title: The state of ED on-call coverage in California.
abstract: The ED provides initial treatment, but failure of specialists to respond unravels the safety net. To assess the scope of problems with on-call physicians in California. A mailed anonymous survey to all CAL/ACEP physician members (1876) asking patient, physician and ED demographics, specialist availability for consultation, insurance profile, and availability of follow-up care. 608/1876 physicians responded (32.4%), representing 320/353 California EDs (90.6%). The seven specialties in which the greatest proportion of EDs reported trouble with specialty response were: plastic surgery (37.5%), ENT (35.9%), dentistry (34.9%), psychiatry (26.0%), neurosurgery (22.9%), ophthalmology (18.4%) and orthopedics (18.0%). 71.6% of responder EDs reported that their medical staff rules required ED on-call coverage. However, the percentage of responders who stated that hospitals paid each specialty for call was low: neurosurgery (37.3%), orthopedics (34.4%), ENT (17.9%), plastic surgery (15.1%) and ophthalmology (13.1%). On-call problems were more acute at night (77.2%) or on weekends (72.4%). Patient insurance negatively affected (69.9%) willingness of on-call physicians to consult for at least a quarter of patients. Regarding follow-up, 91% reported some trouble, whereas 64% reported a problem at least half the time. Surgical sub-specialists are the most problematic on-call physicians. Insurance status has a major negative effect on ED and follow-up care. The on-call situation in California has reached crisis proportions.
authors.affiliation: Department of Emergency Medicine, UCI Medical Center, University of California-Irvine, 101 City Drive South, Orange, CA 92868, USA.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Rudkin
authors.forename: Jennifer
authors.initials: J
authors.lastname: Oman
authors.forename: Mark I
authors.initials: MI
authors.lastname: Langdorf
authors.forename: Maryann
authors.initials: M
authors.lastname: Hill
authors.forename: John
authors.initials: J
authors.lastname: Bauché
authors.forename: Paul
authors.initials: P
authors.lastname: Kivela
authors.forename: Loren
authors.initials: L
authors.lastname: Johnson
mesh_terms: D039602:After-Hours Care; D000359:Aftercare; D001291:Attitude of Health Personnel; D002140:California; D003815:Dentists; D004635:Emergency Medicine; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005500:Follow-Up Studies; D006801:Humans; D007348:Insurance, Health / Q000145:classification; D007400:Interprofessional Relations; D008505:Medical Staff, Hospital / Q000458:organization & administration; D008511:Medicine; D009493:Neurosurgery; D009885:Ophthalmology; D009985:Orthopedics; D010036:Otolaryngology; D011570:Psychiatry; D012017:Referral and Consultation; D013038:Specialization; D013043:Specialties, Surgical; D013518:Surgery, Plastic; D000078329:Workforce