Sunday, January 13, 2008

Emergency Room Call-Another Doctor Shortage


Across the United States, and certainly in Northern California...hospitals are facing increasing difficulty with the availability of certain specialties to cover emergency rooms. In the past, if a patient is seen in a community hospital by the emergency physician, she can call on a panel of specialists to come in when needed to see the patient. Physicians in Neurosurgery, Orthopedics, Psychiatry, OB, Oral Surgery and even General Surgery are saying "no-more" and these hospitals now either need to transfer the patient out, or pay the doctors to be on call. (If they can even find the doctors)

There are numerous reasons why physicians have little interest in taking call. Hospitals are required to treat everyone, regardless of their ability to pay. With the increasing ranks of uninsured patients, the doctor is also treating for free. There is a perceived higher-risk of malpractice litigation if things don't go well. Since a good "relationship"is the best way to "not" get sued...a new patient might be more litigious. The time taken away from the office (now at high cost) just isn't worth coming in, and there are less hungry young doctors in many communities that are trying to build a practice by taking ER call. Additionally, the days of the "gentleman" physician are long gone. Most doctors have a crushing work schedule and carrying the "2 ton beeper" on nights and weekends is no longer part of the deal.

What is the solution to this problem that is NOT GOING AWAY? At the present, hospitals are ponying up the $$$$ to pay doctors to be on call. This amounts to millions of dollars a year for just one hospital and probably billions across the country. You can count that in to the invisible but real rising cost of health care. I see this increasing as time goes on.

States should be proactive about enacting legislation that protects on-call doctors from lawsuits when they see uncompensated patients...extend the "Good Samaritan Laws" to cover E.R's. The United States needs to really look at how health care is delivered and reimbursed. There truly is a physician shortage in certain specialties that is becoming obvious as our population ages. Patients expect the high tech care they read about but it is worthless if there isn't an available doctor to deliver it at 1:00 AM.

This is a national problem that needs national solutions. I've not heard anything about health care reform that would solve this dilemma. How about a commission to look at the problem and make recommendations that are taken seriously by policymakers. I don't want to arrive in an ER with a stroke or a major trauma and be told "The doctor is not in".

16 comments:

Guy said...

this is exactly what is going to happen as more and more doctors do not want to be responsible for patients for no cost, and as malpractice costs keep increasing there is little benefit to covering the emergency room.

Anonymous said...

I am an ophthalmologist in So Cal. ER Call is optional in my hospital, but pays $200 per day and uninsured care is reimbursed at Medicare $ rates. It is still not enough for me, I do not participate. Id rather be home with my family and sleeping soundly.

Anonymous said...

With respect, I'll take issue with the malpractice relief for ER call. Relief for all, or relief for none. I'm talking about the usual cap on noneconomic damages.
If there is relief, especially Good Samaritan relief, for ER work, as in no damages allowed at all........well, the trial bar is nothing if not imaginative. They will find ways to go after the non-ER part of the medical care. The FP in the office will end up holding the bag for a misadventure in the ER.

Rich said...

Not to mention the vast population of illegal immigrants using the ER for basic health care and clogging up the works.

Don't get me started on that. ;))

Howard Citron said...

I must say, as a medical malpractice defense lawyer, the nameless and faceless emergency medicine physicians and consultants in the ED many times beocme the focus of medical negligence claims - that is coupled with the fact that these doctors are normally mandated by the hospital to carry higher limits of malpractice insurance to receive the "benefit" of being on the call list.

Brian said...

"Not to mention the vast population of illegal immigrants using the ER for basic health care and clogging up the works.

Don't get me started on that. ;))"

You mean the vast population of mostly healthy illegal immigrants that are able to perform a feat that few Americans could do (cross a scorching desert unaided while possibly being shot at by ranchers, in search of a better future). Also remember that it is those illegal immigrants that pay taxes at their jobs (since they are taken out before they are paid) and who do not file a tax return because of their status or fear of being deported that generated a surplus. How do you think the surplus that Bush and Gore were talking about was generated? Millions of hardworking illegal aliens getting taxed like everyone else but not reaping the benefits of a citizen.

In my eyes the problem is that the health care system has become a pot of gold for many lawyers and insurance companies. They see lots of money going in and they are looking to get their share of what could go toward the care of a patient. What is very unfair is a lawyer taking away 25-30% of a malpractice lawsuit settlement. How can anyone treat someone without insurance and hope that they will not get sued when around the corner there is an attorney looking to make a large amount of money and possibly ruin a doctor who believed was doing the right thing?

dot30 said...

In California there is a medical malpractice cap of $250,000. Nobody is making millions. In fact, you can read article after article of attorneys refusing winnable malpractice cases because there is not enough money in it for them.

Rich said...

Brain, What don't you get about Illegal? slap my great gandparents in the face some more why don't you.

Kim said...

The big issue in our area is neurosurgeons. There aren't enough of them to go around, but when you need one, you need one fast.

Anonymous said...

I'm an orthopaedist in Virgnia at a county hospital and have also noticed the alarming amount of illegal aliens showing up in our ED for non-emergent care. Clogging up the system for those who truely need emergent care. In fact, the problem is compounded by private hospitals directly telling the patients in their ED's "go to the community hospital and they will treat you." Now we have two wasted visits to the ER.

Uninsured Americans need to look at themselves and consider their health insurance needs above cell phones, designer shoes, tobacco, alcohol, drugs, and their cars before they complain. But that won't happen because we are traditionally short-sighted and would rather get a hand out from more productive citizens of our society.

david said...

Why is Hospital Negligence on the rise? I don't understand with technology getting better by the day, I would have thought it would be going down. Is there a possibility that it has always been this bad, but its only now with the medias attention on it that we see more of it.

Anonymous said...

Dam is it always about the money? Which is most important a persons life or dam money? This world is pitiful

Anonymous said...

Dam is it always money, money, money? What do we po folks do just die?

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