Many Specialists Refusing To Respond to Emergency Call, Citing Loss of Income and ‘Inconvenience’

"[F]ed up with the losses of money, autonomy and prestige," California's physician specialists are increasingly refusing to "honor expectations" to respond to emergency situations, the Los Angeles Times reports. The problem -- which is occurring nationwide, particularly in states with high numbers of residents who are uninsured or in managed care plans -- has resulted in delays in treatment and even patients' deaths, emergency room doctors say. The Times reports that in California, many specialists have launched an "unofficial rebellion" and are not "bother[ing] with the onerous inconvenience" of dropping work in their offices or coming in from home in the middle of the night to care for patients who typically are uninsured. According to a California Medical Association survey from last year, 60% of California specialists at hospitals where serving on call is voluntary had stopped or reduced that service: 40% said they had reduced the amount of time spent on call, and 20% said they no longer participated in the program at all. Many specialists say that they are withholding their services because "there is no guarantee that they will be paid" (Rohrlich, Los Angeles Times, 12/31.) California Orthopedic Association President Dr. Steven Ross said, "I'm getting called at 3 o'clock in the morning, and the only people I'm getting called for are people who are not going to pay? Why would I do that?" (Merrill, San Francisco Examiner, 12/30). Dr. Arthur Caplan, a bioethicist as the University of Pennsylvania, said that doctors have a "professional obligation" to care for the uninsured, adding that the problem is largely a business dispute. "Businessmen and women do not come out for free in the middle of the night," he said. Specialists have begun pressuring all hospitals to make on-call services voluntary or to pay specialists in return for being on standby. For example, some California hospitals have agreed to pay up to $1,900 per day for specialists to be on call. Such fees are paid in addition to whatever specialists can collect from patients and insurers (Rohrlich, Los Angeles Times, 12/31).