By: Michael J. Sarabia, MD, FACEP

As we celebrate the fifteenth anniversary of the first freestanding emergency center (FEC) in the nation's southwest, we can reflect on the impact FECs have made on the delivery of emergency healthcare. Created to offload the overcrowded hospital ED while still providing superior care, FECs are an innovative venue for the delivery of the same emergency medicine available in the larger buildings of hospitals. The practice philosophy remains the same, and nationally 400+ facilities reach millions of patients annually.

In Texas we have witnessed the transformation of community standards from third-world level access to modern medicine – and with an improved overall patient experience. Once treated at an FEC (hospital or independently owned), patients "never want to experience healthcare any other way," as one FEC system promotes.

The free market that allows for independently owned and licensed FECs is to be credited for the rapid speed with which we have seen the long overdue transformation. There would be uproar should we ever go back to the old days of poor access, which just last year earned a grade of "D+" on the nation’s report card from the American College of Emergency Physicians (ACEP).

There was once concern that FECs would suppress hospital economics. On the contrary, hospitals are experiencing a growth phase where FECs are most numerous. Houston has been dubbed the "epicenter" of FECs, and yet its hospital EDs are experiencing alarming overcrowding. Paramedics have even been witnessed to advise patients to refuse transport and be seen at my FEC instead of the over-crowded hospital.

As bad as things are in Houston, they would clearly be worse without FECs. Patients wait times in EDs in Los Angeles, where there are no FECs, can exceed 24 hours! The contrast is remarkable, yet California is slow to acknowledge the casualties of the status quo.

Most who are against FECs have very little firsthand exposure to the model. In contrast, we now have the perspective of hundreds of ER doctors who work in FECs (both hospital and independently owned). The Section for FECs of ACEP recently conducted a survey of physicians and over 300 responded. Results showed that they believe:

• FECs are an important access point to emergency healthcare
• Patients are more satisfied with the care that they receive from FECs by comparison to hospital EDs
• FECs lessen burnout for the physicians who treat the patients.

In summary, freestanding emergency centers are here to stay. Recent modifications to current proposed legislation show that the news is getting around. FECs bring tremendous value to emergency healthcare, and they are clearly good for patients.

To learn more about this growing industry, please consider attending the inaugural National Conference for FECs (http://www.nafeconline.org/), co-sponsored by TCEP, TAFEC, and NAFEC.  This promises to be a celebration as we embark on the next fifteen years, during which a nation will surely be transformed for the better by FECs.

Michael J. Sarabia, MD, FACEP
Board Member, Texas Assoociation for Freestanding Emergency Centers
Founding Board Member, National Association for Freestanding Emergency Centers
Councillor, Section for FECs of ACEP
Medical Director, PhysiciansER
Attending, Baylor/St. Luke's Healthcare System