Today’s "ER in crisis" story

Dr. Peter Viccellio, the head of the emergency department at Stony Brook University Hospital on New York’s Long Island, said many doctors refuse to perform surgery on the uninsured or those covered by Medicaid because they are so poorly reimbursed.
“A lot of people show up because they have conditions that are treatable, but in many cases no one will treat them beyond giving them some pain relief because they have no money,” said Vicellio, a 27-year ER veteran whose department treats 75,000 people a year. “I see lives destroyed because of the inadequacies of our hodgepodge system. It’s pathetic.”

Comments

Anonymous
You get what you pay for. That rule has never been repealed.
The government, largely federal, has created a sense of entitlement to medical care without being willing to pay even the overhead cost of individual physicians delivering that care. What did you expect?
Anonymous
It’s unlikely the complaining physician depends on billing the patients or their insurance carriers directly for his overhead costs and his income. More likely he’s employed by an agency or institution and his paychecks are a condition of employment, are received regularly, have a predictable amount, and never bounce. He also goes home at a roughly predictable hour and has no personal obligation for patient follow-up. Easy to complain when you’r in that poaition. He’s basically saying: “Why aren’t these consultants supporting me?”
Contrast that with the consultant surgeon or physician who has mandatory overhead payments and when called to the ER has little expectation of payment and unknown time and malpractice liability.
Anonymous
No mention of the surprised patient, uninsured but having been treated initially in the ER, and given a referral card for a specialist in town, discovering that the followup is not goung to be on the same easy terms as the ER visit.
As above, when you pay nothing, how can you complain about not getting what you paid for?
John J. Coupal
Spoken like a true department chairman.
Is the good Dr. an M.D. ?
Anonymous
People who go into medicine are generally altruistic. What has happened is that we’ve let this altruism hogtie the profession with ever expanding expectations. This ER physician feels a surgeon should come into the hospital, operate on a patient for free, but still pay his malpractice from some special resevior of money he/she has.
We are entering an age of two tier medicine, whereby the rich (read insured) get excellent care and the poor (read medicaid or uninsured) are not guaranteed excellent care. If they are lucky enough to live in my community with charitable surgeons they will get their surgery (and still be allowed to file a lawsuit if their expectations aren’t met). But in most other places, physicians are waking up and either demanding a call fee from the hospital, or refusing to be a slave. A slave is defined as someone who does work for no money. That is now what the country expects from doctors.
Anonymous
Well, really, a volunteer is defined as someone who does work for no money. A slave is defined as someone forced to do work for no money. The physicians are choosing not to- hence, not slaves.
But I agree with everything else you’ve said
Anonymous
oh vomit! we live in a society in which everything is rationed by money. WHY should medicine be different than food or heat or clothes? As for the doctors’ whining about being viewed as slaves, it’s your own fault. By insisting that somehow you are a profession, different from anyother business, you create the expectation that you are not moved by financial concern but respond to a higher calling. If doctors don’t like being asked to do things without being paid, they should stop the babble about altruism and their higher professional committment.
Anonymous
How can you refuse to operate if you are the attending on service that month?
Anonymous
It is only academic centers that have “attendings on call” that month and they get paid a salary. In private practice different hospitals have different systems. Some mandate that ER call is the price of hospital privileges. Other places pay specialists in short supply to take call. I’m sure there are places where there is no assigned ER call for a certain specialty and the poor ER docs have to beg someone to come in, even for someone wihtout insurance.
Private practice is indeed an abrupt change from the Utopia that is and acadmic center, but the majority of care is performed in private practice centers.
As far as the volunteer/slave analogy goes, I agree. But what you are witnessing, whether you vomit while you are seeing it or not, is the gradual changing from volunteering to do things, to politely declining to do things. When physicians made enough money to pay off their student loans and send their kids to college it was easy to see someone for free and talk about the profession of medicine. When you are fretting about overhead/personnel costs/malpractice premiums, the ugly spector of reality rears its head and you realize you can’t save the world. Perhaps our vomitous friend should do some volunteer work for the general surgeons in our nation’s inner city ERs?
Anonymous
Professionalism usually means holding one’s work to the standards of a profession, that is doing for the recipient of services what the standards of the profession regard as being in the recipient’s best interests (as opposed to doing what is in some other interested party’s interest over that of the recipient.)
There is no implied obligation to work without payment, and one does not become less a professional by insisting on being paid. Unfortunately, there are a lot of people who think that the demand for payment should not interfere with their access to services, and that if it does, then those demanding payment are being “un-professional”. That is nonsense, and is a specious attempt to tie terms of compensation to ideas of professionalism, and to imply that there is an ethical fault in insisting that the patient acknowledge financial responsibility for services.
Is demanding that a surgeon on staff of a hospital– who receives no compensation from the hospital for any services he performs–provide free services to ER patients, or effectively do the same by requiring services to the indigent or uninsured on demand a form of slavery? Probably not; the surgeon can always quit, as many now are. But it does qualify as a form of extortion. Hospitals make money when the surgeon does surgery at the hospital (for patients who do pay), and they also receive funds from government entities when their facilities meet certain standards of staffing and ability to care for trauma. That standard cannot be met without the availability of the surgeon. So the hospitals are using staff membership as a lever to extract uncompensated work from surgeons so that they can claim government money, ironically precisely because those surgeons are made available for uncompensated work.
I see no reason why the hospitals shouldn’t have to pay surgeons to be on call.
Anonymous
This is one more argument for an NHS in this country. I agree that Docs. should be paid. I also know that sick people, even the poor, need treatment and sometimes they need surgery. It makes me sick that we are a barbaric generation of people. For the sake of our country, I hope that in a hundred years from now, we are looked upon as being the most barbaric generation of all. It will mean that our grandchildren and great grandchildren will have succeded where we have failed miserably with human compassion.
Anonymous
“It’s unlikely the complaining physician depends on billing the patients or their insurance carriers directly for his overhead costs and his income. More likely he’s employed by an agency or institution and his paychecks are a condition of employment, are received regularly, have a predictable amount, and never bounce. He also goes home at a roughly predictable hour and has no personal obligation for patient follow-up. Easy to complain when you’r in that poaition. He’s basically saying: “Why aren’t these consultants supporting me?” “
Wrong, most ER docs are NOT salaried and depend on patient billing just like the other consultant doctor.
Anonymous
You mean the individual ER doc sends a HCFA form to an ER patient’s insurance, awaits payment, and then himself sends a personal bill to the patient for any co-pay? I seriously doubt it. I’ll check with the chief of our ER next time I see him.
What happens when a patient is in the ER overlapping two shifts? Does that patient’s insurance company or the individual get bills from two different doctors for the same ER visit?
Anonymous
Our small community hospital on the island of Hawaii has only 2 orthopedic surgeons on staff. For the past 4 years they have not been on call 15 days per month each. In contrast they are on call for 7 days each. This means that for 16-17 days per month the ER physician has no ortho on call. The majority of that time patients are air evacuated off island to Honolulu. Except, get this, 2 air evac planes have crashed in the past year and now the entire state of Hawaii has only one air evac plane. Back up from the Coast Guard is available sometimes but not always. Some recent delays for air-evacuation to Honolulu where the only major hospitals are situated have been 50 hours! Think of that when you’re booking your dream vacation in Hawaii.
Anonymous
Might want to expand your discussion beyond Medicaid and “entitlement” to free care. Though I have insurance, my employer has reduced the benefit twice in as many years. I’m a middle manager with 20 years of service but had to decline a surgery recommended by my doctor because it would have been financially overwhelming. I think the costs involved are becoming increasingly out of reach for a larger and larger segment of the middle class. While I have no idea what the solution is either, I am relatively certain that at this point, the problem has gone well past Medicaid reimbursement and the poorest of the poor.
jerry
“You mean the individual ER doc sends a HCFA form to an ER patient’s insurance, awaits payment, and then himself sends a personal bill to the patient for any co-pay? I seriously doubt it. I’ll check with the chief of our ER next time I see him.
What happens when a patient is in the ER overlapping two shifts? Does that patient’s insurance company or the individual get bills from two different doctors for the same ER visit?”
Yes, A bill will be sent on behalf of the ER group. If a patient is “passed off” to another ER physician he/she will not be sent a bill from each. The point is that most practicing ER physicians are not salaried by an employer and make a living trying to collect what is billed.
Anonymous
Lately, I had to refuse more patients because they lack insurance. I see them a few times for free but then I expect some sort of payment arrangement, discounted but still… I mean, people go and fix their cars all the time and they pay, they don’t expect free service. I have been discounting and giving a lot of free care but lately I am less and less inclined to do so, because nobody discounts anything for me on a daily basis.
Anonymous
Anon 8:39 said
“People who go into medicine are generally altruistic.”
I disagree. About thirty percent of our doctors are foreigners. Many of these foreigners come from nations where their medical skills are sorely needed. Why do these foregners come here? I personally think that most come here primarily for $$$$$ and not for altruistic reasons.