The worsening of ED on-call coverage in California: 6-year trend☆
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Fig. 1
Percent of hospitals reporting trouble obtaining response by on-call specialists, in 2000 and 2006. OB/GYN indicates obstetrics and gynecology; ICU, intensive care unit.
Fig. 2
Specialties for which a higher proportion of hospital reported trouble obtaining response in 2006 than 2000.
Fig. 3
Average number of 21 on-call specialties by type of hospital in 2000 and 2006, with error bars for 95% confidence intervals.
Fig. 4
Number of 21 specialties for which emergency physicians reported trouble with specialty consultation more than 50% of the time, by hospital type and year of survey, with error bars for 95% confidence intervals.
Fig. 5
Percentage of hospitals reporting trouble (defined as ≥ 50% of the time or more) obtaining response by on-call specialists, for all 21 specialties, by hospital type and year of survey, with error bars for 95% CIs.
Fig. 6
Number of 21 on-call specialties for noncommunity hospitals and for community hospitals by minority and insurance status, with error bars for 95% CIs.
Abstract
To reassess problems with on-call physician coverage in California, we repeated our anonymous 2000 survey of the California chapter of the American College of Emergency Physicians. Physicians responded from 77.4% of California emergency departments (EDs), 51.0% of ED directors, and 34% of those surveyed. Of 21 specialties, on-call availability worsened since 2000 for 9, was unchanged for 11, and improved for 1. Of ED directors, 54% report medical staff rules require on-call duty, down from 72% in 2000. Hospitals have increased specialist on-call payments (from 21% to 35%, with 75% paying at least one specialty). Most emergency physicians (80.3%) report insurance status negatively affects on-call physician responsiveness, up from 42% in 2000. Emergency departments with predominately minority or uninsured patients had fewer specialists and more trouble accessing them. Insurance status has a major negative effect on ED consultation and follow-up care. The on-call situation in California has worsened substantially in 6 years.
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Presented at the 4th Mediterranean Emergency Medicine Congress, Sorrento, Italy, September 2007, and Society of Academic Emergency Medicine, Annual Meeting, Washington, DC, May 2008.
☆Source of funding: internal department funds.
