Hospitals, doctors redraw bottom line for 'on-call' work
YOUR ARTICLE "In shift, doctors 'on call' get pay" (Page A1, April 15), about how some hospitals are being forced to pay for physicians' on-call time, correctly asserts that the breakdowns in our healthcare delivery system are the major reason why this long-held tradition in medicine is eroding.
I was pleased that reporter Christopher Rowland asked me to discuss the trend. Unfortunately, my brief quote in the article captured only a fraction of a long conversation.I did say that it's "unfortunate" that young physicians don't provide on-call service for free anymore. After reading that, you might suspect that I'm either insensitive to the views of younger physicians or clueless about the tensions between physicians and hospitals. I like to think that I'm neither.
It is an unfortunate situation, but for a more complex reason. The disintegrating practice environment is undermining many of the unspoken social contracts that used to hold medicine together -- social contracts that have served patients well. On-call care, provided at no additional compensation, used to be one of those contracts. But with so many physician practices on the edge of insolvency, this is now untenable. I blame no one for choosing not to do this anymore. To their credit, some hospitals recognize this, and are adjusting their point of view. I suspect that others will follow suit.
Dr. KENNETH PEELLE President, Massachusetts Medical Society Waltham
THE GENERAL public (including, apparently, the media) has a very dated view of a general surgeon's business today. With spiraling overhead costs, malpractice insurance rates, and ever-shrinking health insurance reimbursements, is it any wonder that doctors wish to be treated as contractors?
Hospitals are allowed to recover costs of treating uninsured patients from a large free-care pool; physicians are not. Hospitals demand 24/7 call coverage by their specialists, who are in no financial position to be able to take time off from their practice to cover their assigned shift. What patient is happy to see their surgeon bleary-eyed from lack of sleep before going into the operating room?
The financial realities of medicine make it difficult to recruit young surgeons from other parts of the country to come here. Medical school tuition costs are comparable to a good-sized mortgage. Older doctors and the Massachusetts Medical Society can wag their fingers all they want, but the reality is that times are a lot different than they were before managed care. It's time that doctors were not obligated to indentured servitude, and receive fair pay for their work. It's the only way we are going to be able to keep excellent medical professionals here.
SANDY MARTIN Salem 
