Make on-call specialists a priority

By Jose F. Arrascue
http://www.sun-sentinel.com

South Florida Sun-Sentinel readers of this newspaper may remember seeing stories about some emergency patients being transferred from Palm Beach County to Broward County due to a lack of capacity to treat them in Palm Beach, where they should be treated. Understandably, Broward’s doctors aren’t happy about the practice, and neither are we physicians of Palm Beach County.

But too often, physicians in Palm Beach have been blamed for these problems, when complicated factors prevent us from always having them within our control. To avoid future patient transfers, which mean lost time in a medical emergency, we need the public’s help.

Doctors in Palm Beach County endure one of the most threatening medical work environments in the nation. As a result, physicians have been opting out for years, leaving shortages of critically needed specialists in our emergency departments.

Many specialists in Palm Beach County can be sued by any patient they treat in an emergency room. Unlike Broward County, which offers some of its on-call doctors immunity from lawsuits through its broad network of public hospitals, almost all of Palm Beach County’s on-call specialists are vulnerable.

Medical malpractice insurance would protect physicians from the financial burdens of lawsuits. But since malpractice policies can cost more than $100,000 per year for some physicians in South Florida, the significant majority of physicians taking emergency room duty are forecast to work with no insurance whatsoever in the near future.

Despite the high risks, our physicians receive one of the lowest reimbursement rates from Medicare and Medicaid in the nation.

Filling the gaps for many critical specialties in our emergency departments will require more physicians, but instead, they’re leaving the county in droves. An infusion of young physicians would help, since they would help stem the oncoming tide of physician retirements in the county. But just 357 of our nation’s 15,736 medical school graduates in 2005 were from our state.

It’s a vicious cycle. As more physicians quit, the demands on practicing physicians become even greater and fewer doctors want to come to Palm Beach County. Those who remain endure longer hours, increasing risk, and decreasing payments, resulting in higher stress and lower job satisfaction — all of which results in a higher likelihood of leaving.

There are solutions. Offering on-call specialists immunity from lawsuits would provide many with the assurance that it’s safe to return to practice. We also need to boost the number of young physicians in the county. Creating a more hospitable climate to practice will help overall recruitment efforts.

But we can’t do that alone. Florida legislators have been slow to embrace laws that would protect on-call specialists in Palm Beach County. By encouraging your representative to do so, you would help ensure that an on-call specialist will be available to serve here at home.

Jose F. Arrascue, M.D. is president of the Palm Beach County Medical Society.
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