By Nick Jacobs

For the first time in twenty years, something has happened that has never happened at our hospital before. Our Emergency Room Physicians have refused to provide full coverage for the department for Christmas Day. Now, don't get me wrong, they have contracts, and this shouldn't BE a negotiation, but, due to the extreme shortage of physicians nationwide and the inability to curb liability insurance costs in Pennsylvania, many of these physicians are working the system to their advantage.

In a normal situation, it would be simple. Hire more docs, and give notice to the offenders. The problem is that Emergency Room physicians aren't really easy to recruit right now. This creates an interesting situation. It is also clear that these phenomena may be a sign of the times for those of us running hospitals. As we see more and more shortages in the medical field, those available may become more selective about their availability.

We have seen leveraging that borders on financial blackmail, their version of supply and demand. When neighboring hospitals will hire them at per diem rates, sans benefits, those of us who pay contracted salaries and benefits find our hospital's schedules conflicted as the employees embrace both worlds as often as possible. Two days here, three days there, three days somewhere else . . . with a salary range that can vary by 60 or more dollars per hour.

Fortunately, a friendly, partner doc from our sister facility has agreed to cover the Christmas shift that is OPEN, but the fact that we were in this situation is NOT something that feels good to those of us who have hundreds of other employees who are always willing to work for all of the Holidays.

So, brace yourself America for challenges like this, or open the borders and let our neighboring physicians come to work in the U.S. because, as we Boomers ride off into the sunset, this is NOT going to be an easy or comfortable transition.