Physicians cut back emergency on-call shifts, study finds

Hospitals are providing incentives to bring back specialists, including paying stipends and liability insurance.

By Damon Adams, AMNews staff. Oct. 25, 2004.

At one time, being on-call for emergencies was a way to build up a patient base. It also was a sign of dedication to the profession.

But some physicians say a professional approach to on-call coverage is being overshadowed by other problems that are making it less desirable to doctors. Rising medical liability premiums have made some high-risk specialists less willing to take call. More physicians are embracing lifestyles that allow additional time for family and outside activities and less time for 24-7 schedules. Low reimbursements also make on-call duty unattractive.

"A lot [of doctors] would like to be professional about it. But there are real economic issues for them if they are not being paid," said Brad Zlotnick, MD, a San Diego emergency physician and director of strategic development for Emergency and Acute Care Medical Corp., an on-call specialty physician management organization. "It used to be you'd compete to be on-call because that's how you'd get new patients. Not anymore."

The woes of on-call coverage also have pitted some emergency physicians against specialists.

"On some nights, they might yell at you and say, 'I'm not on-call for your hospital,' " said Ben Vanlandingham, MD, who worked in emergency departments in Arizona.

A new survey of 1,427 hospital emergency departments found that emergency physicians were spending more time seeking specialists for consultation and admission of emergency patients. The survey by the American College of Emergency Physicians also found that 16% of emergency directors said some specialists were negotiating with their hospitals for fewer on-call coverage hours.