Professionals in the Pit

Overwhelmed by the tense, frenetic atmosphere and enormous work load in the hospital emergency room, many doctors view duty in what they call the "pit" as a form of cruel and unusual punishment; others regard it as a purgatory through which they must pass on the way to a more relaxed form of practice. But Dr. Gaius Clark, 40, of Lansing, Mich., loves every minute of it. "It is an exciting type of medicine," he says of his full-time work in the emergency room at Lansing's St. Lawrence Hospital. "You are under a great deal of stress, making all sorts of life-and-death decisions at the same time. It is stimulating and challenging."

Clark is typical of an evolving breed of doctor--the professional emergency-room physician--who is beginning to replace the inexperienced interns, overworked residents or unlicensed foreign doctors still used by most U.S. hospitals to staff their emergency departments. A growing number of hospitals, recognizing the increasing demand for emergency care, are turning to specialists like Clark for ER coverage. As a result, they are providing their patients with far better care--and actually saving money--by increasing the efficiency of their emergency-room operation.

Some hospitals are making the switch by appointing a director of emergency services and providing him with a budget to hire his own staff. Others are taking advantage of a recent development in health-care delivery and contracting with medical corporations to cover their ERs.

St. Joseph Hospital in suburban Burbank, Calif., has hired the four-doctor Burbank Emergency Medical Group to run its emergency department. Four Chicago-area hospitals rely on an eight-year-old organization called Medical Emergency Service Associates (MESA) for their ER coverage. MESA has 40 full-and part-time physicians to assign. Each doctor makes his own financial arrangements with his patients (the average charge is $12), but the fees are paid to MESA, which pays its members by the hour rather than on a fee-for-service arrangement.

None of the new emergency-care corporations seems to have any trouble attracting doctors. Many young physicians welcome the guaranteed salaries, regular hours and scheduled vacations that characterize full-time ER work. Some are even more attracted by the psychic rewards that emergency medicine offers. "I like the type of medicine where the pathology is often critical and what I do is often crucial," says Dr. Ellen Taliaferro, 33, who helped form a group that provides service to hospitals in Santa Monica and Inglewood, Calif. "It makes me feel very good that I make a difference."

Most emergency physicians share Dr. Taliaferro's feeling. At the same time, they recognize that their profession also has its limitations. "We are specialists in breadth, rather than depth," says Dr. Jerry Hughes, 35, a Viet Nam veteran who serves as director of emergency services at St. Mary's Long Beach Hospital in California. "I may open a patient's chest to massage his heart, but it's the cardiac surgeon who is going to put in the plastic aorta. Our job is to keep the patient alive."

To make sure that Hughes and his colleagues can carry out that aim, many schools are expanding their training for emergency physicians. Two years ago, there were only three residency programs in emergency medicine in the U.S. Now 15 institutions offer such training (although the University of Southern California still has the nation's only full-fledged department of emergency medicine). Other efforts are also under way to upgrade emergency care. The 4,000-member American College of Emergency Physicians has already won the provisional imprimatur of the A.M.A.; the college hopes to have emergency medicine recognized as a separate specialty.

Most doctors believe that such recognition is likely. The nation's 7,500 emergency physicians have already shown that they can provide more and better care to patients than most hospitals now offer. There is an increasing demand for that care. Last year some 60 million Americans sought treatment at hospital emergency rooms. This year the figure is expected to grow by another 6,000,000.

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