Rudkin Scott E, Langdorf Mark I, Oman Jennifer A, Kahn Christopher A, White Hayley, Anderson Craig L
Department of Emergency Medicine, University of California, Irvine, Orange, CA 92868, USA.
Am J Emerg Med. 2009 Sep;27(7):785-91. doi: 10.1016/j.ajem.2008.06.012.
To reassess problems with on-call physician coverage in California, we repeated our anonymous 2000 survey of the California chapter of the American College of Emergency Physicians. Physicians responded from 77.4% of California emergency departments (EDs), 51.0% of ED directors, and 34% of those surveyed. Of 21 specialties, on-call availability worsened since 2000 for 9, was unchanged for 11, and improved for 1. Of ED directors, 54% report medical staff rules require on-call duty, down from 72% in 2000. Hospitals have increased specialist on-call payments (from 21% to 35%, with 75% paying at least one specialty). Most emergency physicians (80.3%) report insurance status negatively affects on-call physician responsiveness, up from 42% in 2000. Emergency departments with predominantely minority or uninsured patients had fewer specialists and more trouble accessing them. Insurance status has a major negative effect on ED consultation and follow-up care. The on-call situation in California has worsened substantially in 6 years.
为重新评估加利福尼亚州随叫随到医师值班覆盖方面的问题，我们重复了2000年对美国急诊医师学会加利福尼亚分会进行的匿名调查。来自加利福尼亚州77.4%的急诊科、51.0%的急诊科主任以及34%的被调查者进行了回复。在21个专业中，自2000年以来随叫随到的可及性在9个专业中变差，11个专业保持不变，1个专业有所改善。在急诊科主任中，54%报告称医务人员规则要求随叫随到值班，低于2000年的72%。医院增加了对随叫随到专科医生的报酬支付（从21%增至35%，75%的医院至少为一个专业支付报酬）。大多数急诊医师（80.3%）报告称保险状况对随叫随到医师的反应性有负面影响，高于2000年的42%。以少数族裔患者或未参保患者为主的急诊科专科医生较少，且联系他们更困难。保险状况对急诊科会诊和后续护理有重大负面影响。加利福尼亚州的随叫随到情况在6年里大幅恶化。
