Pay stipends to various specialties to provide ED backup services.

Advantages

• Although there is a cost to the hospital, the cost of administering the program can generally be absorbed into existing hospital functions.
• The cost to the hospital is fixed so that the hospital is insulated from the risk of an increased number of patients requiring the services of the ED backup physicians.
• The hospital may only have to pay those specialties that are in short supply and/or are vocal and powerful within the medical staff structure.

Disadvantages

• It is difficult to determine what the value of a stipend for a specific specialty should be. National norms are not helpful since the value of a stipend paid to a specialist in another geographic area may be the result of political pressure exerted by the specialty rather than a reflection of the actual services provided by that specialty.
• Some specialists or physicians within a specialty are disenfranchised because their specialty does not receive a stipend or the rules for distribution of the stipend within a specialty are unfair.
• Since the physician has already been paid, the physician may avoid emergency patients by declaring that the patient's presenting problem is not related to their specialty. And as in the Draft Solution above, the patient then becomes a "hot potato" and is bounced from one specialist to another.
• Since neither the hospital nor the physicians have any real information about the amount and intensity of services provided, there is a risk of continuous renegotiation of the stipend amount.
• If patient volume drops, the hospital must continue to pay the stipends even though there is no patient revenue to offset the stipend expense.
• The issue of "sibling rivalry" surfaces as some specialists are paid and others are not. Additionally, some specialties receiving stipends may feel that they are underpaid when compared to other specialists. This sense of inequity can lead to bitterness and unhappiness within the medical staff.