SOURCE // DISPATCHES READER-SUBMITTED UPDATES FROM THE FOUR CORNERS
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Q. What are some of the reimbursement challenges that you’ve faced in emergency care? ______________________
01 AMERICAN SAMOA Emergency physicians are hospital employees and get paid based on training, experience, and years of service. Work in the ED is the only location where overtime shifts are compensated above normal payroll. Being a US territory, we are held to a “US level of care,” but we only get 25% of the funding. EM and medicine in general is at least 75% dependent on medicare/medicaid funding and matching contributions from the American Samoan Government (traditionally mismanaged and diverted to other projects) ______________________
02 AUSTRALIA We have a single payer system and a
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set pay-grade system at the consultant level. However, there are numerous shortages and many EPs work as locums and VMOs and make extraordinary amounts of money (1-2 million a year [AUS]). This encourages people not to contract and to remain on locum terms. ---------------Our challenge is getting recognition for the work we do. We have no private billing ergo the government gets no income from us; we cost them money. Therefore they dislike us. ______________________
03 BAHRAIN We are faced with a system of work schedules not consistent with rest of the world and a poor basic salary. We have 8 hour shifts 5 days a week and the allowances for evening and night shift are not worthwhile. We have to
Spring 2013 // Emergency Physicians International
work extra shifts to increase the pay. So emergency doctors might work 24-26 shifts to increase their pay. There is no risk allowance.
policies are too costly.
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COSTA RICA The problem is that most of the ER docs work at public hospitals ---------------Have to work many hours (+70/week) to get a decent salary, and there are no incentives for doing a better job. Plus, we can’t bill for procedures or studies done.
04 BRAZIL As we are not a specialty we don’t have reimbursement per procedure or productivity. We don’t make more money if you work better or see more patients, or have better outcomes. ---------------EM is not a regulated specialty and so there are too many doctors of different specialties competing for jobs. ______________________
05 COLOMBIA Bank debts are too high, and health
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07 FRANCE There are no reimbursement challenges because the majority of us belong to public hospitals. The incomes are modest, but they regularly fill the bank accounts.