Surgery News - August 2007 - (Page 15)

AUGUST 2007 • SURGERY NEWS PRACTICE TRENDS 15 On-Call Specialist Gap Forces Patient Transfers B Y J O E L B. F I N K E L S T E I N Else vier Global Medical Ne ws he increasing lack of on-call specialists at hospitals across the country is forcing some emergency department staff to find nearby cities where patients can see specialists. “I was in situations in El Paso where we had no neurosurgery, and we had to ship patients out to other cities,” recalled Dr. Juan Fitz, an emergency physician in Lubbock, Tex. “Now we’re finding it here in Lubbock: With maxillofacial, we have no call; [with] neurology, we have no call.” And as Dr. C. William Schwab recently told the U.S. House Committee on Oversight and Government Reform, “There is a tremendous crisis developing on the surgical side to staff the in-house care that must take place after the emergency department.” Implications of the shortage will become even more profound as the nation’s 80 million baby boomers age, said Dr. Schwab, chief of the division of trauma and surgical critical care at the University of Pennsylvania Medical Center in Philadelphia and an ACS Fellow. Dr. Schwab cited the findings of an Institute of Medicine panel on which he served. “Providing emergency call has become unattractive to many specialists in critical fields such as neurosurgery and orthopedics,” according to the institute’s June 2006 report, “Hospital-Based Emergency Care: At the Breaking Point.” Problems such as collecting payment for on-call services, especially from uninsured patients, and liability concerns loom large. “Patients are often sicker, and emergency procedures are frequently performed, in the middle of the night or on weekends, when the hospital’s staffing and capabilities are not at their peak. A national survey of neurosurgeons found that 36% had been sued by patients seen through the ED,” the report continues. And the problem is getting worse, Dr. Ramon W. Johnson, an emergency physician at Mission Hospital, Mission Viejo, Calif., and a member of the American College of Emergency Physicians board of directors, said at the House hearing. Dr. Johnson cited the results of a national survey of emergency department directors conducted in the spring of 2004 and again in the summer of 2005. The ACEP survey found that in 2004, 67% of the departments reported having too few specialists on call, while by the next year the number had risen to 73%. More than half said the problem was due to physicians leaving the hospital to practice elsewhere. The survey found that the top five specialists in short supply were orthopedists, plastic surgeons, neurosurgeons, otolaryngologists, and hand surgeons. Many of those who are still willing to take emergency calls have agreed to fewer on-call coverage hours. Although taking emergency calls was once a requirement to maintain hospital privileges, physicians now have a greater ability to perform outpatient procedures in their offices, at ambulatory centers, or elsewhere besides the hospital, explained T Dr. Robert Berenson at a recent forum held by the Center for Studying Health System Change. “This is a big issue. Hospitals are working very hard to try to draw lines as to which physicians they are going to compensate for taking call or for caring for uninsured patients,” said Dr. Berenson, a senior fellow at the Urban Institute, Washington, D.C. “It has not yet become standard that all docs are getting paid by the hospital for ER call, but it is increasingly a cost of business.” Given that choice, specialists may prefer not to take emergency calls, in part because of the impact it has on their lifestyles and in part because being on call all night can cut into their ability to keep regular office hours, said Dr. Fitz. Recently, the number of neurologists willing to take emergency calls at the emergency department in Lubbock dropped from half a dozen to none. “If somebody comes in with a stroke, there’s nobody to call,” said Dr. Fitz. It’s a problem felt throughout the state of Texas— often most acutely by patients and their families, he added. “In the Houston area, they have found that there is sometimes no call for general surgery. With all the hospitals in Houston, people in Houston have to be transferred either to San Antonio or Austin,” he said. New Mexico had been sending patients who need specialty care to Lubbock, a referral center. “The problem is that now we, too, are short on specialties,” said Dr. Fitz. ■ NOW AVAILABLE : ATLS FOR DOCTORS STUDENT MANUAL, 7TH EDITION The ATLS® Program was developed to teach doctors one safe, reliable method for assessing and initially managing the trauma patient. The course teaches an organized approach for evaluation and management of seriously injured patients and offers a foundation of common knowledge for all members of the trauma team. The emphasis is on the critical “ﬁrst hour” of care, focusing on initial assessment, lifesaving intervention, reevaluation, stabilization, and, when needed, transfer to a trauma center. This publication, in its 7th edition, was written for use in ATLS Student Courses and is updated approximately every four years. Price: $80 each To obtain an ATLS for Doctors Student Manual, visit the American College of Surgeons online publication catalog at: https://web2.facs.org/timssnet464/acspub/frontpage. cfm?product_class=trauma https://web2.facs.org/timssnet464/acspub/frontpage.cfm?prroduct_class=trauma https://web2.facs.org/timssnet464/acspub/frontpage.cfm?prroduct_class=trauma

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Contents Drug Developments News From the College Thoracic Surgery Head & Neck Surgery

Surgery News - August 2007

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