I am a family physician by training, and I thank God every day for that foundation. About a decade ago, I transitioned to emergency medicine, thinking I’d left primary care behind. Back then, primary care problems—hypertension, diabetes, routine medication refills—would occasionally show up in the ER, but they weren’t the norm. Fast forward to today, and they’ve become a central part of my shift.
It’s not because people suddenly decided the ER was a convenient place to manage their chronic conditions. It’s because many patients no longer have a choice.
In countless towns across America, primary care physicians are retiring or leaving, and there aren’t enough replacements to meet the demand. Patients who once had a trusted doctor now find themselves scrambling for care. When they call the remaining clinics, they’re often told, “We’re booked for months,” or worse, “We’re not accepting new patients.” The advice they get? “Go to the ER.”
And so they come.
In a single day, I might treat a diabetic patient in desperate need of insulin, a child with a routine ear infection, an elderly woman who needs her blood pressure medication refilled, and a young adult battling depression who can’t get in to see a psychiatrist. The ER has become the safety net for everything—not just emergencies but also the holes in our health care system.
This isn’t what emergency medicine was designed for, and the strain is palpable. It’s not just the patients who are suffering; it’s the health care workers, too. The system is stretched so thin that burnout has become an epidemic. I’ve seen talented, compassionate colleagues walk away from medicine altogether, pushed to the brink by a relentless and unsustainable workload.
So, what’s the solution?
We have to prioritize prevention. We know that prevention reduces costs and saves lives. It’s far cheaper—and more humane—to help a patient manage their diabetes early than to treat them for a stroke or amputation later.
We also need to make primary care a more attractive career choice for young physicians. Right now, the incentives are misaligned. Medical students graduate with mountains of debt, and primary care often pays less than specialties. We need to reward prevention—not just financially but by recognizing its critical role in keeping our communities healthy. We need to reimagine medicine where we work to keep people healthy. We say there is a shortage of doctors, but we are working against our best interest.
I don’t know how much more stress our system can take before it reaches a breaking point. I just hope we can act before it’s too late.
Until then, I’ll keep doing what I can in the ER, knowing I’m often the only doctor standing between my patients and a complete collapse of their care. But this is no long-term solution. It’s a bandage on a system that desperately needs surgery.
Pamela Buchanan is a board-certified physician, speaker, and thought leader dedicated to transforming health care and championing mental well-being. With more than 20 years of medical experience, she is a TEDx speaker known for her powerful talk on “Emotional Flatline,” which explores the emotional toll of high-stress professions, particularly in emergency rooms during the pandemic. As the author of The Oxygen Mask Principle and Emotional Flatline, Dr. Buchanan teaches self-care as a revolutionary act for working mothers, health care professionals, and high achievers.
In addition to her work as a physician advocate and ambassador with the Lorna Breen Foundation, her work extends to coaching and consulting, focusing on helping physicians navigate burnout and preventing burnout in medical students and residents. She strives to keep more physicians practicing. Dr. Buchanan’s mission is to help people break free from burnout, prioritize self-care, and live with purpose.
Dr. Buchanan is the founder of Strong Medicine and can be contacted for coaching, workshops, and speaking engagements. She can also be reached on TikTok and Instagram.
