Patients have tons of unrealistic expectations and are very demanding despite their ignorance. For example think of all the people who want MRIs of their backs, knees, etc. in the ED.
We face ever increasing regulatory pressures for things like med reconciliation, core measures, HCAHPS, etc. (all of those are searchable on this forum for more info) coupled with decreasing reimbursement and other financial pressures like med mal, elimination balance billing and so on.
There is more and more use of the ED for inappropriate things like primary care, circumvention of outpatient preapprovals and second opinions. There continues to be a serious problem with getting specialists to take call.
A partner of mine who has been a doc since the 70s once told me "There is no social problem that can not be made into an ER problem." I didn't appreciate how right he was for several years but I live it every day now. If you've got homless and addicts and mentally ill and you don't want to deal with them just dump them into the ER. If no one can get primary care or referrals or outpatient tests or second opinions or prescriptions dump them in the ER. If they can't speak English or the smell bad or they can't pay or they're non-compliant, you guessed it, dump 'em in the ER.
It just wears on you after a few years.
