Driven away by the three ills of American medicine – too much work, too little pay, and the fear of malpractice lawsuits:

On-call surgeons worry there’s more chance of getting sued by a stranger whom they rush to treat in an ER than by an established patient having elective surgery. “Anything can happen in an ER,” says Jose Arrascue, a kidney specialist in Boynton Beach, Fla.”If you have no rapport with the family, they may conclude you did something wrong, and you are wide open for a suit. That really concerns me.” There have been calls for legislation exempting doctors on ER duty from lawsuits, but the idea of immunity from malpractice hasn’t appealed to federal or state lawmakers.

To minimize risk, many doctors stop taking ER calls. Or, Valadka says, surgeons may limit the types of operations they do in regular practice, which means they won’t be called in for emergencies that are beyond those limits. For example, some neurosurgeons””ironically””have stopped doing brain surgery and focus only on the spine.