The On Call Nightmare

This week I have the distinct honor of being on call. Let me explain to you what that entails. For one, my patients and the patients of other doctors I am covering for can call me for any problems they may have during hours when the office is closed. I think the public watches too much Grey’s Anatomy because people honestly believe that I live in the hospital and my entire life is exclusively geared towards their every desire. People are surprised to hear that I actually have a life outside of medicine. Because of this, people have no problem calling me at any of hour of the night with their non-emergent issues. It is not unusual to get the call at 3 am from the patient with ear pain that has been going on for a week. The chutzpah of some people who call me in the middle of the night is not to be believed.

As bad as that part is, it is not the worst part of being on call. The worst part is the requirement to take emergency room call. As part of my privileges at the hospital I belong to, I am required to share in taking care of people that show up in the emergency room with problems within my specialty. Now this may sound like a reasonable system but the truth is the system is broken. Many times the people who show up in the ER have no medical insurance. I am required to travel to the ER, take care of the patient, travel back home, all for free (yes, I can bill the patient but I never get paid). And worse, this patient can sue me if things, for whatever reason, go wrong. A high percentage of lawsuits are generated by emergency room visits. I essentially have legal exposure and must pay exorbitant malpractice premiums without the possibility of generating compensation. Now you tell me what other profession is enslaved like this.

Taking it a step further, if I am up in the middle of the night taking care of the nonpaying patient I may have a full day the next day with multiple surgical cases and a full schedule of office visits. So here I am operating and consulting on my insured patients with little or no sleep. There is no way anyone can be at their best having been deprived of sleep. The emergency room effects the care of those who are not even there, but just unfortunate enough to have picked their appointment on the day after a bad night for the doctor.

One will ask why then would I maintain privileges in the hospital and I would answer that I really do not want to. But, I am forced to have privileges by whom else but the insurance company. To be on their panels you must maintain privileges in a hospital.

There is no doubt that the system of emergency care is completely broken. More and more doctors are electing not to take emergency call unless they are compensated for it. This will affect care for people who truly require emergent care. Ultimately, it is always the public that suffers.

Well I’ll end it there. I just heard my beeper going off.