AMA meeting: Delegates explore on-call coverage, at-home genetic tests

A shortage of specialists taking call at hospitals sparks debate at CEJA forum.

By Kevin B. O'Reilly, AMNews staff. July 7, 2008.

Chicago -- Most hospitals are struggling to find specialists to provide emergency on-call coverage, and many are paying a stipend to attract them.

But are physicians obligated to take call? Is it OK for hospitals to mandate medical staff to do so? Should hospitals compensate some doctors for taking call but not others?

These are some of the questions delegates examined at the Council on Ethical and Judicial Affairs open forum at the AMA's Annual Meeting in June. Delegates also discussed the need for guidance from CEJA on ethical issues related to the explosion of direct-to-consumer genetic testing.

Nearly three-quarters of hospitals say they have inadequate on-call coverage, according to a 2006 American College of Emergency Physicians report. Neurosurgeons, orthopedic surgeons, trauma surgeons, ob-gyns, ophthalmologists and dermatologists are some of the specialists hospitals have trouble getting to take call. More than a third of hospitals now pay specialists, usually surgeons, to provide on-call coverage, ACEP says.

Constance Powell, MD, a Portland, Ore., psychiatrist and alternate delegate for the American Psychiatric Assn., said many physicians used to feel compelled to take call by the unwritten social contract between doctors and society. In exchange for working strenuous hours, physicians were rewarded with excellent pay and high social esteem, Dr. Powell said.