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ER On-Call Risks

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Next-Gen Podiatrists Opting-Out?

By Dr. David Edward Marcinko; FACFAS, MBA

 

Of course, it’s getting more expensive these days to take hospital call as physicians and podiatrists are electing not to take this responsibility because of decreased reimbursement rates. Others opt-out because of a desire to spend more time with family, and/or scheduling conflicts. And, let’s not forget the liability concerns.

 

Historical Review

 

But, back in the day, I recall eagerly signing up for call to make a few extra bucks [it was a very competitive proposition back then], as I started my fledgling practice.  About a decade later, I didn’t make much on-call money any more, but continued my rotation and chalked it all up to societal “pro-bona care”. It was good for the residency program, as well. And, the increased service visibility still garnered me a few lucrative patient referrals.

 

Then, it became a financial mess and out-of-office time-loss, and ultimately a great liability and headache. Fortunately, I could afford not to do it any more; and quit. Let the younger guys and gals “pay their dues”, I reasoned.

 

Legal Issues

 

Today, there is a growing revolt of specialists against hospital on-call duties that threatens to violate Federal law and lose status as trauma centers. And, specialties other than podiatry most likely to refuse call include plastic surgery, ENT, psychiatry, neuro-surgery, ophthalmology and orthopedics.

 

Of course, refusing to respond to assigned call may be a violation of Federal law and carries fines as much as $50,000 per case.

 

Opting–Out

 

In contrast, refusing to sign up for call does not violate the law, and some physicians and podiatrists are taking this option. The opting-out problem is especially acute in California where hospitals are combating the issues with compensation, reporting miscreant doctors to the authorities, or threatening to remove them from staff completely.

 

This is hardly a good situation for podiatrists who may have only recently won the right to ER call coverage in some areas.

 

Assessment

 

Nevertheless, some doctors are fighting back with lawsuits.

 

Other Supporting Opinions

 

Essayist Jeff Goldsmith, President of Health Futures Inc, and Associate Professor of Public Health Sciences at the University of Virginia* recently opined that:

 

“We can expect intensified conflict with private physicians over the hospital’s 24-hour mission and service obligation, specifically providing physician coverage after hours and on weekends. Younger physicians have shown decreased willingness to trade their personal time to cover hospital call in exchange for hospital admitting privileges as their elders did. Those admitting privileges are either less essential or completely unnecessary in an increasingly ambulatory practice environment. The present solution is for hospitals to pay stipends to independent practitioners for call coverage or to contract with single specialty groups large enough to rotate call internally.”

 

Conclusion:

 

And so, as a podiatrist, what are your thoughts on this highly emotional, and increasingly contentious, topic? Is it related to a type of “informed-consent” for the attending podiatrist?

 

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko MBA is available for medical seminars or other speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

Copyright 2008 iMBA Inc: All rights reserved, USA. Use is restricted to www.ePodiatryConsentForms.com subscribers and visitors only. No redistribution is allowed. To avoid violation of iMBA Inc copyright policy, please register for your own free membership.

 

Related Information Sources:

Board Certification Preparation: www.PodiatryPrep.com

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Referrals: Thank you in advance for your electronic referrals to www.ePodiatryConsentForms.com

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Written by cmps

September 1, 2008 at 9:42 pm

Posted in On-Call ER Risks

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