The nurses get paid, the Emergency Room doctors get paid, the physician assistants get paid, the phlebotomists get paid, but private doctors covering Emergency Rooms across the country increasingly do not get compensated for their work. Despite Obamacare insurance mandates, as of now, the majority of patients seen by on-call specialty physicians are not insured and will never pay these doctors who see them in Emergency Rooms, operate on them after hours, or care for them as inpatients.
“Where is my ENT doctor? My nose is bleeding damn it! I’ve been waiting for an hour already, this is ridiculous. Tell him to get his ass over here!” screams an uninsured patient in an Emergency Room.
The doctor on-call for this patient was a private doctor who recently decided to quit the Emergency Call Panel for that hospital. The private hospital could not find a substitute Ear Nose & Throat physician who would come in at 3:30 AM to see this uninsured patient with severe nose trauma. This problem has been illustrated in depth by a popular article by Gretchen Henkel, Situation Critical: Otolaryngologists See Diminishing Returns for Taking Emergency Call and by the 2008 Los Angeles Times article, Specialists Shun Emergency Rooms.
The doctor who recently quit the ER panel….what is he missing out on by quitting? No longer does he have to leave his family, wake up at ungodly hours, or postpone his weekend plans to cover patients demanding immediate care who have no intention of paying him and every intention of suing him if they are dissatisfied with their care. He no longer has to sacrifice his dignity and quality of life to work for free with not a penny of compensation from the hospital. He can still run a busy practice and can still operate on patients at a number of outpatient surgicenters and get paid and respected for his expertise, skill, and time.
Many private physicians working in large hospitals are not paid by the hospitals for their coverage of hospital emergencies. These physicians sacrifice days and nights of their busy schedules leaving their families, missing important events, being constantly interrupted by pages, losing sleep, and postponing time off to cover the non-insured free of charge in Emergency Rooms and in Inpatient Wards by remaining on hospital call panels.
Why do they do it? Because hospitals require them to in order for these physicians to use hospital operating rooms and other facilities. Frankly, these hospital policies are blackmailing physicians into providing slave labor.
Why are these hospital free labor policies utterly wrong? Because physicians should NEVER be forced to work for free ESPECIALLY for emergency care coverage—the most time consuming and high risk work. While physicians, of course, should volunteer to help those in need, they should not be forced to provide free services particularly by hospitals many of which make millions of dollars in revenue a year or get substantial tax breaks, donations, and grants for being non-profit and providing care for the uninsured. There are 10 important reasons why doctors should never accept contracts to provide free labor for hospital Emergency Rooms and Inpatients.
- Gross Inconvenience
- Extremely High Liability
- Difficulty in finding sub-specialists to co-manage higher risk cases
- Almost no way to collect any form of payment from the patient
- Very little benefit in building a practice
- High risk of morbidity/mortality of the patient
- Extremely Time-Consuming
- Free follow-up care if patient is admitted to the hospital
- Loss of regular income by cancellation of normal surgical schedule or clinic to see emergencies
- Higher risk of hospital disciplinary action, restrictions, medical board reporting, license revocation, and case reviews for emergency or trauma cases
What is the solution? It is a no-brainer. Hospitals must compensate doctors for covering their emergency room panels at a fair market price, they need to hire more staff physicians who have ER call built into their salaries, or they have to just put up with losing referrals and operating room income from private specialty physicians who are not going to tolerate these abusive policies anymore.
There are enough ASC’s (Ambulatory Surgical Centers) now that many specialty physicians have no need to be bound by the slave labor laws of hospitals demanding that physicians work at their hospital free of charge in order to operate or see patients at their institutions. A 2006 survey by the American College of Emergency Physicians found that 73% of emergency departments in the United States had inadequate on-call coverage by specialist physicians.
“If the state of California’s licensing and certification division came into our hospitals to examine whether we had all the specialists we say we do, they would shut down over half of the hospitals in Los Angeles County because we don’t have coverage,” according to Jim Lott, executive vice president of the Hospital Assn. of Southern California.
Since Obamacare mandates have taken effect in 2014, ER visits have increased dramatically according to the journal Science and the Huffington Post. Busier Emergency Rooms across the country have increased the obligations of specialty physicians on ER panels and will, in turn, further escalate the reluctance of these physicians to perform even more free emergency services with even more liability.
Forcing physicians to provide free services at any hospital to earn “privileges” (and then, in some cases, demanding that doctors pay the hospitals hundreds of dollars in annual medical staff dues on top of this!) is degrading and abusive to all physicians.
P.S. Do you know what most hospital CEOs make per year? Are they willing to work for the hospital free of charge?
Lionel Jeffreys MD MPH