Specialist shortages in the emergency room

One of the best medical blog writers is ED physician Edwin Leap. With all the talk about emergency room specialist shortages, he implores his specialist-colleagues to step up to the plate:

And here’s one last reality. This is America. It isn’t the Communist block with bizarre borders and border guards. If a patient needs your care, but isn’t from you community, why does it matter? I’d keep them if I could, but I can’t, so help me out! I know you may have financial incentives, or you may be overwhelmed already, but I’m not sending them by the bus-load, only rarely, and one at a time. And only when I can’t do it myself.
Attention Doctors”¦step up to the plate! Let’s be the professionals, heal the sick, treat the wounded, comfort the dying. The money will come, I promise, if we act like the heroes we can be, the heroes we should be. Let’s reclaim medicine! But we can only do it if we take care of those’pesky sick people.’ After all, they need us.

Comments

Anonymous
“The money will come, I promise, if we act like the heroes we can be, the heroes we should be.”
Sorry, wishing that you’ll get fairly compensated for the trouble fo taking care of these patients, will not make it come true.
The implication/accsuation here is that we greedy specialists want “Bags of gold” falling into our laps. Did it ever occur to Dr. Leap- who after all works SHIFTS- that we greedy specialists might not want to get up bleary eyed in the middle of the night?
Would he be so sanguine if I were to call him up in the middle of the night (AFTER he’s put in a full shift) and ask him to come cross town to take care of something for me (and the patient, of course)? Could I accuse him of being GREEDY because he balked? Could I accuse him of being anything less than a “hero” if I assured him the patient was insured and that surely, if we all collectively just wished hard enough, the money or public acclaim would follow??
Anonymous
Sorry, but the single payor system ALREADY in place in the US (Medicare, Medicaid and EMTALA) has brought ER care down to the level of Britain or France.
Throw in the unregulated and utterly corrupt John Edwards Junk Science Trial Lawyer Industry and ER patients are made persona non grata. Every risk-management course I have taken says to avoid ER patients like the plague.
The only partial solution I can come up with is to make ER care exempt from all malpractice suits. However, since the trial lawyer industry controls the democrat party, and exerts untoward influence on the Republicans, even simple reform of ER liability becomes highly problematic. But not imposssible if we look at Texas.
Ed Sodaro MD
Anonymous
Sorry Dr Leap but you need to spend a little more time OUTSIDE the ER. When is the last time you pulled a 36 hour call (a call night sandwiched between two work days. How about an 80 plus hour call (a weekend call). I don’t have much tolerence for some jacka$$ who pulls 8-12 hour shift work telling me to “step up to the plate”. Don’t even get me started on unecessary phone calls for “ER CYA” reasons.
Anonymous
As an ER doc you’re probably salaried by the hospital. You could see 0 patients or a 100 patients an hour you’ll still get paid. You DON’T pay office expenses, hiring personnel, or worry about financing ultrasound or X-ray machines.
As a specialist in a private practice, I don’t get paid unless I see patients. And seeing patients with insurance with crappy reimbursement essentially means I’m doing work that won’t sustain my practice so then NOBODY wins.
Edwin
Wow, lots of anger there! Look, I know it’s a drag getting up in the middle of the night. I don’t expect it for everything. I’m more than happy to deal with most of the things that come in, and at this point in my career, thank you very much, I rarely make ‘cya’ calls to specialists unless I genuinely need advice.
The problem is, sometimes people really need something at night, and can’t get it. Sometimes specialists are very difficult to consult for genuinely ill people. We’ve even had difficulty getting ENT’s to respond to zone II neck penetrations! What am I supposed to do about those wounds? Take them to the OR?
And how about mandible fractures, that are really painful and need surgery, but for whom I can get neither an ENT nor an oral surgeon to offer care? What do we do? Say ‘good luck!’
I’m not for a single payer system by any means. For all its bugs we have a great system. But as much as it sucks to go out in the middle of the night, you picked your specialty and I picked mine. I do work shifts, I am NOT paid by the hospital, I have a 25% uninsured population and I have sucky things about my job too. Drunks, drug abusers, violent patients, psychotic patients with no psych back-up, ‘pre-jail screening exams,’ etc.
So be careful assuming that your job is bad and my job is good. And I think it really diminishes the discussion to call someone names like jacka$$.
I know that it’s tight for everyone, and that specialists don’t have ‘bags of gold’ falling their laps, and are tired too.
But we have to be available to help people who need us. Otherwise, what’s the point of the profession?
Non-anonymously,
Edwin Leap, MD, FACEP

Specialist shortages in the emergency room

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