Written by: Dr. Wyatt Decker
Published: March 2, 2026

Americans walk into an emergency room more than 150 million times every year for any number of reasons — chest pain, broken bones, a worsening illness or a traumatic injury. 

In almost every instance, they are met with experienced doctors and nurses and some of the highest quality clinical care in the world. The number of lives saved in ERs across the U.S. is incalculable.

And yet, the ER has become a microcosm of everything that is wrong with the health system. Long waits and expensive care. Overcrowding and underfunding. Burned out doctors and frustrated patients.

ER visits have increased steadily over the last decade, and often for reasons that are relatively benign. I saw this frequently during my 20-plus years as a practicing emergency physician: people who came to the emergency room because they couldn’t fill their prescription, couldn’t get in to see their doctor, or simply had nowhere else to go.

I recall one patient, Mrs. Gonzales, who arrived at the ER one weekend with swollen ankles and shortness of breath. After evaluating her, it was clear she had decompensated heart failure, one of many chronic diseases that can be easily managed with lifestyle changes and generic drugs.

But how she arrived at my ER was more interesting. In the week leading up to her visit, she noticed her ankles were swelling more than usual. Then she stopped walking to her corner market because she would be short of breath within just a few steps. Lacking a primary care doctor, she reached out to several clinics, but they were booked out for months or didn’t take her insurance. By Friday afternoon she began gasping for air even while sitting in her apartment. She called her daughter, who was understandably alarmed and called 911 who immediately dispatched an ambulance.

Mrs. Gonzales’ story is not unique. I saw a version of this scenario play out hundreds of times during my career.

The harsh reality is we have failed both patients and clinicians by creating the system we have today, where the emergency room is the first place you go, not the last resort. It’s a product of our fee-for-service system that has deprioritized primary care, preventive medicine and evidence-based interventions that keep people healthy over the long-term.

The system can be better. Skilled experts can get to you earlier and with fewer hoops to jump through. It can surround you with nurses, doctors, specialists, pharmacists and home health workers who work together to intervene earlier and with a more holistic view of your health. It can have your back during an emergency, but it can also try and stop that emergency from happening in the first place.

Proactive care models that deliver better outcomes are the answer. A recent study compared traditional Medicare members and Medicare Advantage members in fully-accountable care models — meaning physicians were accountable for the cost and quality of patient care. Those in fully accountable models were nearly 20% less likely to use the ER unnecessarily.

Emergency rooms exist for a reason. With the right approach, better care coordination, and aligned incentives, we can begin preventing manageable health conditions from reaching the point where the ER is the only option.