Family Medicine and Emergency Physicians’ Perceptions of Inappropriate Emergency Room Use in Saudi Arabia: A Cross-Sectional Survey

Background: Inappropriate emergency room (ER) utilization for nonurgent conditions is increasingly recognized as a challenge for health systems, contributing to crowding, delays in care, and increased healthcare costs. Physicians working in emergency and primary care settings may have different perspectives on the magnitude, causes, and consequences of this problem. This study assessed physicians’ perceptions of inappropriate ER utilization in Saudi Arabia and compared perspectives between family medicine and emergency medicine physicians. Methods: We conducted a national cross-sectional, web-based survey of family medicine and emergency medicine physicians practicing in Saudi Arabia in January and February 2026. The questionnaire assessed perceptions of inappropriate ER use, perceived contributing factors, and perceived impacts on care delivery and workforce outcomes. Comparisons between specialties were performed using chi-square tests. Multivariable logistic regression was used to identify factors associated with reporting that at least half of ER visits were inappropriate. Results: A total of 412 physicians completed the survey, including 214 family medicine physicians (51.9%) and 198 emergency physicians (48.1%). Overall, 352 physicians (85.4%) agreed that inappropriate ER use is a major national problem. A large proportion of physicians reported that many ER visits are nonurgent (n=334, 81.1%) and could be managed in primary care settings (n=318, 77.2%). Emergency physicians were more likely than family physicians to report that ER visits are frequently nonurgent (174 of 198 (87.9%) vs. 160 of 214 (74.8%), P<0.001) and manageable in primary care (176 of 198 (88.9%) vs. 142 of 214 (66.4%), P<0.001). Limited access to primary care was identified as a contributing factor by 304 physicians (73.8%), and after-hours service gaps by 286 (69.4%). A total of 346 physicians (84.0%) agreed that inappropriate ER use delays care for critically ill patients, and 328 (79.6%) agreed that it negatively affects patient safety. In multivariable analysis, emergency physicians were more likely than family physicians to report that at least half of ER visits were inappropriate (adjusted odds ratio (aOR), 2.14; 95% confidence interval (CI), 1.38-3.31; P=0.001). Perceived weaknesses in the referral system (aOR, 2.78; 95% CI, 1.84-4.19; P<0.001) and limited primary care access (aOR, 1.89; 95% CI, 1.23-2.91; P=0.004) were also independently associated with this perception. Conclusion: In this survey of physicians in Saudi Arabia, inappropriate ER utilization was widely perceived as common and consequential for healthcare delivery. Emergency physicians were more likely than family physicians to characterize ER visits as frequently inappropriate and to report negative impacts on patient safety and care delivery. Strengthening primary care access and referral systems may help reduce nonurgent ER visits and improve the efficiency of emergency services.