"Malpractice fears have thrown the emergency medicine system into crisis"

Any wonder why you can’t get neurosurgeons to cover emergency rooms anymore?

“Neurosurgeons in this town have to pay over $90,000 a year just for the privilege of getting out of bed on a Friday night to drain the blood from the brain of a victim of a drunk driver crash,” says LDS Hospital emergency doctor Todd Allen. “And they say, I’m not gonna do it. Because the patients are sicker. The procedures are sometimes more invasive and more risky with more complications. Why take that risk if they don’t have to?”

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  • Anonymous

    >>”I don’t wonder. Why would a neurosurgeon who makes on average over $300K a year just working office hours want to do ER?

    Really, Kevin, your efforts at blaming literally everything on malpractice “fears” is getting to be a little much.”

    Why not? They’re related. If you do ER service, your insurer charges you more for coverage than if you don’t. So if you are working in the office only for $300K–which I very much doubt is the net income for a neurosurgeon who doesn’t do any surgery, just office neurology–doing ER duty for whatever that earns probably won’t cover the costs of the extra insurance. Even if it does, it probably adds call schedule coverage headaches and other after-hours annoyance that hardly makes the additional ER scope of practice worthwhile. Why people think working for nothing and paying the costs out of your pocket ought to be any more attractive to doctors than anyone else in self-employment is a mystery. More of the denial and entitlement self-indulgent mindset: “if I need something I am entitled to it whether I can pay or not.”

  • Anonymous

    “So if you are working in the office only for $300K–which I very much doubt is the net income for a neurosurgeon who doesn’t do any surgery, just office neurology”

    The average salary of all surgeons is $250K, so assuming neurosurgeons make a little more is not unreasonable.

  • Anonymous

    The assumption isn’t that simple. Withdrawing fron the ER call roster usually means withdrawing from access to the OR too. That means the neurosurgeon probably will have to operate at another hospital, which may reduce the referrals he may receive from the hospital staff where he no longer is operating, or it may mean he has to reduce his surgical practice scope to that which can be done in an outpatient surgery center. That would mean that he would do fewer complex and higher-reimbursing cases, which may diminish his reputation in the referring community. All that means reduced income. But the lost time to uncompensated ER duties and higher costs of insurance coverage still might make that kind of compromise worthwhile. That might easily be the kind of decision a late-careeer surgeon might make as he turnes down his practice.

  • Anonymous

    California neurosurgeons have discovered the answer-refuse to cover the ED unless they are paid $1500-$2000 per day for coverage. So worst case $547500-$730000 to be available. Now no need for much of an office, so that expense goes away. Oh and if you can convince a second hospital to pay for coverage it really gets good!

  • Anonymous

    “refuse to cover the ED unless they are paid $1500-$2000 per day for coverage. So worst case $547500-$730000 to be available. Now no need for much of an office, so that expense goes away. Oh and if you can convince a second hospital to pay for coverage it really gets good! “

    As long as you don’t mind being on call EVERY DAY!!!

    A little commmon sense, please….

  • Anonymous

    “California neurosurgeons have discovered the answer-refuse to cover the ED unless they are paid $1500-$2000 per day for coverage. So worst case $547500-$730000 to be available.”

    What a novel idea! Paying the neurosurgeon to provide services…

  • Anonymous

    Where I am, er call is not a choice. If you have privileges you are on call for the er and consultations. Don’t answer calls or show up and your privileges are cancelled, thus no admitting, no operating.

  • Anonymous

    ER call as a routine part of medical practice for surgeons developed generations ago when surgeons could charge whatever they wanted to whomever they pleased, and scarcely had any malpractice worries. They could make enough from the few prosperous emergency cases to make up for the modest reimbursement from middle class patients and no reimbursement from the poor. They built a reputation and a practice thereby. There were no beepers or cell phones so the stress was mitigated by the fact that he really couldn’t be asked to be two places at one time–he dealt with what was in front of him at the moment.

    Now, he still has the unreimbursed cases, and reduced reimbursement on all the rest. If Warren Buffet is enrolled in Medicare and comes into the ER, the treating physicians are limited to sub-market reimbursement rates–essentially charity rates–so he now gets the bad without the good.

    Little wonder that more and more physicians can no longer justify doing it. For at least a generation now, most have seen it as a drain but did so either for access to the hospital or out of a sense of duty. The odd thing about practicing medicine, is that the “overtime” is reimbursed less than the regular hours.

    In our city, the neurosurgeons just built their own specialty hospital, so they don’t need the OR’s at the general hospital to make top dollar.

    While envy of their stunningly high incomes, by my non-proceduralist standards, would tend to make me wish otherwise, I must admit that it is completely fair and rational for them to be paid to provide ER coverage if it is not wothwhile for them to do so otherwise.

    I too no longer cover ER’s (forswearing general hospital work to accomplish this) because, while I know I will get financially stiffed regularly practicing medicine, I really hate when it happens at 2 am.

  • Anonymous

    “Where I am, er call is not a choice. If you have privileges you are on call for the er and consultations. Don’t answer calls or show up and your privileges are cancelled, thus no admitting, no operating.”

    You need to build your own ambulatory surgicenter with a few partners and then give the hospital’s ER the middle finger.

  • Okulus

    The surgicenter idea is nice, except most surgery centers require operating surgeons to have admitting privileges at a hospital within a set radius of the surgery center. This is so that if a patient becomes unstable while at the surgery center, the operating surgeon can theoretically admit that patient to the hospital. Now in practice, it really makes no sense, since instability usually implies anaesthetic-related problems or cardiopulmonary events, and the most appropriate specialist to be caring for a patient with either of those kinds of problems would not likely be the same one doing surgery at a surgery center. Still the requirements stand, even if they are illusory.
    I rarely need my local hospital for anything. Most of my ER consultation is gratis (not my choice) Nearly all my surgery is done at a surgery center and yet, because of their rules, I must still affiliate at the hospital.

  • Anonymous

    “…most surgery centers require operating surgeons to have admitting privileges at a hospital…”

    The laws differ state to state. Some states have no such law. Sometimes the surgicenters have empirically adopted such rules but they may in fact not be necessary according to the law. If you owned your own surgicenter with a few surgeon partners you could set your own rules, depending on your state’s laws. As far as I am concerned, the requirement that a surgeon needs to have priveleges at a hospital inorder to gain priveleges at a surgicenter smacks of anticompetition. The hospital lobbyists are powerful and must be held to account here. These sort of laws/rules need to be challenged in court. These are the types of things that the ACS should be working on…

  • Anonymous

    I have read the previous comments that are primarily focused on ER. I am not a doctor but rather a consumer. I empathize with most of your comments; they are not that different than the way the rest of us would feel. I do find it mystifying that the physicians with their relative wealth can not band together to create a political force that would result in a better system. The current system is a fraud. On my Explanation of Benefits, I typically find that the hospital or doctor has been paid by the insurance carrier only 1/7 to 1/10 of the charge made for a service. This level of disparity for insured versus non-insured is criminal. Doctors, surgeons and specialists deserve to be paid more than other professions because they spend a tremendously greater amount of time in training to be able to practice. On the other hand, medical professionals (nor any of the rest of us) should attempt to gouge people in a time of need to inordinately profit. Medical malpractice insurance and malpratice suits to get money should be illegal. The AMA as it currently acts should be abolished. Unlike the current practice, the physicians who understand the intricacies of medical procedures should properly govern themselves and eliminate the doctors who are “impaired” or generally of poor competence. Sorry, no breaks, not any ever, for the guy on drugs or alcohol in surgery (exception for the guy on the road helping an accident victim before the paramedics arrive). Physicians should be required to teach and medical schools and application acceptance should be quadrupled. I believe that we would all benefit from this and even the physician in the end would get more satisfaction from life. Note that everyone in our society would need to understand that life has risks and your bad luck is usually not somebody else’s fault. You have the resources and the contacts. How about it guys, are you going to get together and create a better system, or be like the guys on my street who wait for somebody else to fight their battle. If your eyes are on the money, don’t bother, whatever you create will be no better than what we already have.

  • Anonymous

    what does one have to go through to be a neurosurgeon thses days? do you need to go to premed and then med school or a “specific” med school to do that?

  • Anonymous

    “Physicians should be required to teach and medical schools and application acceptance should be quadrupled.”

    The problem with this is that if you accept more than what is accepted now, your standards HAVE to be lowered, and we all know what that means. Not to mention that a glut of physicians in the market makes it more difficult to find a job and will drop reimbursement substantially. A little common sense, please.

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