Nearly half of Oregon's hospitals cannot provide on-call specialist treatment around the clock to emergency patients in at least one specialty, despite paying substantial stipends, and 13 percent of Oregon's hospitals have had their trauma designation downgraded as a result.
K. John McConnell, PhD, Assistant Professor, Emergency Medicine and a health economist in the OHSU Center for Policy & Research in Emergency Medicine, was the lead study author. He and colleagues recently published these findings in the online version of the Annals of Emergency Medicine ("The On-Call Crisis: A Statewide Assessment of the Costs of Providing On-Call Specialist Coverage").
The study relied on a cross-section, standardized survey of chief executive officers from all hospitals with emergency departments in Oregon. The e-mail based survey asked about payments made to specialists to take call and examined changes in hospitals' trauma designation and ability to provide continuous coverage for certain specialties, as described in the paper's abstract.
The statewide survey, conducted in the summer of 2005, showed coverage shortages in most specialties, with the most acute shortages in orthopedics and neurosurgery. More than half of all hospitals expressed difficulty in maintaining specialists on call for three or more specialties. The eight specialties measured were trauma surgery, general surgery, neurosurgery, plastic surgery, hand surgery, neurology, orthopedics and obstetrics.
Nearly half (43 percent) of all hospitals provided some subsidy to at least one specialty, on average approximately $1,000 per night, in an attempt to attract more consistent specialty coverage. Ninety percent of large, urban hospitals in Oregon are compensating at least one group of specialists through stipends or guaranteed rates of pay.
"This study adds to a mounting body of evidence that the on-call crisis is a serious threat to the integrity of our emergency care system and is the weak link in the chain-of-survival in many communities throughout the United States," said contributing author Loren A. Johnson, MD, FACEP, Chief Medical Officer, Sutter Emergency Medical Associates in Davis, California.
The study represents the first comprehensive survey of the costs of changes in on-call coverage, noted McConnell. Although the study concerns Oregon, study authors noted that the problem may be substantially worse in other states, citing specific data from California where the total annual cost of stipend payments exceeded $600 million in 2005.
The study received significant media coverage in early January, including a front page article in The Oregonian and discussions on Oregon Public Broadcasting radio.
