Dr. Matthew Cross
Over a year ago, the way I practiced medicine disgusted me. I worked in a busy emergency room in a large metropolitan hospital in San Antonio that had long waits, no available hospital beds, overworked staff, and a continuous flow of ambulances waiting outside.
I was constrained to performing abdominal exams with patients sitting in chairs instead of lying prone, having personal medical discussions with patients given only a thin curtain for privacy, and constantly apologizing for the ever-long wait times. With so few beds available, I witnessed a patient with a hip fracture forced to remain in a wheelchair and a man with a collapsed lung and multiple rib fractures sitting in obvious distress in a waiting room chair.
When I moved to freestanding emergency rooms, the changes were immediate and overwhelming. Now, all patients have a bed within minutes of arriving, the fully built, multi- room facility provides total privacy and, most satisfyingly, I never find myself questioning whether I’m ethically providing the best possible care to my patients.
Texas currently ranks 47th in the nation in emergency care and received a “F” for access from the American College of Emergency Physicians. Freestanding emergency rooms are alleviating this disaster but have recently been under attack.
Locally, an opinion article published by the HZ on May 5 written by Benard Swift, a physician and owner of urgent care facilities throughout South Texas, misinforms and misleads the public by giving a false description of medical care in the freestanding emergency room (FSER).
The article written by Dr. Swift references a March study comparing costs of FSERs, hospital-based ERs (HBER), and urgent care clinics (UCC) by looking only at final diagnoses. While a final diagnosis is a commonly accepted method for research, it is not a fair way to judge what a prudent layperson believes is an emergency. Your child may have abdominal pain, and you may believe they have appendicitis. Until they are diagnosed with a less severe cause, it is an emergency. The less severe final diagnosis will still be abdominal pain, but the value is ruling out the surgical emergency. Also, the study fails to adjust its findings for age, medical complexity, or acuity level. A 60-year-old with history of cancer having leg pain is different from a healthy 20-year-old with the same compliant.
UCCs may be less expensive, but they do not offer the same services as the emergency department settings provided in FSERs. Emergency care facilities are 24/7/365, have an ER trained, board certified physician and RN at all times, must maintain state of the art equipment, and have laboratory capabilities, radiology, CT scanners, and ultrasound equipment. With fewer services offered and less highly trained personnel on staff, urgent cares do not meet these same standards. Comparing the two is like comparing apples and oranges and it should come as no surprise that UCCs are less expensive.
Dr. Swift also states that FSERs are inferior to hospital-based ERs, a subjective claim that should ring false to anyone who has experienced both facilities. The freestanding emergency room provides a safer, cleaner environment and sees patients in a considerably timelier manner. FSERs are usually positioned in areas where access is easy (try navigating the San Antonio medical center area when in a medical emergency).
Furthermore, obtaining labs or radiology results and starting treatments including antibiotics or pain medication is much faster in FSERs. I can have antibiotics started for a severe infection faster than most HBERs can get a patient to a room. As for heart attacks and strokes, FSERs have comparable times for heart-catherization and giving “clot busting” medications for strokes. Most HBERs are not heart, stroke, or trauma centers as Dr. Swift mentioned.
Dr. Swift’s mischaracterization of the FSER teeters dangerously close to jeopardizing patient health by working to steer employers and individual patients with emergency conditions to overcrowded or less capable facilities.
Having worked in both the hospital and freestanding emergency room, I have seen the difference in quality and service. But as a physician, I urge anyone with symptoms of an emergency condition to immediately visit the closest-possible emergency facility.
The sooner you can be seen and treated, the better. The only groups that benefit from decreased patient access to health care are the insurance companies.
Dr. Matthew Cross is a board certified emergency physician and medical director for Physicians Premier Emergency Centers, a chain of 7 FSERs located in New Braunfels, San Antonio, and Corpus Christi.
View the original article in the New Braunfels Herald-Zeitung here.