Maybe you got shortchanged in humility and common sense? Would you still have enough IQ points left after a head injury to get your self to the proper hospital?

All kidding aside, I think you are right that it is proper to be able to know what services a hospital provides. I certainly don’t see deceptive advertising. Even at the large tertiary care ER’s I work at that have excellent specialty back up, the sign outside the ER says something simple like “Emergency Department: Physician on Duty, Basic Services Available”

I don’t know what kind of answer you would get if you asked a hospital what specialties they provide. For instance at the community hospital I work at there are neurolgists, gastroenterologists, hand surgeons, ENT physicians on hospital staff, but they do not participate in an ER call panel. So if you called the hospital and asked if there was ENT physicians on staff the answer would be YES, but if you came through the emergency room and needed one in an emergency at midnight the answer would be NO. It is also a moving target. For instance we have a plastic surgeon that will do ER back up call on Mo, Wed, Fri., on other days there is no coverage.

Hospitals are not likely to advertise what they DONT HAVE out of fear of commiting an EMTALA violation. This is federal law inacted in 1986 that has grown into a monster with lots of unintended consequences. Basically it says that every emergency department must evaluate any one presenting for the presence of any life or limb threatening condition regardless of nationality, insurance, how drunk and obnoxious they are, etc…
Telling you at the triage window that we don’t have a neurosurgeon for your head injury and that you should get in your car and go elsewhere is a clear violation of EMTALA law which has very serious consequences. This is investigated by the feds, results in a personal 50,000$ fine to the physician and the hospital, as well as risking all future payments from Medicare. So the feds have ERs and hospitals held by the balls on this one. It is an unfunded mandate, that in my opinion clearly delays care for some individuals and limits disclosure of what services are really available. So write your Congressman. We have lobbied and marched on the capital building in white coats but policy makers don’t get it yet.

It is not about the money. It is about patient care. I don’t think I would make less or more money if EMTALA wasn’t so cumbersome, or if there was more clear hospital service availability disclosure. However,it would clearly be better for patients if more specialists were willing to back up the ER. When I talk to them it all comes back to inconvenience, nonpayment, and liability, liability, liability.

The point of this discussion is that when the ER doc (who has to evaluate everybody who walks in, is rolled in, or dumped at the door and gets paid only if you or your insurance company decide to pay him) reaches a conclusion that you need a surgeon/cardiologist/gastroenterologist/psychiatrist to take over to keep you alive and or pain-free, it would be nice for you if one of those folks were available. Increasingly, the cost/benefit equation for those highly trained and valuable specialists is coming down overwhelmingly on the side of not getting involved. Aside from clergy, there is no other profession that tasks itself with the responsibility of being there for you at all hours, no questions asked, payment if any to be determined at a later date, and to standards that are internationally acclaimed. Back when part of the deal was that you were grateful if we did our best, paid us the same way you paid your other debts (as much and as soon as you can), and were willing to accept a less than perfect outcome without filing suit, we were happy to keep up with our part of the bargain. Now that the government tells us that we have 30 minutes to get there or be fined $50K, lawyers offer to come to the hospital to help you file your lawsuit before your sutures are removed, no way to get you to pay your bills, and the contempt of a substantial segment of society, a lot of us are rethinking our position. That’s why you may have to drive 3 hours to get your hand fixed, by which time it may be too late. Some people think that this situation is a step backwards for American society, and are concerned enough to think about trying to reverse the trend. If you disagree, that is another great thing about America. My physician colleagues are happy to care for my family members at 3 am because they know that I will not sue them if things don’t turn out right, and I will be there for them if needed. None of us will be there for you.

1:If you walk into an ER with a severe hand injury the ER has to deal with it even if that means shipping you to another ER out of city AND STATE (I have seen both). To tell someone waiting “we don’t have a hand surgeon go down to the next hospital” in the waiting room is not legal. CJD and Elliot would live to have an open and shut case like that.

2: Actually I have seen multiple family’s extreme frustation when I have to tell them we don’t have neurosurgery or hand surgery (including threats of legal action)
in the setting of a severe hand injury or a SDH (and
understandably so). They just “don’t accept it”. Of course you lose very critical time with transfers under these circumstances. Additionally we have neurosurgery 3-7 days per week and hand surgery 1-3 days per week on call in the ER how do you propose we tell the community which days we have this coverage?
It is more and more difficult to get certain subspecialty coverage now. Your testing score has very little to do with not understanding how ER’s work medically and legally.

I would love to be the ER doc on when this moron slices off 3 of his fingers using a power saw and I have to explain to him we have to ship him 150 miles away to the nearest hospital with a hand surgeon because we have none because they won’t take call due to the liability risk. He loses his limb due to time constraints, that’s “what’s so hard about that?”

That is exactly what many doctors are doing!!!!! The layman is the one that will be hurt. When you seriously hurt or injured you will be taken to an ER. There may not be a plastic surgeon, hand surgeon, neurologist, orthopedist or whatever “ologist” to take care of whatever specialized problem that you have. You are likely to not even to get a board certified Emergency physician.

The ER is the “canary in the coalmine” for the collapse of the medical system.

Said by someone who doesn’t know a thing about medical practice. I have worked as an ER physician for 15 years at multiple different hospitals. At none of them was there any arangement where I was paid by the hospital. Not a single cent. At my current hospital the “self pay” rate is about 25%

Some people obviously don’t have a clue how medical compensation actually works. Capitalizing idiotic remarks only draws attention to their ignorance.

Not true for the majority of physicians. I care for many indigent patients, with no reimburesment, and all the risk. My hospital does not pay me or any other doctors for care.