Scary Shortage

It's getting hard to find some medical specialists in an emergency.

A patient staggers into The Queen’s Medical Center emergency room coughing up blood. Following proper procedure, the ER doc calls a local gastroenterologist to come in and consult on the case, and possibly perform an endoscopy to look for the cause of the problem. The first gastroenterologist he contacts says no, he’s busy. The second says the same, and so on and so on. Couldn’t happen here, right?

In fact, local ER and intensive care unit docs say they are facing a scary shortage of gastroenterologists willing to take emergency cases at local hospitals. Sometimes an ER doc will have to call nine or 10 gastroenterologists before they can find one willing to do the job. That can mean crucial lost minutes at a time when a patient may literally be bleeding to death. Although local ER and ICU docs say that in the vast majority of cases they can secure the needed specialist, the time they waste trying to locate one to come in cuts into their capability to care for critically ill patients. The problem has cropped up at all of the state’s major hospitals that render intensive and emergency care. It’s more than just a shortage of stomach docs. Hawaii hospitals often scramble to find neurosurgeons, hand surgeons and anesthesiologists for emergency cases. “When hospitals have trouble finding a specialist, it means patients may need to wait longer for specialized care and it can put them at risk,” says Dr. Richard Friedman, vice president for medical affairs at Queen’s.

A melange of local and national factors have brought about this frightening state of affairs. Med schools have turned out too few doctors in these specialities—gastroenterology, in particular—to meet soaring healthcare demand. Combine that with the fact that physician payments from Hawaii health insurance companies lag behind payments in Mainland markets, and it’s no surprise that these in-demand specialists give Hawaii a pass. At the same time, many malpractice insurance companies now refuse to cover physicians who take emergency calls and are not full-time staff members of a particular hospital.

For their part, physicians, who are facing skyrocketing malpractice insurance costs, prefer to avoid risky emergency cases where the chances of lawsuits are higher, but the chances of full payouts from insurance companies are actually lower. That is because many people walking into ERs often have less than adequate insurance.

On top of that, the shortages create situations where exhausted specialists have to pull all-nighters in ER cases, and still see full slates of patients the next day, with far less than adequate sleep. That, says Friedman and others, could put even more patients at risk.

The status quo is also costing hospitals a bundle. Most offer specialists a stipend of $1,000 and up per night to take calls. That’s on top of the fees the physicians charge for their services. Local hospitals and the University of Hawaii School of Medicine are mulling over ways to attract more specialists, including intensive recruitment and establishing fellowship programs to bring in young specialists for training who could shoulder some of this burden. For now, though, patients with bleeding ulcers or severed hands will simply have to wait.