Hand Call Coverage at Busy Urban Trauma Centers

[William Bromberg]

Background on the site:
Memorial Health University Med. Center, Savannah
State Level I, ACS unverified (dropped when the neurosurgeons refused
to publish a backup call schedule)
1300-1400 registry admits, 2200-2300 activations

Our plastics and ortho hand trained/privileged individuals split hand
call (about 1:5) they get paid a stipend (about $750/night I think).
Prior to this we had a hand call schedule that all the ortho and
plastics people were on without a stipend — it was a HUGE hassle to
get someone to come in with a lot of pass the buck being played. No-one
would do replants ("We're not a center!").

Now it's just a moderate hassle to get someone to come in. There's
still some pass the buck (the plastics people don't have wrist
privileges having been blocked years ago by the ortho guys so if there's
a wrist injury they get passive aggressive and say to call ortho, etc.
etc. etc.).
Nobody will do replants.

If you do give in and pay up make sure that there's a contract to
define what "hand call" means.

Bill

>>> "Dr. Andrew Berson" <aberson at agvscs.com> 3/6/2008 4:45 PM >>>

To list members:

I'm looking for input from busy level I and II centers on how hand
call
coverage issues are being handled.  Specifically, is this coverage
provided
by the ortho traumatologist or by a separate hand call list.  The issue
that
we are dealing with is that after years of a very successful call
roster for
this subspecialty, we are running into a very untenable situation.  In
the
past this coverage was provided by the ortho-traumatologists that had
a
robust elective hand surgery practice.  These surgeons are already part
of
the paid call roster for orthopedics, and were providing hand
"coverage" on
nights where one of their non-hand surgery colleagues might be on call
for
general ortho trauma.  Now, the hand surgeons are refusing to provide
this
coverage unless they are given an additional stipend.  The general
ortho-trauma physicians do not feel comfortable in caring for
significant
hand issues, since this is not part of their elective practice.

The question is, should a board certified orthopedic surgeon, on a
paid
trauma call list at a busy level II trauma center be capable of
evaluating
an injured hand and at least providing initial management of the
injury,
until their "hand surgery" partner is available the next day, or are
we
forced to give into the demands of the hand specialists and provide
another
stipend position on the call roster.  (It should be mentioned that the
amount being requested outpaces the stipend paid to the IN HOUSE
Trauma/Acute Care surgeon, even thought hand call is a home based call
which
does not receive many true emergencies).  

Please give any constructive feedback.  I would also be interested to
know
how many list members are seeing similar issues with their hand call
rosters.

Thank you in advance.

Andrew J. Berson, M.D.
Assist. Trauma Director
Memorial Health System,
Colorado Springs, CO

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