title: The worsening of ED on-call coverage in California: 6-year trend.
abstract: To reassess problems with on-call physician coverage in California, we repeated our anonymous 2000 survey of the California chapter of the American College of Emergency Physicians. Physicians responded from 77.4% of California emergency departments (EDs), 51.0% of ED directors, and 34% of those surveyed. Of 21 specialties, on-call availability worsened since 2000 for 9, was unchanged for 11, and improved for 1. Of ED directors, 54% report medical staff rules require on-call duty, down from 72% in 2000. Hospitals have increased specialist on-call payments (from 21% to 35%, with 75% paying at least one specialty). Most emergency physicians (80.3%) report insurance status negatively affects on-call physician responsiveness, up from 42% in 2000. Emergency departments with predominantely minority or uninsured patients had fewer specialists and more trouble accessing them. Insurance status has a major negative effect on ED consultation and follow-up care. The on-call situation in California has worsened substantially in 6 years.
authors.affiliation: Department of Emergency Medicine, University of California, Irvine, Orange, CA 92868, USA. srudkin@uci.edu
authors.forename: Scott E
authors.initials: SE
authors.lastname: Rudkin
authors.forename: Mark I
authors.initials: MI
authors.lastname: Langdorf
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Oman
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Kahn
authors.forename: Hayley
authors.initials: H
authors.lastname: White
authors.forename: Craig L
authors.initials: CL
authors.lastname: Anderson
mesh_terms: D039602:After-Hours Care; D002140:California; D004635:Emergency Medicine / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000191:economics; D006176:Gynecology / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000191:economics / Q000458:organization & administration*; D006280:Health Workforce; D006764:Hospitals, Community / Q000458:organization & administration; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008505:Medical Staff, Hospital / Q000458:organization & administration; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008511:Medicine / Q000458:organization & administration*; D008913:Minority Groups / Q000706:statistics & numerical data; D009774:Obstetrics / Q000706:statistics & numerical data; D012017:Referral and Consultation; D013038:Specialization