The Public Impact of the ER On-Call Crisis

Imagine that your child or an elderly relative falls and severely fractures an arm in the evening or on a weekend. You take them to the local Emergency Room to have the arm set, and normally an orthopedic surgeon will be called in to treat the patient. However, this time the ER doctor says that there is no specialist available to treat them. If you are lucky, a short trip to another nearby hospital might be all that is needed. But the trip might have to be a longer one, to Roanoke or Charleston, for example.

Altogether, BRMC has 14 medical specialties and sub-specialties that require on-call coverage by physicians in the evenings and on weekends. As of September 30, there were nine of those for which on-call coverage is either non-existent (Endoscopy, Nephrology and Neurology) or incomplete (ENT, Pulmonology, Plastic Surgery, Opthalmology, Orthopedics, Urology).

Sometimes, there just aren't enough doctors to cover the Emergency Rooms in Mercer County's three hospitals, which are experiencing these difficulties with increasing frequency. Sometimes each of the hospitals has to transfer patients to other facilities as a result.

BRMC, for example, is able to provide comprehensive Emergency Room coverage for on-call services only 67 percent of the time. This level of coverage is not satisfactory, but it is the best level among Mercer County's three hospitals. Unless each hospital can cover all its regular specialty call needs, a patient's preference for which hospital he will be treated in will be a matter of chance, not choice.

As long as West Virginia's medical malpractice crisis persists, this problem will worsen, as more and more doctors leave or restrict their practice and, in the current environment, recruiting quality new physicians is increasingly difficult.

The role of local hospitals, and what patients expect of us, is that we should be able to take care of all but the most serious medical problems when patients come to us. But today, that is getting more and more difficult.

However, if area hospitals and physicians work together, a system can be devised that provides an on-call physician in most of these medical specialties at one of the three hospitals every day. At its meeting on October 2, the BRMC Board of Directors authorized administration to move forward in seeking a solution to this crisis through the establishment of a countywide cooperative on-call schedule to assure that coverage is available to our patients. Meetings involving area physicians and hospitals will be held in the very near future to find a solution to this problem.

Back