Doctors, Hospitals Must Work Together to Cure Trauma-Care Ills

The strike by neurosurgeons at one trauma center and a threatened strike by orthopedic surgeons at another show that the cracks in the medical care system are widening. Inadequate care for the poor and the growing number of uninsured workers are no longer issues that San Diegans with medical insurance can ignore.

When trauma doctors stop taking cases, everyone is affected when they need medical care most.

Last month, the four neurosurgeons at Scripps Memorial Hospital in La Jolla, who were seeking higher fees, refused to be on call, causing the trauma center to turn away head-injury cases for five days. Last week, the seven orthopedic surgeons at Palomar Medical Center made the same threats, nearly shutting down North County’s only trauma center.

Fortunately, the doctors’ actions had minimal effect on emergency care. But doctors and health officials expect the problem to worsen. More physicians are opting out of trauma work because they feel inadequately compensated for the disruptions to home life and private practice that result from frequently being on call.

The doctors’ emphasis on money as the salve for the stresses--rather than other approaches to minimizing the burden--makes it easy to see them as greedy. It’s true that much of their trauma work isn’t fully reimbursed because many vehicle accident and assault victims are uninsured. But most people, even most professionals, only dream of making what neurosurgeons and orthopedic surgeons earn.

The effect of doctors’ fees on escalating costs will be one of the most vigorously argued issues over the next year, as the debate on health care reform intensifies in California. But, while the larger debate rages, trauma doctors and hospitals must find ways to distribute the financial pain of caring for the uninsured without damaging the county’s vital emergency care network.

What the trauma neurosurgeons and orthopedists were doing by asking hospitals to compensate them for the high number of nonpaying patients they treat is no different from obstetricians dropping out of the Medi-Cal program. It’s little different from hospitals seeking higher Medi-Cal or Medicare reimbursements or shifting unreimbursed costs onto insurance companies, and ultimately employers, through higher fees. When insurance companies look for ways to exclude high-risk people, they are shifting costs to the taxpayers. When San Diego County sued to get more beds in state psychiatric hospitals, it was hoping that the court would force the state to shift resources from other counties or programs.

Each is trying to get someone else to shoulder the costs of treating uninsured or under-insured patients.

The buck passing--or bill passing--will continue until there are major systemic changes in health care delivery and priorities. But the buck stops in the trauma center, where ability to pay is not--and should not be--one of the vital signs doctors check.

If San Diego doctors, hospitals and health officials want to maintain the quality of trauma care that they are so proud of--a system that has reduced preventable deaths by 90%--they will have to work together on solutions.