Emergency Departments Have Problems Finding, Retaining On-Call Specialists

Main Category: Primary Care / General Practice
Also Included In: Public Health
Article Date: 24 Dec 2007 - 8:00 PDT

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Hospital emergency departments nationwide are "increasingly unable" to find and retain specialists to help treat seriously injured and ill patients at a time when EDs are "already struggling with overcrowding and growing patient loads," the Washington Post reports. A nationwide survey by the American College of Emergency Physicians in 2005, the most recent available, found that 73% of 1,328 ED directors said they had a problem with inadequate on-call coverage by specialists.

"The historic relationship between physicians and hospitals is unraveling," according to Ann O'Malley, a physician and senior researcher who co-authored a new study of the issue for the Center for Studying Health System Change. O'Malley attributes the trend in large part to the increasing number of physician-owned specialty hospitals, which reduces the need for doctors to work on-call hours in EDs in exchange for use of a hospital's facilities for their private practices. Other factors include fear of malpractice lawsuits, a reluctance to treat uninsured patients who cannot pay, and a "growing intolerance for the disruption" of their personal lives and private practices, according to the Post.

Linda Lawrence, president of ACEP, said the lack of specialists in EDs nationwide "can mean death" for many patients. "Patients have died in transport, or waiting to find a neurosurgeon or getting to a heart center for a cardiologist," Lawrence said.

Compounding the problem is the increasing number of patients seeking ED care. According to CDC, the annual number of ED visits increased by 18% from 1994 to 2004. During the same time period, the number of hospitals operating 24-hour EDs decreased by 12%. Some hospitals have begun hiring full-time or part-time ED specialists, while others have begun covering fees for physicians treating the uninsured and paying doctors daily or monthly stipends for on-call work.

Leon Benson, an associate professor of clinical orthopedic surgery at Northwestern University, said, "I can understand nationally why this is becoming a bigger issue, because the system is being pressured," adding, "More volume is getting through a pipe that's getting smaller in diameter. And then what you actually do while you're on call gets to be more and more painful" (Lee, Washington Post, 12/21).

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