There is a growing crisis in Americas hospitals because of a shortage of both otolaryngologists and other on-call specialists. This crisis causes delays in patient care and may impact the quality of care provided to patients. Otolaryngologists, through their special training in the management of adult and pediatric airway emergencies, facial trauma, foreign bodies and other head and neck emergencies are a vital component of the emergency medical system.
Hospitals have a legal obligation to provide screening and stabilization services to all patients that seek emergency care. As part of this obligation, hospitals are required to maintain a list of physicians who are on-call to treat patients in the emergency department. Otolaryngologists have graciously accepted this responsibility in the past as a requirement related to their utilization of hospital services. Many otolaryngologists no longer have the former tight hospital links, in addition to lacking contractual relationships with the hospitals payers and this effectively results in the physician providing uncompensated or undercompensated care. Additionally, such in-hospital care often delays care to the ill patients waiting in their office, or adversely affects a physicians personal life. Physicians can no longer afford to underwrite these hospital services. Given the many rapidly evolving reimbursement models and increasing overhead expenses including the additional liability associated with providing emergency care, these costs to physicians can no longer be sustained, nor can they be recouped. Most otolaryngologists still practice as a small business as a small group or solo practice. Accordingly, providing uncompensated hospital services adversely impacts their business and translates into the inability to invest in IT infrastructure, forced reductions in their own staffing levels or benefits, or an inability to provide quality care to their patients.
It is the position of the American Academy of Otolaryngology–Head and Neck Surgery that hospitals which include otolaryngology services through their emergency department and/or hospital consulting service should compensate otolaryngologist-head and neck surgeons at fair market value for providing on-call services. This compensation should be in addition to any reimbursement received for patient care provided.
Important Disclaimer Notice (Updated 7/31/14)
Position statements are approved by the American Academy of Otolaryngology–Head and Neck Surgery or Foundation (AAO-HNS/F) Boards of Directors and are typically generated from AAO-HNS/F committees. Once approved by the Academy or Foundation Board of Directors, they become official position statements and are added to the existing position statement library. In no sense do they represent a standard of care. The applicability of position statements, as guidance for a procedure, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to these clinical position statements will not ensure successful treatment in every situation. As with all AAO-HNS/F guidance, this position statement should not be deemed inclusive of all proper treatment decisions or methods of care, nor exclusive of other treatment decisions or methods of care reasonably directed to obtaining the same results. Position statements are not intended to and should not be treated as legal, medical, or business advice.