Get Me a Neurosurgeon, Stat!
As fewer doctors sign up for on-call emergency room duty, patients suffer
Elsie Bishop didn't expect to die in New Mexico. The 74-year-old left her Arkansas home in the summer of 2004 on a driving vacation with a friend and reached Santa Fe in early September. After dinner one night, she complained of extreme nausea, and an ambulance took her to a local hospital. "They did a brain scan, which showed a bleeding aneurysm," says Jim McKenzie, her longtime fiancé, who got a call from the hospital later that night. "And the poor doctor in the emergency department was beside himself. He tried to call a neurosurgeon, but there was no one around." It took hours, but the doctor finally found one in Albuquerque, more than 60 miles away, and arranged a helicopter evacuation. "The whole left side of her brain was filled with blood by the time I got there on Friday morning," McKenzie says. "There was nothing to be done. She died on Sunday. I don't know for sure, but if they'd had a neurosurgeon in Santa Fe, things might have been different."
It's not just Santa Fe that's scrambling. Across the country, three quarters of emergency departments report a shortage of specialists like neurosurgeons and orthopedists, according to a 2006 survey by the American College of Emergency Physicians. That's up from two thirds when the survey was done in 2004. "This is the weak link in the chain of survival," says Loren Johnson, the emergency department director at Sutter Davis Hospital in Davis, Calif., and a researcher on medical staffing shortages. Emergency rooms depend on specialists to come in at any hour, any day, to, say, treat stroke victims or reattach fingers severed in an accident. But "specialists just don't want to cover emergency rooms anymore," says Johnson. Earlier this month, he coauthored a study published in the online edition of the Annals of Internal Medicine reporting that nearly half of Oregon's hospitals cannot provide emergency on-call treatment around-the-clock in at least one specialty. A recent survey of emergency departments throughout the Southeast showed that 54 percent had to divert patients to another hospital because they didn't have the appropriate specialist on call.
These delays hurt, and sometimes kill. The Joint Commission, hospitals' major credentialing body, has cited lack of specialists as the cause of 21 percent of emergency department "sentinel events"—unexpected deaths or serious injuries due to slow treatment.
Modern maladies. So where have all the specialists gone? They've been driven away, observers say, by three modern maladies of American healthcare: too much work, too little pay, and the fear of malpractice lawsuits. "Put all those things together, and who would want to be in this business?" asks Todd Taylor, who teaches emergency medicine at Vanderbilt University in Tennessee.
There were about 114 million visits to ERs in 2003, a 26 percent increase over the previous decade. During that same period, about 700 hospitals closed. But the number of surgeons in the country remained the same. That means more people jamming into fewer emergency rooms, with no extra doctors around to treat them. "When I started working at a hospital in Houston, we would be on call for the emergency department for a month at a time, and it wouldn't be that much of a burden," says Alex Valadka, vice chair of neurosurgery at the University of Texas Medical School in Houston, adding that a week might go by without his pager waking him. "By the time I left that hospital, a few years ago, I'd take call for a week, and it would be really heavy, with cases on many of those nights," he says. "The volume of ER work has become ridiculous."
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