Los Angeles Times Examines 'Exodus' Of Specialists From Southern California Emergency Departments

Main Category: Primary Care / General Practice
Also Included In: Public Health
Article Date: 29 Apr 2008 - 5:00 PDT

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Specialists in Southern California have "abandoned emergency [departments] in droves" -- a trend that has exacerbated backlogs in EDs and affects both insured and uninsured patients, the Los Angeles Times reports. Mark Langdorf, ED director at University of California-Irvine Medical Center, said that physicians can handle about 80% of patients who come to the ED for care but that about 20% must be treated by a specialist. According to the Times, "That can mean hours on the phone trying to find a specialist or arranging a transfer to a larger hospital." Jim Lott, executive vice president of the Hospital Association of Southern California, said, "If the state of California's licensing and certification division came into our hospitals to examine whether we had all the specialists we say we do, they would shut down over half of the hospitals in Los Angeles County because we don't have coverage."

According to the Times, "The most obvious reason for the flight of specialists from emergency rooms is the surge of patients who have no medical insurance or who use Medi-Cal, which pays some of the lowest rates in the country." Medi-Cal is the state's Medicaid program. In addition, "It has become virtually impossible" for some people to find specialists in private practices, "so they turn as a last resort" to EDs, which are required to provide treatment under federal law regardless of ability to pay, the Times reports. The number of specialists "could grow even scarcer" if the state cuts Medi-Cal payments by 10% to reduce the budget deficit, according to the Times.

Lott said that other reasons specialists move away from EDs are that patients are often drunk or on drugs, there is a higher risk of being sued by an ED patient than a longtime patient and insurers limit physicians' ED payments. Lott also said that many specialists are "looking for a lifestyle that doesn't tie them to a hospital on evenings and weekends," adding, "Some of them you couldn't pay any amount of money to -- they just won't take the call."

One tactic some hospitals have used to gain more specialists is paying them stipends to be on call. However, Irv Edwards, former president of the California chapter of the American College of Emergency Physicians, said that it is a temporary solution (Engel, Los Angeles Times, 4/25).

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