Question: Is it ethical to relinquish your hospital privileges to avoid emergency department call coverage?
Answer: At a time when ophthalmologists were almost exclusively dependent on a hospital for providing surgical services, it was relatively easy for hospitals to expect and secure uncompensated emergency coverage.
Over the last several decades, however, ophthalmology has transitioned to a predominantly independent private practice model that is less reliant on hospital services and facilities. In this environment, the necessity of maintaining hospital privileges and uncompensated hospital on-call duties has come into question.
In some communities, hospitals have begun to encounter difficulty maintaining coverage needed to meet federal requirements as well as credentialing criteria such as “trauma center” designation. They have therefore found it necessary to contract for paid coverage in essential specialties such as orthopedics and neurosurgery, as well as subspecialties less often called upon for emergency care. While many ophthalmologists continue to provide uncompensated coverage—motivated perhaps by requirements of insurance credentialing, tradition or a sense of community responsibility—others witnessing these paid arrangements have negotiated with hospitals to be compensated for emergency coverage. For these ophthalmologists, compensation provides a new incentive to maintain hospital affiliation.
If one wishes to avoid emergency coverage under any circumstance and is willing to relinquish hospital privileges, withdrawal from the hospital that requires emergency call is not per se unethical.
However, withdrawal may have implications for recredentialing from certain third party payers and potentially adverse effects on practice volume, professional reputation and collegiality with ophthalmologists who may be called upon to see your patients.
While there are no specific ethical guideposts for those who are considering relinquishing hospital privileges, the potential for important consequences beyond relief from the inconvenience of emergency call coverage should be considered.
For more information or to submit a question for this column, contact the Ethics Committee staff at ethics@aao.org.