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.

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.

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?

Wrong, most ER docs are NOT salaried and depend on patient billing just like the other consultant doctor.

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.

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?