Specialists continue to refuse ER call. Some hospitals are stepping up to the plate to keep these physicians on board:
Today, many doctors rely far less on hospitals, conducting much of their care in out-patient settings. As a result, they are less inclined to shift their schedules, work weekends and disrupt their private patient care routines to rush to hospitals to tend to patients, most of whom, doctors say, are uninsured and more likely to sue if something goes wrong . . .. . . Robert Ball, a urologist at Inova Fairfax, said declining insurance reimbursements make it harder for doctors to leave paying patients in their private offices while they treat other patients in the emergency department for free.
“Most physicians want to do the right thing, but it’s gotten to the point where we can’t stay in practice in Northern Virginia,” Ball said. “The days of the wealthy physician are over.”
Related posts:
- Are the days of the independent physician coming to an end?
- Squeezing physician reimbursements: A vicious cycle
- The specialization of family medicine
- It’s about time: Doctors starting to drop insurance
- Poor reimbursement leads to physician shortages
- The market works for hospitalist salaries
- Is there really a physician shortage?
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{ 13 comments }
Interesting article. So when compensation for “specialists” goes down they refuse to take indigent call unless they are paid. I am a Family doc and have seen this happen in my community. And the hospital “Steps up to the plate”(OR TROUGH) for the por specialist making three to 8 times what I make annually. And will the hospital support Primary care taking indigent call? Ha!
I’m real sorry if you specialists income has gone down. But when you get down to my level we can sit across the table from one another and share a glass of whine.
Sad, but true, America’s health care non-system is circling the drain. Hospitals have kept this fact a secret by continuing to apply band-aids. Paying for specialty call is just another band-aid. Once the specialtists get used to the new money what is next?? More money of course. Anyway you paid me once why not twice, or three times oh well… you get the picture. And where does the money come from, for the most part taxpayers who have grown weary.
Until hospital closures become a routine headline, resulting in reduced access for emergency care and hospitalization, I doubt that a real fix to the dilemma will be crafted.
My prediction? Two tiers; the days of the “county hospital” will return, private and specialty hospitals (no poor people please)will expand. Oh and I forgot, the best and brightest will no longer choose medicine as a profession-way to much work for way to little return. The upside-you tell me
None of the family physicians and very few internists in my community take ER call. The hospital provided hospitalists when these guys grumbled about ER call. The surgeons, surgical subspecialists, and medical subspecialists (cardiology, GI) are still required to take ER call to maintain their hospital privileges. Sounds like a great idea up in Virginia, but I agree that this is another flush as the healthcare system in America swirls down the commode.
Taking call at hospital emergency department is charity work, paid or not. It is true that nobody in their right mind wants to do after hours care, much less risk their neck going to the ER in the middle of the night. And ER patients interrupting 60 or more patients a day in the office certainly cannot be accomodated. The solution is not paying private doctors to cover call they realistically cannot cover, but large hospitals like you did your at with staff and residents/fellows filling in the gaps. Oh, and getting the nonemergencies to be seen in the office.
The government, payors, and even hospitals have conspired to reduce physicians to the level of labor that can be controlled by those more powerful entities for their benefit now. Now they complain because they find that labor expects to be paid to show up?
How will physicians ever be able to survive on the low six figures? Ohh the humanity!
“How will physicians ever be able to survive on the low six figures? Ohh the humanity!”
Well said by another envious, personally insecure whiner that somehow feels better if he/she thinks hard working successful people are getting cut down to their level.
Must be graduate of public education specializing in liberal self defetism.
For the stereotypical idiot anon 8:54:
low 6 figures. 6 figure debt. Plus every business skill availble to scrounge and get 6 figures.
It’s the hardest 6 figures to scrap together.
Every business skill available? Judging by the way some of you whine it appears your business skills are limited. You’d wither and die in the real free market.
“How will physicians ever be able to survive on the low six figures? Ohh the humanity!”
They won’t. They’ll leave medicine and go into business.
After 7 years, I just closed my practice and started a mobile imaging company. Free market, here I come!!!
The issue of covering indigent call has had a great impact on primary care in Northern Kentucky. The largest provider of indigent care in the area will only provide “9 to 5″ care for patients. Patient’s are now “abandoned” to the ERs at night and on weekends where they enevitably are admitted. These admissions are forced other primary care practices for the “priviledge” of caring for your own patients in the hospital.
In 2006 the number of such cases rose from 10% to 40% of our admissions.
Without the hospital “stepping up to the plate” and reimbursing for this burden we will no longer be able to remain finacially viable and cannot continue to provide inpatient care.
I am a surgical subspecialist that takes call for our practice and the other practice in town as well as the local ED. We make less money than the national average in our specialty and enjoy the high cost of living in New England. This ED call thing… it’s not all just about money. We seldom use the hospital and it is a financial loser for us. We need our privileges to stay on our insurance plans and continue to operate. The staff bylaws are very tight about call and noone is exempt unless released by their department. Other than the control issues of policy with the hospital…we feel an obligation to our fellow docs in the ED not the hospital corporation. Those are the realities and “fox hole” feel good reasons we take call. The not so savory area is that our “not for profit” hospital continues to expand, hire hospitalists for the primary care docs, has purchased approx. 75% of the medical staff including urology and surgery and is the largest employer in our city. If they roll out another capital campain/physician extorsion plan I will surely die. There are a growing number of us that would like to be compensated for our work but fear we are not coming into this from a position of power when we approach the hospital. The administration pays themselves handsomely and enjoy “Bergermeister” authority. It would be easier to give of our time if they were in dire straits or we were a charity hospital with a mission of charity. Let’s call a spade a spade…they are a business as are we. We are trapped by our moral and ethical obligations and they are not. If change is not coming, I plan on retiring as soon as I can afford to.
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