs, beds and cabins serve as Gurneys. Providers Globe Eye The sick and injured orders and “hunting rifles” for patients. It seems chaotic and unwelcome because it is the case.

This is the new standard for emergency services in the United States, the result of a spectacular increase in the number of beds occupied by patients waiting for a space in a traditional hospital room. We call them “boarders” and in many emergency services, they regularly represent half or more of all the available care spaces.

With a fraction of beds at stake for newcomers, waiting room patients – even some arriving by ambulance – are more and more likely to be seen, examined and treated in the hall. The consequences are as predictable as it is devastating: results for more worse patients, fragmented care, longer hospital stays, hot air balloon costs and growing frustration and anger among staff and patients.

The assessment is less visible – but not less harmful – than this weighs on young doctors in training.

A recent study led by Dr. Katja Goldflam, a Yale teacher, documents the extent of the problem. Almost three -quarters of emergency medicine residents she interviewed said the boarding had highly negative effects on their training. They expressed anxiety and an increasing emotional assessment on their decreasing ability to manage patients or manage service waves with confidence, and their growing feeling that they could not provide the kind of care they would expect for their own family.

As an emergency medicine educators with six decades of experienced experience, this seems personal to us. We fail our trainees. We fail our patients. And we compromise the future of doctors and patients.

Damage is not theoretical. One of us recently lived it personally, when his father – in the last months of his life – visited two prestigious Ers. The two times, recently trained doctors have missed simple but potentially fatal problems after brief Stopgap style dating. A bad clinical judgment is more likely and more consecutive, in a precipitated and exceeded environmental environment.

Today, medical education is no longer focused on the memorization of facts. With smartphones, decision support tools and now AI, information is everywhere. What distinguishes a good doctor is the judgment – the ability to navigate uncertainty, to synthesize complex data and to make decisive and precise choices. The construction of this type of judgment requires many patient meetings – “reps”.

No quantity of class learning, reading or listening to Podcast can replace the formative experience of confrontation of a clinical puzzle in a patient who has entrusted you. However, in the crowds of today, doctors in training lose access to these meetings in face to face crucial and to the skills, the skills and the confidence they teach.

Shift changes “rounds” – once a space for discussion and reflection – now works more like inventory checks: here is a 78 -year -old man with heart failure, a 35 -year -old man with appendicitis awaiting gold.

Meanwhile, while the waiting room overflows, doctors disperse in the hall to see new arrivals, hoping to reduce the backlog. “Lobby Medicine” – A disinfected term for care provided in a stripped frame of intimacy, dignity and security – is more than a logistics nightmare. It sends a terrible message to young doctors: that the superficial evaluations of patients, the dismissal of broad spectrum tests and “moving the meat” is acceptable. It’s not.

Why is embarkation empire?

COVID-19 was the inflection point. While the volumes dropped early in the pandemic, they rebounded in a year – and in 2024, according to the metrics of the national hospital, stood 10% above 2021 levels. In 2023, Research has shown A 60% increase in boarding and a quadruple increase in median boarding times compared to pre-countryic ERs.

The reasons are complex and systemic: the financial pressure to keep the beds at the full hospital (each open space is lost in income), an aging population with larger needs, a decrease in access to primary care and a system of collapse of rehabilitation, qualified nursing or health health. Hospitals are supervised, forced to provide basic care during waiting days, sometimes weeks, so that the follow -up services are available. It is not uncommon for a third party or more patients in a hospital to be pending while waiting for an appropriate exit destination. The bottleneck takes place: the districts become detention areas, emergencies become a de facto district and the hall becomes emergencies.

So what is the correction?

The simple response – The end of boarding – has been the rallying of well -intentioned efforts for decades. Almost all failed. For what? Because overcrowding of emergency services is not the root problem. It is the canary of the coal mine of a system of service of dysfunctional health care riddled with incentives and poorly aligned priorities.

The real change will require a collective indignation which pours beyond ER, in the reception boxes and in the agendas of hospital administrators, insurance leaders and elected officials.

Consider trips by plane. Imagine if Los Angeles International Airport has closed three of its four tracks, forcing all takeoff and landing on one. Travelers would revolt. The Federal Aviation Administration would intervene. The system would be made to repair – because it is dangerous, ineffective and unbearable.

But when the same thing happens in health care, some patients can bark angry and frustrated in the face of expectations of several hours, but most of the shoulders, grateful, for an exhausted emergency time.

Enough.

If we want better health care, it means investing more – adding beds, staff and follow -up capacities. This means creating primary care options other than a default trip to emergency. This means recovering emergencies not only as a place of healing, but as a place of learning. A place where doctors are not taught in disaster areas, but in environments that allow the connection and understanding of our patients and their diseases. Finally, this means recognizing that the design and investment in better systems and in medical education are crucial to public security.

To form a large doctor is like to train a large athlete. You cannot learn to sink a three points while looking at YouTube. You have to get on the ground. In medicine, it means standing in front of a patient and deciding: what now?

This experience – raw, real and imperfect – is irreplaceable. And we lose it.

The way we take care of patients today will define how we will all be taken care of tomorrow.

ERic Snoey is a Attend an emergency doctor in Oakland. Mark Maroc is a doctor from Los Angeles and professor of emergency medicine.