Real-world solutions for orthopaedic on-call problems.

An increasing percentage of emergency departments are reporting an inadequate number of on-call specialists. This situation is causing a growing crisis in emergency department on-call coverage for patients requiring orthopaedic care. Many orthopaedic surgeons are electing to opt out of emergency department on-call service. For many reasons, including a dwindling supply of eager participants, more medical groups are finding it difficult to fulfill their on-call obligations. This problem demands a variety of strategies to address the multiple causative factors that occur in practice settings. Initially, it may be necessary to incentivize on-call service so more surgeons are willing to participate. Incentives may include improving the group governance and bylaws to avoid confusion on the rules for providing on-call coverage. The on-call experience may require financial improvements, outsourcing with locum tenens, or a complete restructuring of the on-call arrangement with the formation of a hospitalist program.