Most hospital officials are having trouble getting specialists to take emergency department call, according to a national survey of physician executives.
About 64% of physician executives surveyed reported having a problem getting specialists to take call at their hospitals. Many of them—about 47%—report that their hospitals are coping with this problem by paying specialists to take call.
Of those whose hospitals were not offering payments, 46.4% said the idea has been considered.
The survey, conducted by the American College of Physician Executives, was sent to 3,000 physician executives in hospitals and group practices around the country. The poll had 814 responses, or a 27% response rate.
The results of the survey are consistent with previous studies over the last several years, said Alex Valadka, M.D., chairman of the Joint Section of Neurotrauma and Critical Care for the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons.
Dr. Valadka said he sees taking emergency call as part of his responsibility as a physician, but said many of his colleagues just can't afford to do it anymore.
With the high cost of professional liability insurance, physicians are stopping or cutting back on emergency call because certain insurance carriers offer discounts to physicians who cut back on these services, he said.
In the past, physicians may have had enough of a profit margin to cover the cost to them of taking emergency call, he said, but declining reimbursements have mostly eliminated that margin.
“Like any other service, nothing is for free,” said Dr. Valadka, who also is a professor of neurosurgery at Baylor College of Medicine in Houston.
But even with stipends for taking call, some physicians still won't do it, he said. “I think the money will help, but it's not going to solve all the problems,” he said.
These financial incentives need to be coupled with federal medical liability reform to ease the strain of the high cost of premiums, Dr. Valadka said.
Paying specialists to take call helps to offset their costs, but it's only a stopgap solution, said James Bean, M.D., AANS treasurer and a neurosurgeon in private practice in Lexington, Ky.
In the short term, hospitals should create more incentives for physicians to take call. “You've got to create a carrot, not a stick,” Dr. Bean said.
Over the long term, physicians and hospitals should consider the idea of a regional trauma system with a large staff of rotating specialists to handle cases.
“Clearly the community needs physicians to take call,” said Andrew Pollak, M.D., associate professor of orthopedics at the University of Maryland in Baltimore and a member of the board of directors of the American Academy of Orthopaedic Surgeons.
Hospitals and physicians need to work together to provide reasonable ways to manage call, he said.
For example, hospitals should provide stipends to help offset physician costs. In addition, hospitals need to provide physicians with the right resources to work in the emergency department, such as having an adequate level of ancillary staff to assist physicians, Dr. Pollak said.
Emergency physicians have a different take on the issue, however. It's often the hospitals with the highest number of uninsured patients that face shortages in specialist care in the emergency department, said Wesley Fields, M.D., immediate past president of the California chapter of the American College of Emergency Physicians and an emergency physician in Laguna Hills, Calif. But those are also the hospitals that are least able to provide stipends to physicians.
“This really just reflects the weakness of the hospital safety net,” Dr. Fields said. And money diverted to pay for physician stipends often means that less money is available to cover emergency department costs, he said.
Paying stipends to physicians to take emergency department call is taking away from other services and the funding for uncompensated care, said Jeff Micklos, general counsel for the Federation of American Hospitals.
The federation is concerned that more hospitals will need to offer stipends for taking call, Mr. Micklos added. Otherwise, they will be creating an incentive for physicians to invest in local specialty hospitals.