Get me a neurosurgeon, stat!

From US News and World Report:

Across the country, three quarters of emergency departments report a shortage of specialists like neurosurgeons and orthopedists, according to a 2006 survey by the American College of Emergency Physicians. That's up from two thirds when the survey was done in 2004. "This is the weak link in the chain of survival," says Loren Johnson, the emergency department director at Sutter Davis Hospital in Davis, Calif., and a researcher on medical staffing shortages. Emergency rooms depend on specialists to come in at any hour, any day, to, say, treat stroke victims or reattach fingers severed in an accident. But "specialists just don't want to cover emergency rooms anymore," says Johnson. Earlier this month, he coauthored a study published in the online edition of the Annals of Internal Medicine reporting that nearly half of Oregon's hospitals cannot provide emergency on-call treatment around-the-clock in at least one specialty. A recent survey of emergency departments throughout the Southeast showed that 54 percent had to divert patients to another hospital because they didn't have the appropriate specialist on call.

These delays hurt, and sometimes kill. The Joint Commission, hospitals' major credentialing body, has cited lack of specialists as the cause of 21 percent of emergency department "sentinel events"—unexpected deaths or serious injuries due to slow treatment.

So where have all the specialists gone? They've been driven away, observers say, by three modern maladies of American healthcare: too much work, too little pay, and the fear of malpractice lawsuits. "Put all those things together, and who would want to be in this business?" asks Todd Taylor, who teaches emergency medicine at Vanderbilt University in Tennessee.