Emergency and after-hours work performed in country hospitals

Country doctors perform emergency work in addition to their conventional general practice role. Over a one-month period 17 general practitioners in four Hunter Region towns recorded all emergency calls describing the time they were called, the severity of the patients' conditions, the skills used and the time taken. A scale to measure severity of illness was devised and tested for this purpose. There were 1197 emergency calls, mostly seen at the local hospital, either in the outpatients department or on the wards. They were unevenly distributed in time, with fewer calls at night, but the doctors were disturbed during nearly half of their nights on call. Of the calls 15% were for trivial reasons, 34% were for patients who needed standard general practice care, and 50% were for patients who needed the services of the hospital or were already inpatients. Most attendances were brief, but 15% took more than 30 minutes and some much longer. Counselling skills were used for 47% of patients and technical skills in 22%. The strain of the work involved and the disturbance of personal life justify extra payments to country doctors, and the adequacy of current pay schedules is questioned. However, the peculiarities of funding result in the State Health Department underwriting most emergency costs in country towns, whereas in the cities the Commonwealth Department of Health pays for a larger proportion, leading to concern about the high apparent costs of country hospitals. The information in this survey may help improve planning for training and remuneration of country doctors to help ease the current shortage.