The state of ED on-call coverage in California

Inequalities in Specialist Hand Surgeon Distribution across the United States

“…15 Furthermore, it is likely that this pattern contributes to the difficulties some hospitals face in accessing specialist hand services. 1,5,6 Previous research conducted among 56 Oregon hospitals showed that chief executive officers faced difficulties in on-call coverage despite an 84 percent increase in the annual stipend for promoting specialist on-call coverage, including hand surgeons. 2 Rudkin et al, 1 in a statewide analysis of emergency departments in California, identified hand surgery as one of the specialties, among surgical and nonsurgical, that had trouble with oncall coverage greater than 50 percent of the time.…”

“…1,5,6 Previous research conducted among 56 Oregon hospitals showed that chief executive officers faced difficulties in on-call coverage despite an 84 percent increase in the annual stipend for promoting specialist on-call coverage, including hand surgeons. 2 Rudkin et al, 1 in a statewide analysis of emergency departments in California, identified hand surgery as one of the specialties, among surgical and nonsurgical, that had trouble with oncall coverage greater than 50 percent of the time. Other contributory factors may include physician preference for elective ambulatory care without on-call responsibility 6 and socioeconomic incentives.…”

Emergency general surgery

“…This trend toward specialization has created a situation where fewer surgeons are participating in general surgery call schedule, creating potential gaps in availability of emergency surgical care. 7 The field of ACS, with its emphasis on expedient care of the most ill surgical patients with a 24/7 service model, has been posited as a potential solution to this crisis. 8,9 EGS is an important focus of the evolving field of ACS.…”

Acute care surgery in evolution

“…Also considered was the issue of unavailability of surgical specialists to cover emergency calls because of issues of uncompensated care and perceived higher malpractice risk for off-hours emergency care. Emergency rooms across California have reported difficulty maintaining subspecialist coverage with plastic surgery, otolaryngology, dentistry, psychiatry, and neurosurgery being the most problematic (11). This situation is universal and not limited to the state of California.…”