Emergency Room and On-Call Risks

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Next-Gen Doctors Opting-Out

Dr. David E. Marcinko MBA - MSLBy Dr. David Edward Marcinko; MBA, CMP™


Of course, it’s getting more expensive these days to take hospital call as physicians are electing not to take this responsibility because of decreased reimbursement rates. Others opt-out because of a desire to spend more time with family, and/or scheduling conflicts. And, let’s not forget the liability concerns.

Historical Review

But, back in the old days, I recall eagerly signing up for call to make a few extra bucks [it was a very competitive proposition back then], as I started my fledgling practice.  About a decade later, I didn’t make much on-call money any more, but continued my rotation and chalked it all up to societal “pro-bona care”. And, the increased service visibility still garnered me a few lucrative patient referrals. Then, it became a financial and out of office-time loss, and ultimately a great liability headache. Fortunately, I could afford not to do it any more; and quit. Let the younger guys and gals “pay their dues”, I reasoned.

Legal Issues

Now today, there is a growing revolt of specialists against hospital on-call duties that threatens to violate Federal law and lose status as trauma centers. Specialties most likely to refuse include plastic surgery, ENT, psychiatry, neuro-surgery, ophthalmology and orthopedics. And, refusing to respond to assigned call is a violation of Federal law and carries fines as much as $50,000 per case.

Opting –Out

In contrast, refusing to sign up for call does not violate the law, and more physicians are taking this option. The problem opting-out problem is especially acute in California where hospitals are combating the issues with compensation, reporting the miscreant docs to the authorities, or threatening to remove them from staff completely.


In turn, doctors are fighting back with lawsuits.

Other Supporting Opinions

Essayist Jeff Goldsmith,President of Health Futures Inc, and Associate Professor of Public Health Sciences at the University of Virginia*recentlyopined that:

“We can expect intensified conflict with private physicians over the hospital’s 24-hour mission and service obligation, specifically providing physician coverage after hours and on weekends. Younger physicians have shown decreased willingness to trade their personal time to cover hospital call in exchange for hospital admitting privileges as their elders did. Those admitting privileges are either less essential or completely unnecessary in an increasingly ambulatory practice environment. The present solution is for hospitals to pay stipends to independent practitioners for call coverage or to contract with single specialty groups large enough to rotate call internally.” 

NOTE: * Goldsmith, Jeff: The Long Baby Boom, by Johns Hopkins University Press, May 2008.


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4 Responses

  1. Patient Education and ER Visits

    Excellent post Dave, but let’s not forget general ER costs.

    Now, according to Ann Zieger of Healthcare Finance News [February 4, 2009] a new study funded by the Agency for Healthcare Research and Quality [AHRQ] concluded that patients who understand their after-hospital care instructions are 30 percent less likely to be readmitted or visit the emergency department than those who don’t.

    Published in the Annals of Internal Medicine, the research found that total costs, including both hospitalization and projected outpatient expenses, were $412 lower for patients who received complete information versus those who didn’t.

    To draw this conclusion, patients were randomly assigned either to a control group or to participate in a program which used specially-trained nurses and pharmacists to manage follow-up care.

    Within 30 days after educating patients in the pilot program known as Re-Engineered Hospital Discharge, the 370 patients had 30 percent fewer subsequent ER visits and readmissions than the 368 patients that did not. Ninety-four percent of patients participating in the program left the hospital with a follow-up appointment with their primary care physician, compared with 35 for the control group.

    Keep up the good work.

    Dr. Michael Szymanski


  2. How Long Will You Wait at the Emergency Room?

    How long you wait at the ER matters a lot.


    This new interactive news application lets you see travel and wait times at hospital ERs near you.

    Ann Miller RN MHA


  3. 18% of Adults Visited the ER in 2014

    The CDC recently conducted a study on adult emergency room (ER) use in 2014. Here are some key findings from the report:

    • In 2014, 18% of adults visited the ER one or more times.
    • 7% went to the ER because of a lack of access to other providers.
    • 3 in 4 (77%) cite seriousness of the medical problem as the reason for the most recent ER visit.
    • 12% say they went to the ER because their doctor’s office was not open.
    • Adults with Medicaid had the highest prevalence of 2+ ER visits in the past 12 months (18.5%).
    • 14.3% of privately insured adults visited the ER in 2014, while 35.2% of adults with Medicaid did.

    Source: Centers for Disease Control and Prevention, February 8, 2016


  4. ER Mortality Dropped by 48% Between 1997-2011

    Health Affairs recently published research on emergency department mortality. Here are some key findings from the report:

    • Between 1997 and 2011 there was a 48% reduction in ER deaths.
    • More than 136 million emergency room visits took place in the United States in 2011.
    • 40 million of ER visits were injury-related in 2011.
    • 12% of ER visits in 2011 resulted in hospital admission.
    • ER mortality rates fell from 1.48 per 1,000 adults in 1997 to 0.77 per 1,000 adults in 2011.
    • In 63% of ER deaths, patients were in cardiac arrest, unconscious or dead on arrival.

    Source: Health Affairs, July 6, 2016


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