Position Statement

AANS/CNS Position Statement on Improving Access to Emergency Neurosurgical Services

  • AANS/CNS Washington Office

POSITION STATEMENT of the American Association of Neurological Surgeons and Congress of Neurological Surgeons


The Emergency Medical Services (EMS) system is in the midst of a growing crisis because of a recognized shortage of on-call specialists. This problem extends to the provision of emergency neurosurgical care. Since neurosurgeons are a vital component of the EMS system, their active
participation is essential. Reimbursing neurosurgeons for serving on-call to hospital emergency departments is therefore appropriate.


  1. Within their capabilities, hospitals have a legal obligation under the Emergency Medical Treatment and Labor Act (EMTALA) to provide screening and stabilization services to patients who come to emergency departments. As part of this obligation, hospitals are required to maintain a list of physicians who are on-call to treat patients in the emergency room and to ensure that on-call physicians respond when called.
  2. Neurosurgeons have a variety of financial and contractual problems with managed care plans.
    In many instances, these contracts have no on-call arrangement, or require on-call availability
    without reimbursement, or have reimbursement rates that are extremely low. Because of
    these and other economic pressures, neurosurgeons are finding it increasingly difficult to
    subsidize emergency medical care through internal “cost-shifting,” thus limiting their ability to
    subsidize their own on-call activities.
  3. Neurosurgeons are faced with increased risks and liability when providing emergency care.
    Because of the seriousness of cases in the emergency medical setting and because of the lack
    of a pre-existing physician/patient relationship, neurosurgeons have a greater potential to be
    part of a medical malpractice action. In addition, neurosurgeons who provide on-call services
    must also comply with the mandates of EMTALA, subjecting them to potential fines of $50,000
    for any violations of this complex law and regulations.

Click here to view the full AANS/CNS Position Statement on Improving Access to Emergency Neurosurgical Services.