Emergency departments and emergency physician’s primary directive is to care for ill and traumatized patients presenting in an unscheduled fashion. This is constructed without regard for ability to pay and with a high expectation for accurate and timely evaluation and management to exclude and treat emergent and urgent life and limb-threatening conditions. Increasingly limited resources coupled with increasing patient volumes in emergency departments across the country have further strained the expected duties of the acute care hospitals and providers. It is becoming more apparent that emergency department can no longer assume the long-standing role of being everything for everybody. Therefore, it is the position of the American Academy of Emergency Medicine that the redirection of patients who do not have medical emergencies or urgent conditions away from an emergency department is ethical and that a well-developed screening process that appropriately redirects patients is frequently in the patients best financial interest, especially if they have limited resources for payment. The exclusion of an urgent or emergent medical condition requires the performance of an appropriate medical screening examination by a qualified provider. It is the Academy’s position that this process is best performed by a skilled emergency physician. If a hospital enacts such a program, AAEM encourages the screening hospital to provide referral to alternative low-cost hospital affiliated or community resources that are appropriate for the patient’s presenting complaints.