ER the uninsured primary care clinic?

I would say that about 60% of the patients we see at this ER are not even close to emergency. Of those 60% about 80% are uninsured and have now where else to go to see a doctor. It is an interesting dynamic and it is about 3 - 4 generations deep. For example when grandma was sick she went to the ER, so when mom was sick she went to the ER and now all of Mom's kids and Grandma's grandkids all go to the ER for a sore throat. 

How did this start? I am not sure but in today's generation, these patients have an illness and try to make an appointment to see a doctor and the doctor asks what insurance do you have, and the patients responds with public aid or no insurance. They are consequently told that "the doctor does not see public aid or take uninsured patients". They may try this a few times with different doctors and finally they just come to the ER because they know they will get seen at the ER. It's the law. 

Once in the ER if they do not have a primary care doctor they get assigned to the on call internist or pediatrician. I get to call the on call doctor and tell him/her we have an uninsured patient here for you that you now have to see. As you can imagine the on call doctor is never very happy about this. So, Why would he sign up for call in the first place? A lot of hospitals require a certain amount of call to be on staff, some hospitals pay a nominal rate to take call and others rely on the other insured patients who get referred to them through the same process. 

If the on call doctor does have to come in and see the uninsured patient you can be sure that he is not getting paid. In fact, it costs him money to come in and see the patient and makes him liable because he can and occasionally will get sued by these same patients. 

These are just things I have observed about our medical system as I have worked here in the ER. I am not trying to make any statements or judgements, but just simply saying; here is what I have seen. 

Now I must leave to get to the hospital for my overnight shift. It is friday and I am sure the drinking/drugs have begun so it should be a good night and a busy night. All these partying people keep the ER busy. I shall go down and report!