title: The shortage of on-call surgical specialist coverage: a national survey of emergency department directors.
abstract: OBJECTIVE
  problems with on-call specialist physician coverage have been identified as a significant issue for our nation's health care system. Despite this, little is known about the full extent of these coverage deficiencies in emergency departments (EDs), their effect on emergency care provision, or the subsequent effect on patient flow should specialist-requiring patients need to be transferred to centers of higher-level care. The objective was to report the experiences of a national sample of ED directors regarding the degree of difficulty in providing specialist coverage and the effect of on-call coverage problems on emergency patient care.
  
  
  METHODS
  the authors conducted a cross-sectional self-administered survey of a national sample of ED directors. How frequently ED directors reported on-call coverage problems, whether they recently lost on-call coverage, whether their current on-call coverage was reliable, and the potential effect on emergency care provision were all assessed.
  
  
  RESULTS
  the overall response rate was 62% (442 of 715). Seventy-four percent of respondents reported on-call coverage problems with specialist physicians. Sixty percent reported having lost 24/7 coverage for at least one specialty in the past 4 years. Twenty-six percent reported unreliability in their current on-call coverage. Twenty-three percent noted that their trauma center designation level had been affected by on-call coverage, and 22% noted an increase in patients leaving before being seen by a medically needed specialist.
  
  
  CONCLUSIONS
  difficulties in obtaining specialty on-call coverage are a pervasive issue for EDs at the national level. Emergency care provision appears to have been affected, and this issue is further impacted by a perceived unreliability in current on-call coverage provision as well as the attrition of coverage for individual specialties.
authors.affiliation: Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, CT, USA. mitesh.rao@yale.edu
authors.forename: Mitesh B
authors.initials: MB
authors.lastname: Rao
authors.forename: Catherine
authors.initials: C
authors.lastname: Lerro
authors.forename: Cary P
authors.initials: CP
authors.lastname: Gross
mesh_terms: D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000592:standards; D013502:General Surgery; D006302:Health Services Research; D006280:Health Workforce; D006801:Humans; D008505:Medical Staff, Hospital / Q000458:organization & administration / Q000600:supply & distribution*; D011787:Quality of Health Care; D014481:United States