Exodus of specialists from ERs raises concerns
Many are unwilling to work nights and weekends or to care for uninsured patients.
When Dr. Mark I. Langdorf began practicing emergency medicine more than 20 years ago, finding a specialist to help with a complicated case was easy. Newly minted surgeons and fledgling ear, nose and throat doctors would show up in the emergency room with boxes of doughnuts, hoping to pick up patients and build their practices.
Today, specialists not only have dumped the doughnuts, they've abandoned emergency rooms in droves. One more sign of a deteriorating safety net, their exodus is both a cause and a result of the backlogs that plague hospital emergency rooms across Southern California. Their dwindling numbers affect the uninsured and the insured alike.
"Calling 911 gets you a waiting room," said Langdorf, the emergency department director at UC Irvine Medical Center in Orange. "It doesn't get you an emergency doc, and it certainly doesn't get you a right to a medical specialist."
Emergency room doctors can take care of about 80% of the patients who go through their doors, Langdorf said. But 20% of patients need an orthopedic surgeon to set a badly busted leg, an ophthalmologist to treat a shattered eye or other experts. That can mean hours on the phone trying to find a specialist or arranging a transfer to a larger hospital.
Contrary to what many patients may assume, California hospitals don't directly employ physicians. Under a state law that seeks to limit hospital pressure on a doctor's professional judgment, hospitals contract with emergency physicians or physician groups, who do their own billing. (The law does not apply to university and county hospitals.)
In the past, specialists in private practice who wanted to be able to admit their patients to a hospital would seal the relationship by agreeing to be "on call" for emergencies. But today, plastic surgeons and some other specialists do more procedures in office settings than in hospitals. And hospitals' financial struggles have given specialists the upper hand; if told to take emergency calls, specialists can take their elective surgery patients to another hospital.
As a teaching hospital, UCI Medical Center -- like Harbor-UCLA and County-USC medical centers in Los Angeles County -- can draw on doctors in training from the full roster of specialties. That's not the case at community hospitals, the local non-teaching facilities that are far more numerous.
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