[weakfortress]

I'd like to add one more thing to this you probably experienced as well. My family has several people in medicine. All of them have done a stint in a hospital before quitting for greener pastures.

The homeless problem (now renamed "experiencing homelessness" as if this is a cure-all) has reached such critical mass that hospital beds fill up with patients that have no ailments. How do they do this? I'm sure you know. A homeless person who is either withdrawing, or cold, or hungry, or just a nuisance will come into the ER and tell the attending that they are suicidal. At this point a bunch of alarms go off. At least here where I live this means they are issued a bed immediately ahead of nearly all other patients and subject to 24 hour monitoring. They can, depending on hospital load, be given free room and board for up to 72 hours before a psychiatrist is mandated to give them a cursory once-over before sending them back to the street. They'll be back next week, once again suicidal, and once again consuming more resources than they will ever in their life time put back in.

The hospital can do nothing because turning down one of them who is actually suicidal would damage the hospital. So, people with actual real problems are pushed even further to back or left to line the hallways on gurneys because a homeless person was mildly inconvenienced by their, in all likelihood, self-imposed suffering.

Your notes on primary care are spot on. That has been my experienced as a layman with medical family. I know what they are going through yet I still feel shortchanged and often ignored by my PCP. Private clinics are no better.