More physicians expect pay for emergency call

A growing number of physician specialists are refusing to take emergency hospital call unless hospitals pay them for their time.

According to a survey by the American College of Physician Executives published in the May/June issue of The Physician Executive, 46% of responding hospital administrators paid their specialists for emergency call. Of the hospitals that didn't, half were considering doing so.

The American Medical Association supports physician reimbursement for on-call services, particularly if call is required for hospital privileges. The issue was prominent at the AMA in 1999 and 2000, when physicians in California were having difficulty getting HMO reimbursement for emergency care.

According to the ACPE report, there is a combination of factors contributing to the rise in hospitals paying for call coverage.

An increasing number of emergency department patients are uninsured, leaving physicians uncompensated for their work while bearing the increased medical liability risk these patients pose. Surgical specialists have begun to drop their hospital privileges with the establishment of outpatient surgical centers, and they no longer feel as obligated to take hospital call.

Dissatisfaction with reimbursement in general and a growing desire for a balanced lifestyle are other reasons cited in the survey.

Bill Steiger, editor of The Physician Executive-Journal of Medical Management, said the trend is a generational one.

"It's very clear that it's a division between the old school -- that you don't pay specialists, it's a service to the community -- versus the new way of looking at it, that all we have is our time as doctors and we are going to be paid for our time," Steiger said. "Generation X has an appreciation for leisure time that perhaps is not in the culture of the older doctors."

According to open-ended comments from the physician executives responding to the survey, trauma surgery, oral surgery and neurosurgery are the disciplines most frequently asking for on-call pay.

The physicians responding to the survey were divided on the issue.

"The emergency room is an epicenter of actual and potential liability in my practice," one respondent said. "It is also a major source of office, family and personal time loss. Our hospital is currently proposing compensation for ER call. If compensation does not evolve, I am history in the ER."

Another said, "This is a very difficult and sometimes troubling issue for our organization. How do you determine which specialties get compensated for ER call? Our primary care and medical subspecialties provide ER call without compensation. However, our surgical specialists say they will not provide any more coverage unless they are compensated. What do we tell our internists, family physicians and others who are willing to do this without compensation? This is a box I wish had not been opened."

The survey was sent to 3,000 physicians with administrative positions at hospitals and group practices and had a 27% response rate.