Fixing Problems in the ED Goes Beyond 'Up or Out'

This transcript has been edited for clarity.

Robert D. Glatter, MD: Dr Gina Siddiqui, a fourth-year emergency medicine resident at Yale New Haven Hospital, wrote an essay entitled "A Doctor's Diary: The Overnight Shift in the E.R.," which was recently published in The New York Times.

It's a provocative piece that examines the social and economic forces that shape how demand eclipses our ability to provide adequate and appropriate care for a large percentage of patients we see in the emergency department (ED). Gina's previous experience as chief operating officer of a healthcare startup has also influenced her approach and outlook on healthcare and medical education.

Welcome, Gina. It's such a pleasure to have you join us today.

Gina Siddiqui, MD: Thanks for having me.

Glatter: Congratulations on this piece. It rings so true, and many of my colleagues have read it. I wanted to reach out and interview you because the reality that you describe really strikes at the heart of emergency medicine. And the "up or out" thesis you have is very true. Can you describe that and what your impetus was for putting this piece out?

Siddiqui: I think that the fundamental problem of "up or out" is really about us having basically one hammer in the ED, and that's the hospital.