In 2008, according to another report published in the Journal Academic Emergency Medicine, only 60% of California's emergency departments reported having cardiac surgery, otolaryngology, neurosurgery, plastic surgery, or vascular surgery specialists available. And there's no reason to think the situation has improved in two years.
Medi-Cal reimbursement rates are so low, that about 80% of the program's beneficiaries receive care from 25% of California physicians, part of a declining number of doctors willing to accept Medi-Cal as payment. It's hard, if not impractical, to expect specialists to take ED call without some guaranteed methods of compensation, the survey report explained.
"Because Medi-Cal enrollees are more likely to use EDs than the uninsured, enormous impact on EDs and on-call coverage is envisioned," the report says. Nationally, according to the American College of Emergency Physicians survey in April, 2010, 70% of ED physicians believe visits will continue to rise, while 54% predict that the number of specialists willing to take call in the ED will drop.
The report notes that California's call coverage problems must be handled differently than those of hospitals in most other states because the state's bar on the "corporate practice of medicine" precludes most of the state's hospitals (academic medical centers and government owned facilities are exempted) from directly employing a physician.
To grapple with this dilemma, the report highlights, a number of California emergency departments are launching various strategies to make sure their call coverage meets legal requirements, and to brace themselves from anticipated surges in coming years.
To figure out ways to make sure call coverage requirements are met, hospitals are grappling with a number of compensation strategies. No longer can they be relied upon to provide call merely on the promise of insured or otherwise covered patients. Mandatory call for physicians granted staff privileges, "has sharply declined in recent years," the report said.