When you're sick or hurt, you go to the doctor -- but not necessarily your personal doctor.
A new study published in the journal Health Affairs shows that only 45 percent of more than 350 million U.S. patient visits for a newly arising health complaint such as a cough, fever or stomach pain take place with a primary-care physician each year.
The rest take place at a hospital emergency room (28 percent), medical specialist's office (20 percent) or outpatient clinic (7 percent).
The report, based on government surveys of outpatient visits made between 2001 and 2004, found that patients without health insurance received more than half of their acute care in emergency departments.
But other recent research has found that even many insured families either don't have a regular doctor or have difficulty securing a timely appointment if they do.
A 2006 study estimated that more than 60 million Americans lack any relationship with a family doctor, a number that's likely swelled during the recession.
"More and more patients regard the emergency department as an acceptable or even the proper place to go when they get sick, and the reality is that the ER is frequently the only option,'' said Dr. Stephen Pitts, lead author of the study in Health Affairs and an associate professor of emergency medicine at Emory University in Atlanta.
"Primary-care doctors have packed schedules and their offices are typically closed in the evenings and on weekends,'' Pitts added. "Too often, patients can't get the care they need, when they need it, from their family doctor,'' so they turn to an ER. Yet, Pitts said, "Too often, emergency care is disconnected from patients' ongoing health-care needs."
Health-policy analysts have spent decades debating whether emergency departments are needlessly -- and expensively -- clogged with patients who are not in need of urgent care. Some studies have claimed that up to 80 percent of ER patients aren't true emergencies.
But emergency physicians, who make up about 5 percent of the nation's doctors, counter that most ER patients are there because they need to be, and point to a report issued by the federal Centers for Disease Control and Prevention in August as proof. Also based on survey data, it found that only 7.9 percent of patients who came to emergency departments in 2007 could be considered "non-urgent."
Dr. Angela Gardner, president of the American College of Emergency Physicians, noted the study showed that nearly two-thirds of the ER patients came in between 5 p.m. and 8 a.m. during the week or on weekends. "When you are the one who has a sick child, the last thing you want is a 'closed' sign or after-hours message."
Yet that's often what patients hear when they call their family physician, despite efforts by many general practitioners to better organize their offices with more nimble scheduling, time blocks set aside for the "same day" sick and a host of experiments to become "patient-centered medical homes."
Although the federal health reform package includes a number of provisions aimed at increasing the supply and availability of primary care in the long run, many experts doubt those steps can reverse a decades-long trend of fewer new doctors taking up primary care and of veteran family doctors fleeing the field or cutting back on hours years ahead of normal retirement age.
Of course, patients, and particularly parents and caregivers, may see emergencies where doctors -- and insurance companies -- do not. And there is a lot of uncertainty in whether a fever or a cough or sprain or cut represents an urgent health problem or something to gut out until you can get an appointment.
Another study in the same issue of Health Affairs, by analysts at Rand Corp., found that, in the United States, 27 percent of the patients going to emergency departments could be treated at a retail clinic (typically staffed by a nurse-practitioner) or an urgent-care center (such facilities usually have a doctor), based on the level of care provided in the ER.
However, that share dropped to about 17 percent when the researchers took into account the hours that those ER alternatives are typically open. Industry estimates show there are 10,000 to 20,000 urgent-care and retail clinics, but the study did not attempt to measure whether the facilities have the capacity to take on millions of additional patients.