Q. Who are on-call physicians?

A. While emergency physicians are available 24 hours a day, 7 days a week, other medical specialists such as neurosurgeons and cardiologists are "on-call," which means they are called in as needed.

Q. Is there a shortage of on-call specialists in our nation's hospitals?

A. Yes. This is especially true in rural areas, where populations are small and cannot support the practices of specialty physicians who provide on-call coverage.

Q Why is there a problem?

A Lack of funding for specialty services has seriously damaged the infrastructure of specialty backup for the nation's emergency departments. Since many patients seeking emergency care are uninsured or underinsured, on-call physicians often are not compensated for the care they provide to these patients.

Q. Are hospitals required to provide on-call specialists to emergency patients?

A. Yes. The government agency responsible for Medicare clearly places the responsibility on hospitals to have an on-call list that meets the needs of patients.

Q. What impact does managed care have on specialist care for emergency patients?

A. Some health plans are denying coverage and delaying payments for emergency care services. They may refuse to pay physicians who provide emergency care to patients who are "out of network" (i.e., outside the health plan contract). If a medical specialist employed by a patient's health plan is not available, hospitals are obligated under federal law to provide a specialist. However, health plans are not required to pay for such services. While hospitals have absorbed those costs in the past by shifting them to patients who could pay, it increasingly has become difficult to recover those costs with the flat fees provided by many health plans.