[Noah930]

ER coverage is a totally different issue. Traditionally, all physician on staff were required to cover call. It wasn't voluntary or desired by most. You're usually not paid to be on call. And even if you were, who would want to be on call every 3rd or 4th night for the rest of their working careers? That means that any patient who would come into the ER or hospital and didn't already have a doc (or if their primary doc didn't have a specialist he/she would send the patient to) would get assigned to the on-call guy. Maybe other peoples' experiences have been different, but about 80% of the time I get called to the ER it's for a self-pay (aka no-pay) patient. Realistically, that's the opportunity to treat a guy, take on all the legal liability of doing so (for a particularly litigious part of the population), without any likelihood of financial reiumbursement. And usually at a socially inconvenient time, to boot.

Hospitals would conscript docs to be on call because obtaining hospital privileges would usually be contingent upon covering call. A doctor can't just walk up to a hospital and see/admit/treat patients there. First the hospital has to admit a doctor to the hospital staff. So as a condition of obtaining staff privileges, hospitals would force physicians to cover the call schedule. After all, most doctors (in the time before hospitalists) have to be able to use the hospital facilities--they can't just practice from their private offices all the time and expect that none of their patients ever get sick.

So doctors (in general) have been trying to get out of taking call at hospitals. Things like privately-owned surgical centers and ever-increasing specialization of fields of medicine have made that somewhat possible. In turn, ERs started running short of physician coverage (not including docs who specialize in emergency medicine). So there are some hospitals who will pay docs (specialists) for covering the ER, as a way to entice docs to cover them. If a patient has insurance, then the doc may still be able to bill the insurance company directly. But at least the doctor would have some guarantee (from the hospital) of financial reimbursement for their service.