COVID-19 Shines a Spotlight On a Broken Emergency Care System, Providing a Catalyst for Change

By Terry Mulligan DO, MPH

Over the last weeks and months, this unfortunate but predictable (and predicted) COVID-19 pandemic and its crippling impact on our emergency care system and the health care system in general has laid bare the already overwhelmed, overworked, overstressed state of EM and emergency care in our country. Glaringly evident on television every hour of every day, we see examples of the shortage of PPE, ventilators, medications and other emergency care resources; of physicians becoming sick and risking their very lives and the lives of their families; of physicians being fired or punished for speaking out about patient and staff safety; of the corporate practices of medicine that has crippled emergency medicine in the USA, even prior to the COVID-19 crisis. These problems have been obvious to all of us practicing emergency physicians for years but which are now slowly becoming obvious to the rest of our society: selling out long-term safety and stability in favor of short-term profits at the expense of health care workers and patients; the practice of running every emergency department and hospital (not to mention the impact on nearly every other industry and facet of our society) on the knife-edge, right next to the cliff, of squeezing out any and all overage, back-up, surge capacity, cushion and protection -- protections that are necessary for safe and proper provision of modern health care. Unfortunately, for many years similar practices such as these have kept the emergency care system, the hospital system and the health care system “running in the red”: over-extended, under-staffed, under-equipped, under-trained, under-appreciated, under-resourced and misunderstood. These practices have turned this current situation into a possible near-extinction event for the national and global economy, for local and national health care systems, for global public health and health responses, and of course for the many millions of people around the worlds who will likely become infected and may die.

One of the only good things about the the on-going global COVID-19 pandemic is that it can serve to shine a huge spotlight on our already crumbling, overworked, over-stressed emergency care system and our health care system in general, and should serve as the example of the detriments of putting profits over patients, of building hospitals and health care systems in order to make a tiny percentage of people rich at the expense of peoples' health and well-being and their very lives. It is the responsibility of all emergency physicians and especially those in positions of leadership to direct this spotlight, to act now to help all emergency physicians, our patients, our members, and to help the overall EM system during this immediate crisis and beyond. While all of us who work in emergency medicine and in our emergency departments will continue to show up on the front lines, to work in our already overflowing ERs now or soon to be literally bursting with sick and dying patients--we in EM leadership must work to turn this horrible and avoidable tragedy into a spark that could change and improve the entire emergency care system, that could transform our modern health care system into a system based on health, well-being, patient safety, equality, efficacy, timeliness, efficiency and patient-centeredness. We must not lose this opportunity to highlight this current crisis as yet another example of an emergency system being pushed to its limit, of yet another intentional bubble of need and exploitation created by short-sightedness and greed, of being run by corporate and business practices instead of by physicians and by medical ethics and human rights, and to highlight how best to make serious, bold and long-lasting improvements to the emergency care system.