Free call service by urologists: A thing of the past?

In the good old days of medicine, doctors carried black bags and made house calls. Soon, the practice of taking call to retain your hospital privileges may be just as antiquated.

The concept of physicians demanding and getting stipends for being on call at hospital emergency rooms is becoming a well-established trend that many feel will eventually reach into all hospitals. Urologists are no exception.

She explained that the stipends vary according to specialty, with those specialties associated with high-risk illness, injuries, and procedures-neurologists, cardiovascular surgeons, orthopedists, and pediatricians-getting the largest stipends.

"In most cases, the stipends are somewhere between $500 and $1,000 a night, but there are some communities in the state that pay $3,000 a day. That is just to carry a beeper," she said.

President Ronald Reagan signed EMTALA in 1986 as a measure to prevent "patient dumping" and to ensure that all acutely ill patients receive emergency care, regardless of their ability to pay. Neither the president nor the bill's sponsors and supporters foresaw the growth of the nation's uninsured or the consequences of the legislation, an unfunded mandate.

"Before managed care, doctors were willing to accept call as part of being on the hospital staff," Emerson said. "It was also a way to build their practices. They would see these patients in the ER, and the patient would stay with them. That is not how it works in today's world. Now it is very much about the contracts the doctor holds and with which health care systems."

A number of HMOs and other organizations do not reimburse doctors for treating patients who are not on their client list, according to observers interviewed for this article. They also noted that getting Medicare reimbursement was often an arduous task and, for those completely uninsured, an impossible one.