QUESTION: I heard on a recent audio conference that nurse practitioners are not permitted to be listed on the emergency department call schedule. But, it’s commonplace at our Hospital for the hospitalists to split call amongst the doctors and the nurse practitioners. It’s been this way for years. Did something change?
ANSWER: The Emergency Medical Treatment and Active Labor Act (“EMTALA”) has always required that a physician be listed on the on-call roster for the emergency department (“ED”). Nurse practitioners, physician assistants, and other non-physicians do not suffice to satisfy this legal requirement.
That does not necessarily mean your hospital has been doing things wrong, however. When the term “on call” is thrown around by those involved in hospital and medical staff compliance matters, sometimes things get jumbled up a bit – because that term can mean a number of things.
It is perfectly acceptable for nurse practitioners, physician assistants, and other non-physicians to be on call for their private group practice or for their employer (for example, physician assistants who are part of an employed or contracted hospitalist group that covers all patients admitted to the hospital). These individuals likely are responding to calls about the practice’s patients (sometimes from the ED and sometimes from the floor) and they may even agree to take on some unassigned patients who present to the hospital, if no one else is available to assume those patients’ care.
This is different than the ED’s on-call roster. The on-call roster is used by the hospital to ensure that services that are designed to meet the needs of the community are available within the ED. This is the roster of physicians who respond in the event that a patient comes to the ED and is determined to be suffering from an emergency medical condition that requires stabilization. In some (most) hospitals, if the patient lacks an existing patient-physician relationship with the type of specialist (e.g., cardiology, oral and maxillofacial trauma surgeon) whose services are required, the patient is considered “unassigned” and, by policy, the physician listed on the ED’s on-call roster must respond to the hospital to care for the patient (as requested by the ED physician). In some hospitals, all patients who come to the ED after normal business hours are assigned to the ED’s on-call physician, though that is less commonly the policy.
To summarize: When an individual is covering their own practice’s patients, that person is not generally considered to be on the ED’s on-call roster. As long as hospital policy allows it, a practice can choose any of its practitioners to respond to calls to the practice about their own patients.
For the ED roster that is designed with EMTALA compliance in mind, however, a physician must be listed (by name, not by group practice). It is likely that this is the way your hospital has been managing things, since the requirement for a physician to be listed has not changed. The confusion generated during the recent audio conference that you listened to probably lies in the ambiguity over the term “on-call roster.”