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January 8, 1992

Patients Leaving Emergency Departments Without Being Seen by a Physician

JAMA. 1992;267(2):232. doi:10.1001/jama.1992.03480020041017

To the Editor.  —In response to a very timely editorial by Dr Kellermann,1 we propose adding further strategies to the five put forth by the American College of Emergency Physicians to address the problem of overcrowding of emergency departments.Not only has the cost of health care skyrocketed, the cost of obtaining a medical education has substantially increased as well. It is now common to see physicians graduating from medical school with debts greater than $100000. Many minority graduates are dissuaded from returning to work in the inner city by the financial pressures of repaying student loans and providing for their families. In many cases, the choice of specialty training itself is dictated by financial considerations rather than aptitude or interest. There are no financial incentives to encourage graduating residents with high educational debts to return to the inner city where reimbursement on a per-case basis is low