More stress for emergency departments as fewer specialists are on call

A lack of specialists willing to provide on-call coverage and a rise in nonemergency visits are placing greater pressures on hospital emergency departments, a new study said.

These increasing pressures could compromise access to emergency care and contribute to rising health care costs, according to a November study by the Center for Studying Health System Change, a nonpartisan policy research organization in Washington, D.C.

Getting adequate on-call specialist coverage has become more difficult, said the center, which based its study on site visits to 12 communities, including Boston, Cleveland, Miami and Seattle. A perceived higher risk of malpractice litigation, unpredictable hours and lack of reimbursement for uninsured patients are among the reasons that specialists have less interest in providing on-call coverage.

Specialists provide more services outside the hospital, so "specialists are less dependent on the hospital than they used to be," said Ann S. O'Malley, MD, co-author of the study and a senior researcher at the center.

In addition to fewer doctors taking call, EDs also face additional pressures because there is a higher use of emergency departments for primary care, as the percentage of visits for nonurgent and semi-urgent reasons has increased during the past decade.

Some ED directors said more seriously mentally ill patients are seeking care, creating stress for staff. The surge is the result of cuts to state and local mental health services, a decline in psychiatric beds at private and state hospitals and low reimbursement rates for mental health care.

The study said rising pressures on emergency departments are a result of larger forces throughout the health care system, including diminishing access to primary care, financial incentives that reward specialists for doing procedures outside the hospital, and declining funding for community-based mental health services.