department in ours and most urban emergency departments, we divided it to urgent care centers and emergency departments, and we can handle both without competing with each other. but clearly there are more cost effective ways of delivering nonemergent care. access as alluded to, at fordable care act will drive that in that there will be more people who have insurance, have access will want screening tests, all which is go ahead down the road it will prevent more serious illnesses and costly medical expenses, but nothing to cover that right now no provisions in the affordable care act to grow more doctors and more providers. incidentally, other help along the way as long as we know how to utilize it along the way. we have p.a.s, nurse practitioners. a primary care specialist that works with an mp can deliver much more effective care to many more people. models have not been fully