title: The on-call crisis: a statewide assessment of the costs of providing on-call specialist coverage.
abstract: OBJECTIVE
  A recent change in the delivery of emergency care is a growing reluctance of specialists to take call. The objective of this study is to survey Oregon hospitals about the prevalence and magnitude of stipends for taking emergency call and to assess the ways in which hospitals are limiting services.
  
  
  METHODS
  This was a cross-sectional, standardized survey of chief executive officers from all hospitals with emergency departments in Oregon (N=56). This e-mail-based survey asked about payments made to specialists to take call and examined changes in hospitals' trauma designation and ability to provide continuous coverage for certain specialties.
  
  
  RESULTS
  We received responses from 54 of 56 hospitals, representing a 96% response rate (100% of trauma centers). Twenty-three of 54 (43%) Oregon hospitals pay a stipend to at least 1 specialty, and 17 (31%) hospitals guarantee pay for uninsured patients treated on call. Stipends ranged from $300 per month to more than $3,000 per night, with a median stipend of $1,000 per night to take call. Trauma surgeons, neurosurgeons, and orthopedists were the specialists most likely to receive stipends. Seven of 54 (13%) hospitals have had their trauma designation affected by on-call issues. Twenty-six hospitals (48%) have lost the ability to provide continuous coverage for at least 1 specialty.
  
  
  CONCLUSIONS
  Problems with on-call coverage are prevalent in Oregon and affect hospital financing and delivery of services. A continuation of the current situation could degrade the effectiveness of the trauma system and adversely affect the quality of emergency care.
authors.affiliation: Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health and Science University, Portland, OR 97239, USA. mcconnjo@ohsu.edu
authors.forename: K John
authors.initials: KJ
authors.lastname: McConnell
authors.forename: Loren A
authors.initials: LA
authors.lastname: Johnson
authors.forename: Nadia
authors.initials: N
authors.lastname: Arab
authors.forename: Christopher F
authors.initials: CF
authors.lastname: Richards
authors.forename: Craig D
authors.initials: CD
authors.lastname: Newgard
authors.forename: Tina
authors.initials: T
authors.lastname: Edlund
mesh_terms: D003430:Cross-Sectional Studies; D004470:Economics, Medical; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000191:economics*; D013502:General Surgery / Q000191:economics; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000639:trends; D006280:Health Workforce; D017721:Hospital Costs; D006801:Humans; D008505:Medical Staff, Hospital / Q000191:economics* / Q000600:supply & distribution*; D009922:Oregon; D040841:Resource Allocation; D012456:Salaries and Fringe Benefits / Q000639:trends*; D013038:Specialization; D014193:Trauma Centers / Q000191:economics; D017664:Uncompensated Care / Q000191:economics; D014481:United States