BACKGROUND Increasing demand for emergency care and crowded emergency departments (EDs) lead some planners to conclude that inconvenient primary care scheduling increases the number of "unnecessary" ED visits. The reasons that the planners argue for more primary care are: to increase funding for primary care; the unfounded notion that it is less expensive to see a primary care physician (PCP) than an Emergency Physician; and the impractical goal that the ED should be used only by intellectually interesting life- or limb-threatened patients or "true emergencies." OBJECTIVE To explore the rates of patient-reported access to primary care in ambulatory presentations to a rural tertiary care ED. METHODS An observational study was performed in which an anonymous survey was given to a convenience sample of patients who presented by walking into the ED. RESULTS Overall, 70.4% (686/975) of respondents stated that they had a PCP, and 38.1 % (252/661) of the sample had attempted to contact their physicians before presenting to the ED. Of the group who attempted to contact their physicians, 62.8% (130) were neither spoken to nor seen by any doctor. These rates did not change by time of presentation or by day of the week. CONCLUSIONS The results suggest that it is neither a lack of primary care, nor the time of day or night that drives patients to come to the ED.