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.

Exercise has long been linked with stronger brains and reduced risk of dementia and other cognitive diseases. But new research suggests that older adults can significantly improve brain health with only a few minutes of daily movement.

Researchers from the University of South Australia and the U.S.-based AdventHealth Research Institute found that as few as five minutes of moderate-to-vigorous exercise a day correlated to significantly better cognitive performance. The study, published in the British journal Age & Ageing in early April, examined data from hundreds of people 65 to 80 years old.

Researchers found that “huff-and-puff” movements, like running or lap swimming, were associated with better brain functions including information processing, focusing and multitasking and short-term memory. They also found that even a few minutes of moderate exercise like walking improves brain functions.

“Our key finding was that moving from doing zero minutes or very little moderate-to-vigorous physical activity to doing just five minutes a day — that’s where the biggest gain in cognitive function was seen,” said the study’s lead author, Maddison Mellow, a research associate at the University of South Australia.

The researchers distinguished between moderate and vigorous exercise by applying a simple test: whether subjects could still manage to speak full sentences after moving around. Vigorous exercise makes that impossible, said Audrey Collins, a postdoctoral research scientist at AdventHealth Research Institute and the paper’s co-lead author.

The study observed 585 people, all in good health. Their physical activity was measured using accelerometers they wore on their wrists; the researchers tested cognitive functions using online and paper-based tests.

Worth noting: This study also found a “strong relationship” between spending little to no time doing moderate to vigorous activity and poorer cognitive performance, Mellow said. One slightly surprising finding, she added, was that the cognitive performance gains from exercise don’t extend to longer-term memory and visual-spatial functions like judging distances or sizes.

The study was novel in that it categorized how people divided their days into three behaviors: sleep, sedentary and active. And though getting enough quality sleep is important to brain health in midlife and beyond, the researchers said that when forced to choose between minutes spent sleeping and minutes spent exercising, reducing sleep time to spend more time moving resulted in better brain function.

“It didn’t really matter, in this sample, where time was coming from, whether from sleep, sedentary behavior or light intensity physical activity,” Mellow said. “So long as time was being increased in moderate vigorous activity, that’s where the benefits were being shown for cognitive outcomes.”

With that in mind, what are some moderate or vigorous bursts of exercise for older adults to do every day? We consulted experts to give you five accessible options.

1. Walking

Two experts I spoke with each said the easiest way to clock those five daily minutes for brain health is by walking.

“Walking is No. 1, because that’s the easiest,” said E. Todd Schroeder, professor of clinical physical therapy and the director of the Clinical Exercise Research Center at USC. Very sedentary older adults may want to start with simple flat-ground walking at their normal pace, Schroeder says.

If you’re already a steady, regular walker, kick up the pace to elevate your heart rate into that all-important moderate category.

“A brisk walk is considered to be moderate activity,” said Rob Musci, an assistant professor of health and human sciences at Loyola Marymount University. On a scale of 1 to 10, moderate exercise is what you would consider being in the 4 to 6 range, Musci said.

To achieve a real huff-and-puff workout, walking or hiking briskly uphill is excellent, Schroeder said, because it also necessarily requires walking back down hill.

“That interval-type training is good,” he said, “where your heart rate goes up for a time then comes back down.”

2. Swimming

Swimming is a terrific way to get a full-body workout and raise your heart rate.

“It’s easy on the joints,” Shroeder said. “Even if you struggle with the technique of swimming, you can put on fins and get some at least moderate exercise.”

3. Cycling

Cycling can be on a stationary bike or an outdoor bike, many of which are now battery-assisted, making pedaling up hills almost too easy. One reason I like old-fashioned outdoor bikes, sans batteries, is that they also train balance and require your brain to keep you safe.

4. Resistance training

Lifting weights is one of the best ways to maintain muscle strength as we age, Musci said. Try these simple exercises you can easily do at home in fewer than three minutes. They include:

• Tossing a weighted ball from one hand to another (try it standing on one leg)
• Squats holding a kettlebell, dumbbell, a bag of oranges or nothing at all
• Weighted chest presses in boat pose

5. Gardening and housework

Gardening can be a great way to engage core muscles, encourage flexibility and practice fine motor skills. Even basic house cleaning, like scrubbing a bathtub or mopping a floor, can qualify as moderate exercise.

“Anything that gets your heart going is what we’re looking for,” Musci said. “You hear about all these high-end interventions, fitness programs and boot camps, but in reality, it’s just movement.”

The most important thing, he said, is “just getting off the couch.”

Von Zielbauer is the creator of Aging With Strength on Substack.

WASHINGTON — Former President Biden has been diagnosed with an “aggressive form” of prostate cancer, his office said Sunday, a devastating development after having dropped his bid for reelection last summer over widespread concerns over his age and health.

Biden’s personal office said he was examined last week after the president reported a series of concerning symptoms.

“Last week, President Joe Biden was seen for a new finding of a prostate nodule after experiencing increasing urinary symptoms. On Friday, he was diagnosed with prostate cancer, characterized by a Gleason score of 9 (Grade Group 5) with metastasis to the bone,” the office said in a statement.

“While this represents a more aggressive form of the disease, the cancer appears to be hormone-sensitive, which allows for effective management. The President and his family are reviewing treatment options with his physicians,” the statement added.

The former president, 82, had been making his first public appearances since leaving office in recent weeks, including a public address and a lengthy sit-down on ABC’s “The View,” and also hired a communications strategist to help burnish his legacy amid the publication of a series of books critically examining his time at the White House.

Biden has a tragic personal history with cancer, losing his son, Beau Biden, to glioblastoma in 2015, when he was serving as vice president. At that time, he launched the “cancer moonshot,” a government-wide push for improved cancer treatments that he relaunched during his presidency.

The spread of cancer to the bones will make Biden’s cancer difficult to cure. But its receptiveness to hormone treatments could help his medical team inhibit the cancer’s growth, at least temporarily.

Biden dropped out of the 2024 race in July under immense pressure from leadership in the Democratic Party after a disastrous debate with the Republican presidential nominee, Donald Trump, laid bare concerns over his age and acuity.

Within hours of dropping out of the race, Biden endorsed his vice president, Kamala Harris, to run in his place. She quickly coalesced the party around her nomination and avoided a primary battle, but lost to Trump in November.

In a post on X, Harris said she and her husband, Doug Emhoff, were saddened to learn of Biden’s diagnosis. “We are keeping him, Dr. Biden, and their entire family in our hearts and prayers during this time,” she wrote. “Joe is a fighter — and I know he will face this challenge with the same strength, resilience, and optimism that have always defined his life and leadership. We are hopeful for a full and speedy recovery.”

Last week on “The View,” Biden said he took responsibility for Trump’s return to power, because he was in office at the time. “I do, because, look, I was in charge and he won. So, you know, I take responsibility,” he said.

But he continued to reject criticisms that he and his team worked to conceal the effects of his age on his performance as president, saying he was not surprised by Harris’ loss and suggesting he still believes he could have beaten Trump had he stayed in the race.

“It wasn’t a slam dunk,” he said, referring to President Trump’s victory. “Let me put it this way. He’s had the worst 100 days any president’s ever had. And I would not say honesty has been his strong point.”

Trump expressed concern about Biden’s condition in a Truth Social post Sunday. “Melania and I are saddened to hear about Joe Biden’s recent medical diagnosis. We extend our warmest and best wishes to Jill and the family, and we wish Joe a fast and successful recovery,” he wrote.

California Gov. Gavin Newsom was among the many politicians from both parties who posted their warm wishes and prayers for the former president. “Our hearts are with President Biden and his entire family right now. A man of dignity, strength, and compassion like his deserves to live a long and beautiful life. Sending strength, healing and prayers his way,” Newsom wrote on X.

House Speaker Mike Johnson (R-La.) wrote on X: “This is certainly sad news, and the Johnson family will be joining the countless others who are praying for the former President in the wake of his diagnosis.”

Biden was spending the weekend in Delaware with family, an aide said.