Rx for Emergency Doctor Shortage Gets Federal OK

By Phil Galewitz, The Palm Beach Post, Fla.

May 29–Just as it looked like efforts to deal with Palm Beach County’s chronic shortage of emergency room specialists would be a washout, the federal government has tossed the region a life raft.

Federal officials have proposed allowing competing hospitals to work together to set up “community on-call plans” to share specialists.

“This is a gift from heaven to be given this ruling,” said Dr. Michael Collins, emergency department director at Jupiter Medical Center.

Federal anti-patient-dumping laws require a hospital to have a specialist on-call at its emergency room for every service it covers. For instance, if the hospital offers neurosurgery, its ER would have to have a neurosurgeon on call. The idea is to make sure hospitals don’t shuffle patients to other facilities.

But Palm Beach County hospitals have struggled to get enough specialists to cover emergency rooms.

As a result, patients have faced delays in treatment and sometimes endured lengthy transfers to hospitals in Fort Lauderdale or Miami.

Palm Beach County hospitals and doctors have talked for four years about setting up a countywide on-call system.

Three neurosurgeons might be on call at three emergency rooms, allowing hospitals always to have a place to send emergency patients needing the care. Hospitals could “share” hard-to-find specialists.

But the idea languished partly because of concerns it would not pass muster under the federal anti-dumping laws. An alternative proposal that called for local hospitals to use a secure Internet system to locate hospitals with certain specialists on call each day failed to muster support.

Now, the federal government appears to have gotten out of the way.

An April 30 proposal from the Center for Medicare and Medicaid Services endorses the kind of countywide on-call system local hospitals and doctors suggested.

Tenna Wiles, executive director of the Palm Beach County Medical Society, hailed the federal decision as a “major change in policy (that) should eliminate the barriers that have hindered our progress.” The shortage of doctors willing to handle emergencies has remained as big a problem as when it first appeared in 2004.

Dr. Jose Arrascue, former chief of staff at JFK Medical Center, said lack of ER specialists is an issue at virtually every hospital every night. In addition to hand surgeons and neurosurgeons, other hard-to-find specialists include ear, nose and throat specialists, orthopedic surgeons and gastroenterologists.

Palm Beach County Health Care District CEO Dwight Chenette said he hopes to pull together details of an on-call system by year’s end.

But he cautioned that any strategy will have to be adopted by all of the county’s 13 private hospitals in order for it to work — and local hospitals still have concerns about sending patients to competing facilities, or attracting uninsured emergency patients from outside of the county.

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