Problems with quality and access to emergency medical care may be aggravated by the increasing population of uninsured people and the cost of malpractice insurance, but hospitals efforts to solve these problemssuch as providing physicians with stipends for on-call servicealso add considerable costs, according to the Center for Studying Health System Change, which examined 12 metropolitan communities and interviewed 300 representatives from hospitals, physician organizations, employers, insurance brokers, consumer groups and others.
The report notes that specialists are increasingly viewing on-call service as a financial burden that negatively affects their quality of life, takes time away from their practice and exposes them to malpractice risks. For patients, the effect of the shortage may be even worse, including increased risk of death or permanent injury because of delays in receiving treatment, added expense for travel or for another emergency department visit at a second hospital, and inconvenience caused by transfer or travel for fairly routine but urgent matters such as a bone fracture, the report said.
Solutions to the shortage include enforcement of hospital bylaws requiring on-call service, payment for on-call coverage, paying physicians fees for providing service to patients unable to pay for care and contracting with physician groups to provide coverage. Most of these solutions add to the nations healthcare bill, and the study states that one Miami hospital reported that paying specialists for on-call emergency coverage cost it cost $10 million per year.
While an overall shortage of some specialists may contribute to inadequate coverage, the report states that physician unwillingness to take call appears to be a more pressing issue for many hospitals. The report anonymously quotes a hospital administrator in Little Rock, Ark., as saying: There are tons of neurosurgeons. They are all trying to figure out how not to take ER call(s), which generates an artificial shortage.
When asked to comment, a spokeswoman with the American Association of Neurological Surgeons cited a 2006 survey of its members, in which 94% of respondents said that either they or their practice provides emergency coverageup from 83% in 2004. About 57% of the respondents took call two or three days per week, 22% took call four or more days per week and 21% took call one day a week or less.
Other specialists who have been difficult to secure for on-call coverage include: dermatologists, hand surgeons, neurologists, obstetrician-gynecologists, ophthalmologists, orthopedic surgeons, plastic surgeons and trauma surgeons.
The communities studied were: Boston; Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little Rock, Ark.; Miami; northern New Jersey; Orange County, Calif.; Phoenix; Seattle; and Syracuse, N.Y. -- by Andis Robeznieks