(D-Calif.), gave a spirited dialogue on his view of the IOM reports, which he said had offered “no solutions, but lots of problems.”
One report finding that seemed to most amaze Rep. Stark was the shortage of specialists in such fields as neurosurgery or vascular surgery who will agree to work on call in emergency departments. That shortage results in “dire and sometimes tragic results,” according to the IOM reports.
“We don't pay firemen, teachers, and policemen for not doing their full job, and in my opinion, [on-call service for doctors] is part of the job,” Rep. Stark said.
“When you make upwards of $400,000 and $500,000 a year, you're more than compensated.”
Rep. Stark added that his solution to the on-call shortage would be to advise hospitals to withhold privileges to doctors who won't agree to be on call without extra payment.
Research Can Lead the Way
A common thread throughout the final workshop was the great need for further discussion among the emergency care community, the relevant federal agencies, and Congress. The IOM reports and the workshops' attendees also concluded that research is the cornerstone for improvement.
There are many opportunities for emergency care research, said Dr. William Barsan, chair of the department of emergency medicine at the University of Michigan, Ann Arbor.
“Emergency conditions are certainly high impact,” Dr. Barsan said. “You have access to large and very diverse patient populations. Almost every person in the country uses the emergency room at least one time or another, and you can't get any more diverse than that.”
Effective early treatment in emergency departments prevents some of the leading causes of death, such as trauma, stroke, and heart attack, he added. Proper research can help physicians to better treat these conditions.
The challenge, Dr. Barsan said, is that the medical community first needs to address the inadequate research training infrastructure, which provides only a small number of research fellowship training positions in emergency care.
Looking Ahead
The IOM's work on the future of emergency care is not yet complete. The panel is taking steps to incorporate the feedback gathered from the four regional workshops and publish an addendum in the coming months. It will provide more details on areas that the workshop attendees said were underemphasized in the first reports, such as geriatrics, mental health and substance abuse, and the nursing shortage. It also will summarize the workshops' formal presentations, including key sources of evidence.
For more information, visit the IOM Web site at
