“On call” debate continues

In the March 2008 AAOS Now, Thomas K. Miller, MD, called for an “alteration in reimbursement” for those physicians and facilities unable or unwilling to provide emergency care. I can understand his frustration with what he deems are inappropriate referrals. After taking call for 25 years in community hospitals, however, I know that reimbursement is the major reason that my colleagues are now reluctant to take on these very cases. Lowering reimbursement will only make the situation worse.

Health care in the United States has changed. The major medical centers—where the trauma centers are typically located—now compete directly for patients with community hospitals. Many community hospitals have closed; those that are left have fewer staff, less equipment, and less operating room availability.

Dr. Miller implies that outpatient surgical centers may be a reason that some community physicians are too busy for trauma care. In my area, outpatient facilities and clinics are frequently sponsored by these same large medical centers, and they are not open nights or weekends. This leaves the community physician to provide emergency services to patients during those times, a reverse of the referral pattern he disclaims.

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