Despite offering stipends as high as $3,000 a night, Oregon hospitals are struggling to keep specialists on call for emergency-room work, according to a study being published online Tuesday in the Annals of Emergency Medicine.
The study found that almost 50 percent of the hospitals in Oregon are unable to provide coverage around the clock in their emergency rooms in at least one specialty. Based on a 2005 survey of all the hospitals, the study found coverage shortages of on-call doctors in most specialties, with the most acute shortages in orthopedics and neurosurgery.
Nearly 50 percent of the hospitals also pay a stipend, ranging from $300 a month to $3,000 a night, to get specialists to work on call. The median stipend was $1,000 a night.
John McConnell, a lead author and researcher at Oregon Health & Science University, said the issue has serious financial implications for hospitals and potential concerns for patients.
“If you go to the [emergency department] on a Friday night, there may not be a specialist there to take care of you,” McConnell said. “That is important for people to know.”
The problem is most grave in large urban hospitals, according to the study.
At least seven hospitals in Oregon downgraded their trauma designation, which determines what services are readily available to patients, because of a lack of specialty services.
Several hospitals said they were seeking waivers from the state to maintain their trauma level status, despite failing to meet the staffing requirements.
However, the situation is believed to be worse in other states.
Stipends are relatively new in Oregon, where the annual cost is estimated at $13 million, McConnell said.
Other states such as California and Florida have paid stipends for some time, McConnell said. The California Hospital Association estimated its annual cost of stipend payments exceeds $600 million.
The problem stems from a number of sources.
Some doctors are reticent to work on call because of lower-than-wished pay, lifestyle conflicts and malpractice fears. In some communities, there is a shortage of specialists.
The study said the problem is compounded by a change in the interpretation of federal rules on staffing requirements and by the prevalence of ambulatory surgery and specialty centers where there are no on-call demands in emergency rooms.
The cost of getting adequate specialist coverage is affecting hospital financing, the study found. And payment costs could increase as the demand continues.
“You have to be concerned this is becoming a serious financial issue for hospitals,” McConnell said. “They have to decide, ‘Do I pay $75,000 to keep an orthopedist on call or do I let that go and downgrade from a level 3 to 4?'”
The study authors from Oregon Health & Science University, Sutter Emergency Medical Associates, the University of Iowa and the Office of Oregon Health Policy and Research said the problem is likely to intensify without a long-term plan to curb it.