Problems with quality and access to emergency medical care, resulting from a shortage of available on-call specialists, may be aggravated by the increasing population of uninsured people and the cost of malpractice insurance, according to the Center for Studying Health System Change. But hospitals efforts to solve these problemssuch as providing physicians with stipends for on-call servicealso add considerable costs, according to the center, 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, according to the report.
Solutions to the shortage include enforcement of hospital bylaws requiring on-call service, payment for on-call coverage, paying physicians 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 $10 million per year.
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