ERs taking first hit in physician shortage

Study points to low reimbursement rates from insurers

In hospitals across the state, a lack of adequate staffing in emergency services has surfaced as one of the first signs of a widespread physician shortage expected by 2015, says a study released last week by Maryland physician and hospital associations.

‘‘Because emergency services physicians are in short supply, they are demanding high salaries,” Pimentel said. ‘‘The reimbursement rates are not keeping up with what they can get in Virginia, where the reimbursement is much better.”

The shortage has created a greater reliance on backup specialty physicians, she said. ‘‘A lot of hospitals are having trouble keeping the call rosters covered with the appropriate specialists.”

Pimentel was director of the Mercy Hospital emergency department from 1995 to 2007 and now heads up emergency services at Upper Chesapeake Health Services.

‘‘When you go into emergency departments, you see long waiting times and harried personnel. And many people are not necessarily an emergency services-trained person,” she said. ‘‘In my experience, it is getting worse.”

However, Gaurov Dayal, chief medical officer at Shady Grove Adventist in Rockville, said of the situation at his hospital, ‘‘There is an ongoing problem nationally, but here we have taken a lot of steps to alleviate this problem and we don’t have a problem with any of our specialties here with emergency room coverage.

‘‘One thing we have done is utilize hospitalists, physicians employed by the hospital to provide 24⁄7 in house coverage for emergency room and for the whole hospital, across different specialties, including surgery and OB.”

Pimentel said emergency services professional groups have begun to appeal to many hospitals to kick in money ‘‘so we can hire qualified emergency physicians, because it is in the interest of the hospitals to have the emergency rooms work well.”

ER staffing is already a serious physician and nursing issue statewide, said Dr. George H.A. Bone of Largo, a member of the Governor’s Health Care Access and Reimbursement Task Force. The group was created by statute last year to study possible changes needed in the state’s health insurance and medical malpractice systems.

‘‘Recruiting for emergency room physicians is difficult and getting them at competitive prices is another issue,” Bone said. ‘‘That addresses the reimbursement issue because hospitals have to dip into their funds to pay for that. More of that is going on now.”

The study found current shortages of emergency services exist in all Western Maryland, Eastern Shore and Southern Maryland counties, with a ‘‘borderline” of adequate ER physician staffing at hospitals in and around Baltimore city.

Doctors are not coming into Maryland to practice because insurers pay low reimbursement rates and malpractice insurers charge physicians high premiums, said Bone, who has practiced in Prince George’s County since 1986.

According to the physicians association — the Maryland State Medical Society, or MedChi — about 85 percent of insurance coverage in Maryland is controlled by two companies, CareFirst BlueCross BlueShield of Maryland and Mid Atlantic Medical Services LLC, a subsidiary of UnitedHealth Group Inc.

The situation seriously threatens the health safety net in Maryland because all hospitals in the state, except Southern Maryland Hospital, are nonprofit, said Bone, a former MedChi president.

Such nonprofits have a mandate to deliver indigent care, adding further pressure to ERs, he said. Many of the nonprofits must spend their thin bottom line on ERs that they should be plowing back into capital improvements.

‘‘They now have to use that for physician services and such a trend did not exist 10 to 15 years ago,” he said. ‘‘These are small, 100- to 150-bed institutions. They can’t keep that up. When that bough breaks, everything will really come home to roost. I expect that to happen and the question is when.”

The recent study, by MedChi and the Maryland Hospital Association, revealed statewide shortages already exist in primary care, psychiatry, hematology, oncology, anesthesiology, emergency medicine, pathology, general surgery, thoracic surgery and vascular surgery, with a ‘‘borderline supply” in orthopedic surgery.