[McLynnan]

The most pressing is the lack of trauma surgeons. ERs across the country are welcoming the downgrading of their Trauma levels.

I work for trauma services in a Level 2 center that has been searching for another trauma surgeon for over a year. These people don't grow on trees. Neither do neurosurgeons. We don't want to be downgraded, but a hospital must meet certain staffing requirements to qualify as a trauma center and many centers nationwide are on life support.

[Mamzelle]

The other thing that is crucial to the understanding of how primary care has changed is the rise of the "hospitalist"--the primary care doc employed by the hospital to look after patients. This has come about because most FPs run only clinic practices .

FPs don't see patients in the hospital anymore!! They don't have hospital privileges. They don't want hospital privileges, and who can blame them? Without privileges, they don't have to be "on call" to non-paying patients. When the patient calls the FP after hours, he tells them to "go to the ER."

If the patient comes to the clinic and needs to be admitted to the hospital, the FP says "go to the ER and get admitted." They then have to wait to be seen by the ER doc (hours and hours)--then the hospitalist must come down to formally examine and admit the patient (hours and hours).

re: I work for trauma services in a Level 2 center that has been searching for another trauma surgeon for over a year.

Yup--drive carefully, folks. Not only are trauma centers accepting the downgrading of their ERs, but many hospitals are considering not having a trauma center at all.

Americans don't know how good they have it right now--but this system has got to collapse. When and how, who knows?

But, in the meantime, it's really helpful to resent hospitals and their personnel.