| Requests by neurosurgeons nationwide to be compensated for on-call service are growing in frequency. |
The lack of specialist backup is causing delays in patient treatment, an increase in patient transfers between emergency rooms and untimely access to specialists, thereby placing patients at risk. These shortages are intensified by the medical liability crisis, which is forcing many specialists, including neurosurgeons, out of practice or requiring them to seek revenue generation elsewhere.
Neurosurgeons are negotiating with their hospitals for fewer on-call hours and/or to be paid by the hospital for call coverage. Requests by neurosurgeons nationwide to be compensated for on-call service seem to be growing in frequency, but although according to the 2004 AANS/CNS Neurosurgical Emergency and Trauma Services Survey, only about one third of neurosurgeons currently receive a stipend. These requests have, however, been met with mixed responses by affiliated hospitals.
Several informal interviews with representatives of neurosurgical practices in the south and northeast demonstrate the disparities among those who do and do not receive stipends for on-call service.
In the mid-south, a group of neurosurgeons tried to negotiate an equitable arrangement for on-call coverage. After an unsuccessful negotiation, the group withdrew its medical privileges from that hospital. The hospital responded by hiring locum tenens to cover emergency call, but after six months hired the group to cover at $2,000 per day. In the same region, a neurosurgeon in solo practice exclusively covers one local hospital’s emergency room for $1,500 per day.
A northeastern group reported that they have been paid for on-call coverage for more than 10 years. Initially the stipend was based on a percentage of their charges for the patients seen in the trauma unit, and then it became a fixed rate per relative value unit. The group now receives a daily stipend of $2,000 per day with a cost of living adjustment built into the contract.
Another neurosurgeon stated that he was paid $2,200 for each day that he covered emergency call more often than one day in seven. For example, if five neurosurgeons were taking call, each would average two more days per month than the “1 in 7” and would receive $4,400 per month on average.
A group in the northeast covers one main hospital and receives $75,000 per year, which is paid to the corporation and in which all of the group’s physicians share equally. Additionally, some physicians cover a hospital 45 miles away on select weekends. Call begins at 5 p.m. on Friday and ends at 7 a.m. on Monday; they receive $8,000 per weekend.
Other physicians have not been as successful in their negotiations and have elected to limit their on-call availability. One southeastern group tried to negotiate compensation with two large hospitals, without success. Although the hospital requested to schedule the group for full “24/7/365” emergency call, the group declined and elected to be unavailable to the two hospitals for emergencies every other weekend, Tuesdays and Wednesdays. Neither hospital has developed a plan for the days that there is no neurosurgical emergency service available, but tries to transfer patients to other emergency rooms. As a result, sometimes no emergency room will take the patient.
In the mid-south recently, after 18 years of service with a local hospital, a four-physician group notified one of the three hospitals they had covered routinely that they would limit their unassigned call to 10 days per month. Notification occurred after the hospital had hired an osteopathic physician to cover neurosurgery. (The physician was a hospital employee.) The physicians stated they would like to negotiate compensation for emergency call coverage for anything more then 10 days per month. The hospital responded by placing the four physicians on a 14-day suspension of privileges, but would not “officially” respond to inquiries by the physicians as to why they had been placed on the suspension. Unofficially, a high-ranking hospital administration representative cited “call” as the reason for the suspension. The physicians were not given adequate notice and time to appear before the Credentials Committee, which met without the physicians’ input. The “unofficial” notice the physicians received was that the committee had recommended that they be placed on permanent suspension. The group promptly resigned their medical privileges at that hospital.
While the ideal resolution has not been reached in many areas, there clearly is a need to balance hospital and physician duties with the practical realities of overcrowded emergency rooms and the concerns and practice demands of on-call specialists.
Tresa Sauthier, PhD, is the liaison of NERVES, , to the AANS/CNS Washington Committee. She is chief executive officer of Neurosurgical Associates of Northeast Arkansas PA, Jonesboro, Ark.