title: Changes in the cost and management of emergency department on-call coverage: evidence from a longitudinal statewide survey.
abstract: OBJECTIVE
  We measure changes in the prevalence and magnitude of stipends and other payments for taking emergency call during a 2-year period for hospitals in Oregon and evaluate the ways in which hospitals are limiting services and assessing policy options.
  
  
  METHODS
  This was a longitudinal, standardized, e-mail-based survey of chief executive officers from all hospitals with emergency departments (EDs) in Oregon (N=56). The first wave was conducted in the summer of 2005; a follow-up survey was conducted in summer 2006. Hospitals reported on-call payments made to 8 selected specialties.
  
  
  RESULTS
  Among 56 Oregon hospitals with EDs, 43 responded to our survey in both 2005 and 2006, representing a 77% response rate. Among 54 specialties receiving stipends in 2006, the average stipend was $18,324. Total annual stipend payments increased by 84%, from an average of $227,000 per hospital in 2005 to $487,000 per hospital in 2006. In Oregon, between 2004 and 2006, 67% of hospitals lost the ability to provide coverage for at least 1 specialty on a 24-hour, 7-day-a-week basis. Approximately half of hospitals (49%) manage this lack of coverage by transferring patients to other hospitals on a case-by-case, ad hoc basis.
  
  
  CONCLUSIONS
  The cost of maintaining on-call coverage is increasing in Oregon, raising concerns about hospital financing and a degradation of the emergency services. There has not been a systematic response to on-call shortages, with patient transfers primarily managed in an ad hoc, case-by-case basis.
authors.affiliation: Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR 97239, USA. mcconnjo@ohsu.edu
authors.forename: K John
authors.initials: KJ
authors.lastname: McConnell
authors.forename: Craig D
authors.initials: CD
authors.lastname: Newgard
authors.forename: Raymond
authors.initials: R
authors.lastname: Lee
mesh_terms: D039602:After-Hours Care / Q000191:economics*; D001291:Attitude of Health Personnel; D004470:Economics, Medical; D004636:Emergency Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006761:Hospitals / Q000145:classification / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008511:Medicine / Q000145:classification / Q000706:statistics & numerical data; D009922:Oregon; D013038:Specialization