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........

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