Emergency coverage: Top medical staff challenge in 2005

Dear Medical Staff Leader,

At the December 2004 Medical Executive Committee Institute, 89 percent of attendees indicated that on-call coverage issues present a significant challenge for medical staffs. This is an understatement.

While there are hospitals (particularly small hospitals in rural America) that do not have difficulty covering their emergency departments (ED), the majority of urban or semi-urban facilities are now faced with medical staff members' increasing reluctance to provide clinical back-up to their colleagues in the ED.

In response to this challenge, hospitals have resorted to providing outright payment for back-up coverage, contracting with multi-specialty group practices for complete specialty back-up, or enlisting the help of the medical staff to spread the burden of ED back-up coverage equally among all physicians and the hospital.

It is this last effort that I would like to address briefly in today's letter. It is certainly possible that all medical staff members could agree that each physician, regardless of specialty, was responsible for (X) back-up coverage days each month. The medical staff and management could then agree that physicians providing more than (X) days of coverage in a month would be compensated above and beyond the minimum required as a condition of staff membership.  Physicians would more readily accept the responsibility knowing that the responsibility falls equally on all physicians--not disproportionately as is the case today.

Physicians would also recognize that the hospital is attempting to provide reimbursement for coverage above and beyond the minimum required as a condition of staff membership.

This is obviously a complex issue and the space allocated for this letter is not sufficient to fully explain the "burden equalization" program described above.  Please email me if you would like further information about this approach.

That's all for this week!

All the best,

Hugh Greeley