Tuesday, January 01, 2008

Unraveling or Evolving?

The next time you use an emergency room and need a specialist, one may or may not be available.

In earlier days, providing on-call coverage for emergencies was considered an obligation that physicians accepted when they were admitted to the hospital’s medical staff and given the privilege of using its facilities in the care of their patients.

In addition, assuring that physician services were readily available whenever patients needed them was looked upon as a collective obligation of medicine as a profession.

It seems that neither is any longer the case. An article by Christopher Lee of the Washington Post, buried on page A12 of the December 23 issue of The Boston Globe, reported on the growing difficulty hospitals are experiencing in getting specialists to provide emergency on-call coverage. It suggested that the problem was due to “a fear of malpractice lawsuits, a reluctance to go without pay when seeing uninsured patients and a growing intolerance to the disruption in their personal lives and private practices.”

What the article did not mention is that instead of recognizing a professional or institutional obligation, a growing number of specialists are demanding that they be paid by hospitals for providing coverage.

Dr. Ann O’Malley, a physician who has studied this matter, was quoted in the article as saying that “The historic relationship between physicians and hospitals is unraveling.”

Alternately, she might have said that the relationship is evolving. It used to be that the medical profession had the lead role in health care with the support of hospitals. That day seems to be behind us with the mantle of leadership being passed to hospitals, which now have the burden of responsibility for making specialist services available to emergency patients. It is a responsibility that hospitals have resisted, but is now being forced upon them.

Completing this transition is a central element of health care reform.

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