Science
Contributor: The emergency in emergency medicine
If you have been to an ER lately — or if you’ve watched the disturbingly accurate TV show “The Pitt” — you’ve seen scenes that resemble field hospitals more than state-of-the-art medical centers. Waiting rooms have been turned into makeshift care zones. Chairs, cots and cubicles serve as gurneys. Providers eyeball the sick and injured and “shotgun” orders for patients. It feels chaotic and unwelcoming because it is.
This is the new normal for emergency departments in the United States, the result of a dramatic rise in the number of ER beds occupied by patients waiting for a space on a traditional hospital ward. We call them “boarders” and in many emergency departments, they routinely account for half or more of all available care space.
With a fraction of beds in play for new arrivals, waiting room patients — even some arriving by ambulance — are increasingly likely to be seen, examined and treated in the lobby. The consequences are as predictable as they are devastating: worse patient outcomes, fragmented care, longer hospital stays, ballooning costs and rising frustration and anger among staff and patients.
Less visible — but no less harmful — is the toll this takes on young doctors in training.
A recent study led by Dr. Katja Goldflam, a Yale professor, documents the scale of the problem. Nearly three-quarters of the emergency medicine residents she surveyed reported that boarding had highly negative effects on their training. They expressed anxiety and a mounting emotional toll over their diminishing ability to manage patients or handle department surges with confidence, and their growing sense that they could not provide the kind of care they’d expect for their own families.
As emergency medicine educators with a combined six decades of experience, this feels personal to us. We are failing our trainees. We are failing our patients. And we are compromising the future of doctors and patients alike.
The damage is not theoretical. One of us recently experienced it personally, when his father — during the final months of his life — visited two prestigious ERs. Both times, recently trained physicians missed straightforward but life-threatening problems after brief, stopgap-style encounters. Poor clinical judgment is more likely, and more consequential, in a hurried and overwhelmed care environment.
Today, medical education is no longer centered on memorizing facts. With smartphones, decision-support tools and now AI, information is everywhere. What sets a good doctor apart is judgment — the ability to navigate uncertainty, synthesize complex data and make decisive, accurate choices. Building this kind of judgment requires many patient encounters — “reps.”
No amount of classroom learning, reading or podcast listening can replace the formative experience of confronting a clinical puzzle in a patient who has entrusted you with their care. Yet in today’s crowded ERs, physicians in training are losing access to these crucial face-to-face encounters and the skills, competence and confidence they teach.
Shift change “rounds” — once a space for discussion and reflection — now operate more like inventory checks: Here’s a 78-year-old with heart failure, there’s a 35-year-old with appendicitis still awaiting an OR.
Meanwhile, as the waiting room overflows, doctors scatter into the lobby to see new arrivals, hoping to reduce the backlog. “Lobby medicine” — a sanitized term for care delivered in a setting stripped of privacy, dignity and safety — is more than a logistical nightmare. It sends a terrible message to young physicians: that cursory patient assessments, firing off broad-spectrum tests and “moving the meat” is acceptable. It is not.
Why is boarding getting worse?
COVID-19 was the inflection point. While volumes dipped early in the pandemic, they rebounded within a year — and in 2024, according to national hospital metrics, stood at 10% above 2021 levels. In 2023, research showed a 60% increase in boarding and fourfold increase in median boarding times compared with pre-pandemic ERs.
The reasons are complex and systemic: financial pressure to keep hospital beds full (every open space is lost revenue), an aging population with greater needs, dwindling access to primary care and a collapsing system of rehab, skilled nursing or home health options. Hospitals are boxed in, forced to provide basic care while waiting days, sometimes weeks, for aftercare services to become available. It is not uncommon for a third or more of the patients in a hospital to be on hold pending an appropriate discharge destination. The bottleneck trickles down: Wards become holding areas, the ER becomes a de facto ward and the lobby becomes the ER.
So, what’s the fix?
The simple answer — just end boarding — has been the rallying cry of well-intentioned efforts for decades. Nearly all have failed. Why? Because emergency department crowding is not the root problem. It’s the canary in the coal mine of a dysfunctional healthcare delivery system riddled with misaligned incentives and priorities.
Real change will require collective outrage that spills beyond the ERs, into the inboxes and onto the agendas of hospital administrators, insurance executives and elected officials.
Consider air travel. Imagine if Los Angeles International Airport shut down three of its four runways, forcing all takeoffs and landings onto one. Travelers would revolt. The Federal Aviation Administration would intervene. The system would be made to fix itself — because it’s unsafe, ineffective and unsustainable.
But when the same thing happens in healthcare, some patients may bark in anger and frustration at the multi-hour waits, but most simply shrug, grateful, finally, for an exhausted ER doc’s time.
Enough.
If we want better healthcare it means investing more — adding beds, staffing and aftercare capacity. It means creating primary care options other than a default trip to the ER. It means reclaiming the ER not just as a place for healing, but as a place for learning. A place where doctors are taught not in disaster zones, but in environments that allow for connection and understanding of our patients and their diseases. Finally, it means recognizing that designing and investing in better systems and in medical education is crucial to public safety.
Training a great doctor is like training a great athlete. You can’t learn to sink a three-pointer by watching YouTube. You have to step onto the court. In medicine, that means standing in front of a patient and deciding: What now?
That experience — raw, real and imperfect — is irreplaceable. And we’re losing it.
How we care for patients today will define how we all will be cared for tomorrow.
Eric Snoey is an attending emergency medicine physician in Oakland. Mark Morocco is a Los Angeles physician and professor of emergency medicine.
Science
Video: NASA Announces Artemis III Crew
new video loaded: NASA Announces Artemis III Crew
transcript
transcript
NASA Announces Artemis III Crew
NASA announced the crew of Artemis III mission, which will fly to low-Earth orbit to test rendezvous and docking maneuvers with one or two lunar landers.
-
“I am excited to welcome you as the next crew in the Artemis journey to successfully return to the moon — this time to stay.” “I’m honored by the role that I’ve been given. I’m also very humbled by the task in front of us. But first and foremost, I’m grateful.” “So with that, the Artemis II crew, comrade, hands you the baton. You got the controls.” “As you know, we had a significant anomaly at our Launch Complex 36A on May 28. We’ve redoubled our efforts and are moving forward.”
By Alisa Shodiyev Kaff
June 9, 2026
Science
Santa Monica Mountains’ last steelhead trout survived the Palisades fire — and even had babies
Scientists feared the Santa Monica Mountains’ last remaining steelhead trout were dead, smothered by debris flows unleashed by the Palisades fire.
But the endangered fish surprised them: A team of biologists recently spotted 30 of the rare trout — and 21 babies — in Topanga Creek.
“There was a lot of happy dancing in the creek,” said Rosi Dagit, principal conservation biologist for the Resource Conservation District of the Santa Monica Mountains, which works with public and private landowners to conserve natural resources.
That’s because the steelhead here are endangered, at both the state and federal levels. Once, they swam in most streams of the Santa Monicas, but their numbers plummeted amid overfishing and coastal development. Increasingly frequent wildfire has further stressed their habitat. Topanga Creek, a biodiversity hot spot, is home to their last known population in the mountains that stretch from the Hollywood Hills to Point Mugu in Ventura County.
The trout that were spotted, including this one, are part of a distinct Southern California population that’s listed as endangered at the state and federal levels.
(RCDSMM Stream Team)
The California Department of Fish and Wildlife spearheaded a complex mission to rescue trout threatened by the Palisades fire that sparked in January 2025.
Time was of the essence. The fire hadn’t yet been fully contained. But rain was on the way, which would sweep massive amounts of sediment from the denuded hillsides into the water. Fish are often killed this way.
Crews stunned the fish with electricity, scooped them up in buckets, trucked them to a hatchery and ultimately moved them to Arroyo Hondo Creek in Santa Barbara County.
Within days, Topanga Creek was choked with mud. Some assumed the fish left behind were goners.
But in March, the conservation district’s team found four. The following month, when water conditions were clearer, they saw more.
“These fish continue to amaze me,” said Kyle Evans, environmental program manager for the state Department of Fish and Wildlife, who had seen the damage to the creek. “I had seen populations get wiped out in similar situations. So when I heard, I was thrilled.”
Evans surmises the fish that survived were in an area of the creek where less charred material and sediment were swept in.
“These fish likely hunkered down, were hiding under some rocks or places to try to get away from the main concentration of flow,” he said. “And luckily they weren’t buried.”
The ones that were spotted were fairly small, around 6 to 14 inches. Rainbow trout and steelhead trout are the same species, but with different lifestyles. If the fish remain in freshwater, they’ll be considered rainbows. However, they can migrate to the ocean and become steelhead, where they typically grow larger before returning to their natal waters to spawn.
Topanga Creek hasn’t fully recovered from the damage it sustained, but scientists say it’s looking better. Surveys last year were “so depressing,” Dagit said, with very few animals, and stretches that were essentially transformed into flat roads from all the sediment buildup. Some of the riparian canopy burned right down to the creek.
Then came 32 inches of rain over the last nine months, scouring out and moving sediment, creating deeper pools. Dagit said they recently found newt egg masses for the first time in years, as well as a few adult newts and many frogs. Plants that provide cover are starting to recover.
She provided photos comparing certain pools last year and this year, some dramatically transformed. In September 2025, the Shrine Pool could have been an overgrown hiking trail. This April, it was filled with shallow water.
The Shrine Pool in September 2025, left, and the same location in April 2026, right, with RCDSMM’s Isaac Yelchin donning a wetsuit.
(RCDSMM Stream Team)
Topanga Creek is home to another endangered fish, the small but hardy northern tidewater goby, often described as cute. Not long before the trout operation, Dagit led a rescue of hundreds of these fish too. Many were repatriated to the lagoon at the mouth of the creek in a moving ceremony last June.
There’s still the matter of what to do with the trout that were moved to Santa Barbara County last year. Evans would like to bring them home to the Santa Monicas at some point, but isn’t sure if it will happen. On one hand, they could bolster the small, genetically isolated surviving population. On the other, they might inadvertently bring in a disease or bacteria. There is some time to decide. Evans estimates the creek still needs to recover for two to three more years.
For now, the fish are functioning fine in their adopted creek. Experts worried the trauma wrought by the move would disrupt their spawning process, but they had babies that spring. This year, they spawned again.
Science
Pacifica pier cracks, another coastal casualty as seas continue to rise
The Pacifica Municipal Pier was shut down and taped off Thursday after city workers noticed cracks running through the landmark structure and concrete chunks falling into the ocean.
It’s just one of many coastal California structures that have recently crumbled under pressure from a rising and relentless ocean.
Officials from the small, beach city south of San Francisco said the pier was closed due to “cracking, separation, and displacement of the concrete walkway and structural elements.”
It will stay closed while structural engineers asses its safety.
Photos taken by city employees show a wide crack that runs from top to bottom and across the structure as well. Other photos show a large horizontal crack under the foundation of a small restaurant on the pier, the Chit Chat Cafe.
The cafe was also shut down.
This is not the first time the 53-year-old pier has shown signs of stress. In 2021, part of it was shut down after handrails along the edge collapsed. And in 2023, after a series of storms pummeled the Central California coast, damaging parts of the pier, the structure was partially closed for more than year.
Those same storms caused extensive damage in Aptos and Capitola, 70 miles south, where piers and waterfront infrastructure were swept away or damaged.
In 2024, a 150- to 180- foot section of the Santa Cruz wharf was ripped off by powerful waves.
At least 10 of the state’s dozens of coastal public piers were closed for part or all of 2024 due to structural damage sustained in winter storms since 2022. At least five others have longer-term upgrades planned to address structural issues.
“These things are costly to maintain,” said Zach Plopper, senior environmental director at Surfrider. “They are a part of our California coastal culture in many ways, but we’re going to need to reckon with, one, the state that they’re in, and two, the continuous and worsening threats they’re going to experience,”
He said most of the piers were constructed in the early 1900s, and they weren’t built to withstand decades of rough seas, storms and rising sea level.
“With this incoming El Niño, which is forecasted to be significant, and this marine heat wave we’re in the midst of, we’re kind of in uncharted waters as far as what this winter could bring in terms of storms and swells to the California coast, and we’re likely going to see a lot more damage,” he said. “Not just piers, but roads and other coastal infrastructure up and down the state.”
There was no storm in Pacifica earlier this week, so no single event could be blamed for the destruction.
However, a 2025 report from an outside engineering firm, GHD, found that several sections of the pier were in “poor” or “serious” condition, and they recommended closure before anticipated storms or events that could “subject the piles to high winds, swells and large waves.”
The firm found several areas of the pier where concrete was missing and rebar was exposed and corroding.
“The pier has continued to experience high winds and large waves in a harsh marine environment,” the engineers wrote in the report, noting that continuous exposure to seawater or marine spray was “detrimental” to the structure.
A 2023 city report estimated it would cost $19 million to repair.
That same year, a state law was enacted to require local governments along the California coast to plan for sea level rise in the coming decades.
Sea level has risen some 8 inches, on average, along the coast in the past 150 years, Plopper said, and researchers anticipate another foot in the next 25 years.
“We’re going to see profound shifts on our coastline, none that we have ever experienced before, and building static structures on the coast just doesn’t work all that well,” he said. “We’re going to have to make some really hard decisions.”
-
San Diego, CA2 minutes agoDaily Business Report: June 10, 2026, San Diego Metro Magazine
-
Milwaukee, WI5 minutes ago50 electric school buses to transport MPS kids starting this fall
-
Atlanta, GA10 minutes agoAtlanta Dream hold off Chicago Sky 82-75, Rhyne Howard becomes youngest player to hit rare WNBA milestone
-
Minneapolis, MN17 minutes agoOperation Metro Surge cost Minneapolis $700 million, city leaders say
-
Indianapolis, IN20 minutes agoPerson fatally shot on north side of Indianapolis
-
Pittsburg, PA25 minutes ago12+ things to do this weekend, from Pogopalooza and PizzaFest to the Beers of the Burgh Festival
-
Augusta, GA32 minutes ago
World Cup: Where to find a crowd to catch all the action
-
Washington, D.C35 minutes agoPermanent jewelry and pop-ups: Forever Adorned brings custom pieces to your stack