ACPE poll: physician leaders distressed by specialist shortage; On call pay controversial

Physician Executive, May-June, 2005 by Bill Steiger

Some physician executives are outraged at even the mere suggestion of paying specialists to take emergency room call.

"I must be old school because I believe taking ER call is part of a physician's obligation to his/her community ... I am embarrassed to see physicians feel they are not responsible to provide any charity care to their fellow man," wrote one respondent to a recent ACPE poll on specialist pay.

Other physician leaders said paying for call is inevitable. "Today's new physicians want the pay but not the work. Hospitals that rely on the 'voluntary' medical staff may go the way of blacksmiths' shops."

"It is a shame that medicine has come to this," another wrote. "That being said, our hospital will have to do it also as it has become a major issue with many of the medical staff."

The divisions run wide ...

"Physicians have incredible financial pressures to stay in practice. All they can sell is their time. There is no reason for physicians alone to shoulder the entire burden of community health care."

and deep ...

"This is indicative of arrogant specialists."

A couple respondents even went so far as to call specialist pay "blackmail" and "extortion."

While the pay or not-to-pay question is obviously a hot button for physician executives there was one thing the poll respondents mostly agreed on: the specialist shortage is hurting hospitals.

The majority of poll respondents, 64 percent, said they struggle with the problem of getting specialists to take ER call. Only 29 percent said it wasn't a problem.

Sent to 3,000 physician executives in hospitals and group practices across the country, the poll drew 814 participants, a 27 percent response rate.

When it comes to paying specialists to take call, the group was split down the middle--46 percent said their hospitals pay specialists, 44 percent said their hospitals don't.

Yet, of those who said their hospitals don't pay specialists, nearly half (46 percent) are considering the controversial idea.

Perhaps the most interesting responses were found in the comments posted by 445 respondents to the poll. Some blasted the idea, berating any doctor who would ask to be paid for taking call. Others gave hearty approval, pointing out that failure to pay for call could lead to even bigger headaches for hospitals.

Here's a sampling of their comments.

Pro pay

Given the declining reimbursement rates for elective surgery, the increasing medical liability premiums, and consistent medico-legal exposure from emergency room coverage, reimbursement for this activity is only fair.

As the risk of practice escalates, and as payment for services decreases, ERs will have no choice but to reimburse specialists for taking call.

The emergency room is an epicenter of actual and potential liability in my practice. It is also a major source of office, family and personal time loss. Our hospital is currently proposing compensation for ER call. If compensation does not evolve, I am history in the ER.

My personal sense is that this (paying specialists) may make call a bit more palatable. Time away from practice and malpractice risk are increasingly becoming major impediments for practitioner willingness to take call, particularly if the most likely patients to be admitted to or consulted by them are uninsured.

Paying for ED call is inevitable.

Either pay or close the ER.

I am not opposed to it, in fact when I used to take call, I would have liked to have been paid.

Payment, if compliant with fair-market-value standards, is reasonable.

Its time has come.

It should be mandatory. The hospitals have been riding on the good will of the doctors too long. All meetings should be paid as well as any work done by doctors on the hospital's behalf on committees. We are enormous suckers.

No pay

We have some specialists who would like to be paid, but we are holding the line. Our medical staff bylaws require the taking of call, with some exceptions for 1-2 person specialties. We had a little challenge recently when the trauma director resigned, citing "inadequate reimbursement," but have since renegotiated that contract with a different member of the same group, without having to give away the farm.

I think it is outrageous to have to pay MDs to take emergency care of patients.

While the subject has been broached by the orthopedists, the administration is adamant about not paying.

Seems like this will be a monstrous rent in the provision of care to patients. The safety net is vulnerable enough without allowing specialists to decide when and for how much they will come to see patients in the ER. We already struggle with ortho, who often give patients appointments for follow up and then refuse to see the patient in their office because they don't have insurance.

Call is a responsibility of the House of Medicine.

The hospital cannot afford to pay specialists to take call. Once you pay one specialist, all will demand the same. Then every year the rate will rise. Who thinks this will be affordable unless the reimbursement changes?

Disgusting--Physicians have forgotten what they are all about.