Finding specialists to answer ED call getting even harder

Some hospitals are trying to solve on-call shortages by paying daily or monthly stipends.

By Damon Adams — Posted Dec. 17, 2007

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

Emergency departments are finding it increasingly difficult to get specialists to provide on-call coverage, a growing problem that threatens patient access to quality and timely care at hospitals, a new study said.

The study, released in November by the Center for Studying Health System Change, said hospitals have struggled during the past decade to get specialists to be on call at their EDs. But hospital executives and others interviewed for the report said the situation is worsening.

"Across the country, the traditional role of physicians taking call is unraveling," said study co-author Ann S. O'Malley, MD, a senior researcher at the center, which also studied on-call problems in 2005.

The new study found several reasons why specialists avoid taking call. Many physicians are shifting focus from hospitals to their practices and outpatient facilities as more procedures are done outside of hospitals. Treating ED patients takes time and money away from office practices.

"Doctors can get fees for the procedure and get facility fees for doing it at their own center. That's the biggest reason," said Dr. O'Malley, whose study is based on researchers' visits to 12 communities, including Boston, Cleveland, Indianapolis, Miami, Phoenix and Seattle.

Specialists also are concerned that providing ED treatment raises their liability exposure, the study said. In addition, many doctors believe payment for on-call care is inadequate.

Patients are feeling the impact: 21% of deaths or permanent injuries related to ED treatment delays are due to lack of available specialists, the study said. Some patients are transferred to other hospitals, and the increased workload on specialists who are willing to take call increases the potential for bad outcomes.

Hospitals are trying to remedy the problem through contracts with physician groups that require ED coverage, daily or monthly stipends to specialists, or payments to doctors for uninsured patients treated while on call, according to the study. One hospital guarantees doctors Medicare reimbursement rates plus 20% for treating some uninsured patients.

Previous studies have detailed similar on-call troubles. A 2005 survey by the American College of Emergency Physicians said on-call coverage had deteriorated, and 73% of ED medical directors reported inadequate specialist coverage, up from 67% in 2004.

This year, the ACEP created a task force to recommend improvements.

"This is really a big issue," said ACEP President Linda L. Lawrence, MD, of Fairfield, Calif. "Lack of on-call coverage affects all patients."

Back to top


What's being said

Here are some anonymous comments from the more than 500 interviews researchers conducted with hospital executives and physicians about taking call in EDs this year:

"There are tons of neurosurgeons. They are all trying to figure out how to not take ER call, which generates an artificial shortage."
-- A Little Rock, Ark., hospital executive

"[Physicians] look at ED call as a burden. It affects quality of life and finances in a negative way."
-- A Syracuse, N.Y., hospital executive

"All over the country there is an unwillingness of physicians to take ER call. It does have to do with the lack of reimbursement, but also the malpractice issue. Usually big trauma cases and more challenging cases carry more risk -- that's the perception, at least."
--A Lansing, Mich., physician

Source: "Hospital Emergency On-Call Coverage: Is There a Doctor in the House?" November issue brief, Center for Studying Health System Change

Back to top



Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story

Read story


American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story

Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story

Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story

Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story

Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story

Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story

Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn