Harvard doctors agree to drop late-night ED surcharge

After reading the paper on physicians' surcharge for night visits to the emergency room, several questions come to mind. First, what is the purpose of the surcharge? Was it to compensate the physician for the inconvenience of responding to a night call?

One the ironies of this story lies in the fact that ALL of the hospital employees who provide emergency services on the night shift receive a "a night shift differential". This includes professional staff (nurses, respiratory care practitioners, laboratory and radiology technicians) as well as ancillary team members including security, clerical workers and housekeeping staff. These costs however are not tacked on to the patient's bill.

Second, in the case of physicians, if CMS and other insurance companies have refused to pay the surcharge, does the patient then pay out of pocket? Is the surcharge reflected on the final bill the patient receives as a cost not covered by insurance?

Third, all healthcare professionals know that night shift work will be the rule rather than the exception in many domains of practice. Night shift work is perilous for all workers. Studies that have been conducted to examine the effect of night shift work on nurses have found a higher rate of cardiovascular disease, cancer, depression, work-related injuries, sleep disorders, and automobile accidents on route home from work in the morning - some resulting in the healthcare worker's death.

How do we compensate physicians for the added peril of providing services on the night shift? In the case of physicians, many have worked a 12 hour day or longer in the office or surgical suite BEFORE taking call for a night shift. The resultant health risks for physicians AND safety risks for patients are well documented. Is $30.00 an adequate "shift differential" for a physician? How do we compensate an essential health team member, the physician, for night shift care? Do we respond by saying physician's total income compensates for years of night shift work? This has become less of an incentive as physician's salaries drop, while the salaries of nurses and other health care workers' rise significantly. In my work setting, some of the nurses working overtime on the nightshift have yearly incomes approaching those of physicians in office practice.

Laura Mahlmeister RN, PhD
President, Mahlmeister & Associates
Clinical Professor of Nursing, University of California San Francisco
Staff Nurse, The Birth Center at San Francisco General Hospital