As emergency departments face ever-rising demands, hospitals are confronting greater problems obtaining emergency on-call coverage from specialist physicians, according to a study released Nov. 20 by the Center for Studying Health System Change (HSC).
Factors influencing physician reluctance to provide on-call coverage include decreased dependence on hospital admitting privileges as more services shift to nonhospital settings; payment for emergency care, especially for uninsured patients; and medical liability concerns, according to the study. Hospital strategies to secure on-call coverage include enforcing hospital medical staff bylaws that require physicians to take call, contracting with physicians to provide coverage, paying physicians daily or monthly stipends, and employing specialists.
The study’s findings are detailed in a new HSC issue brief, Hospital Emergency On-Call Coverage: Is There a Doctor in the House? The study is based on HSC’s 2007 site visits to 12 nationally representative communities: Boston; Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little Rock, Ark.; Miami; northern New Jersey; Orange County, Calif.; Phoenix; Seattle; and Syracuse, N.Y. HSC has been tracking change in these markets since 1996.
