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".
Posted by Toni Brayer, MD at 6:42 PM