Thursday, February 21, 2008


Typical night in the ER, sewing up a forhead laceration in a gentleman with a blood alcohol level of 0.36. He is a pro and is actually quite licid. He mentions, "Dude! The hospital must sure pay you guys a lot!" I wanted so much to correct him but he had a fit of ketone smelling vomit that I was afraid would catch fire.

I asked around as was supprised at how many people think that doctors are paid by the hospital. We have been trying to get paid for taking call but for the most part taking call is part of the deal to use the hospital to take care of your patients. The only way we get paid when we come in on call is if the patients pay us. In the case of this gentleman, all I get is a chance to wreck the car coming in at 3am, to be tired all the next day and lastly to be sued when he doesn't like his scar. This is part of the job however.

When the ER is filled with patients who don't pay, it becomes harder and harder for physicains to cover call. This is not care rendered for free but rather it costs the physicians as these patients are still followed up, seen in the office and the time and overhead is paid for by the physician. As a result, we are seeing docs drop out of call at an alarming rate. When you add that emergency care is more likely to get you sued, they leave the call system asap. One solution is to re-emburse physicians for taking call.

In the past, hospitals could employ physicians but this has been turned on its head by the medical regulations from Pete Starks laws. Hospitals that employ physicians are in danger of violation the law and this inturn means that the physicians must serve as a sort of sub-contractors within the hospital. This is true even for radiology, pathology and anesthesia. In each case, patients are billed by the doctor groups for the actual professional services of the physicians seperately from the hospital. A way around the Stark laws is that the hospital can pay a stipend to take call to defray the cost that is mandated by the hospitals. In some places this is working, but I am sure Pete Stark is well on his way to outlawing this as well.


SeaSpray said...

I have been reading the medblogs since October 06 and I have learned so much about PMDs, hospitals and the health care concerns/looming crisis.

Even though I worked in a hospital and around docs for 20 years...I never heard the in depth conversations on the topics that are brought to light in the medical blogosphere. Sure I heard the PMDs complain about ins plans. I know one surgeon who was breaking his contract and being sued by the insurance company.

Personally, this girl thinks you private docs should get paid just for getting up at 3am and having to come out into the cold dark nite. I hate that you have the potential for being sued when you are trying to help someone. Most people have no idea what dues you have paid to achieve your success and maintain it. Nor do they know the challenges you face on all fronts just to practice your chosen profession or the long hours. Or the interruptions to your private life. or that for surgeons and ER docs the declining insurance reimbursements. (I think you docs have to unite somehow and take a stand against the ins. companies) have good salaries but most people wouldn't be willing to work as hard as you have and do.

I trust the rewards far outweigh the negatives. I hope so. For instance, it must be an awesome feeling to know you have facilitated healing in a difficult case where it appeared the pt wouldn't get better. I am happy to say my urodoc did just that and I shall be forever grateful to him. :) Or to save a life? You have such an awesome and amazing responsibility.

I also thought you (I mean collectively)got payed by the hospitals to take call. And I thought you wanted to because you also get new patients that way. I guess the snafu is the increasingly self pay population.

I am so grateful that my urodocs were there to take call when I was an ER pt! Wouldn't that be dangerous for the pt if a specialist is required and there is no one to take call to help the pt requiring a particular specialty? What if everyone does that? I would not go to an ER if I knew they could not get on call docs to come in. I don't blame the docs but something has to give. Never heard of Pete Stark and so I looked it up -interesting. Intended for good but lawyers found loopholes and it backfired.

Funny what you said about the "fit of ketone smelling vomit that I was afraid would catch fire." :)

SeaSpray said...

Oh! What does RVU=0 mean?