Where Americans Get Acute Care: Increasingly, It’s Not At Their Doctor’s Office

TLDR

Acute care in the U.S. is increasingly delivered outside primary care, with only 42 % of visits to personal physicians and the remainder to emergency departments, specialists, or outpatient clinics, where emergency physicians handle a quarter of encounters despite being fewer than 5 % of doctors.

Abstract

Historically, general practitioners provided first-contact care in the United States. Today, however, only 42 percent of the 354 million annual visits for acute care--treatment for newly arising health problems--are made to patients' personal physicians. The rest are made to emergency departments (28 percent), specialists (20 percent), or outpatient departments (7 percent). Although fewer than 5 percent of doctors are emergency physicians, they handle a quarter of all acute care encounters and more than half of such visits by the uninsured. Health reform provisions in the Patient Protection and Affordable Care Act that advance patient-centered medical homes and accountable care organizations are intended to improve access to acute care. The challenge for reform will be to succeed in the current, complex acute care landscape.