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Who the ED calls, and how long the answer takes

Published Oct 12, 2026 Updated Oct 12, 2026
In brief

Who the ED calls and how long the answer takes Emergency departments don't just lack physicians They lack answers When an ED physician encounters a case that requires specialty input a consult is ordered Nationally the CDC's emergency department survey...

Post 4 of 7 Emergency Medicine: The Questions That Stall the ED
  1. The Patient Is Ready for Disposition. The Specialist Hasn’t Called Back.
  2. The emergency department's missing lever is not more staff. It is faster decisions.
  3. The Specialist Is On Call. So Why Is the ED Still Waiting?
  4. Who the ED calls, and how long the answer takes
  5. At 3 a.m., the ED Is Carrying Too Many Unanswered Questions
  6. Before You Transfer the Patient: Can You Reach the Right Specialist?
  7. The Curbside Happened. The Handoff Still Has a Gap.

Who the ED calls, and how long the answer takes

Emergency departments don't just lack physicians. They lack answers.

When an ED physician encounters a case that requires specialty input, a consult is ordered. Nationally, the CDC's emergency department survey found a consulting physician was seen in 11.6% of ED visits in 2018, 13.5% in 2019, and 15.7% in 2020 — trending up. Studies that count consults requested (not just completed) put the figure at 20–40% at teaching hospitals. Somewhere between one in eight and one in three ED visits waits on a specialist's answer.

The less-discussed question is which specialties get called, and how long each one takes to answer. A 2026 study from the University of Virginia tracked roughly 35,000 consults over a year and measured the one number that matters — minutes from consult order to an answer the ED can act on. It appears to be the only detailed breakdown of its kind in the United States. The CDC does not record consult specialty nationally. American emergency medicine measures door-to-doctor time in every ED. It does not nationally measure consult-to-answer time.

Here is what the study found:

Specialty called Share of consults Median wait for an answer
Internal medicine 26.8% 90 min
Cardiology 8.2% 164 min
Psychiatry / behavioral health 6.7% 196 min
Neurology 5.6% 178 min
General surgery 5.2% 144 min
Orthopedic surgery 4.9% 154 min
ICU 4.0% 60 min
Neurosurgery 2.9% 155 min
ENT 2.4% 153 min
Ophthalmology 2.3% 160 min
Toxicology 0.9% 92 min

Overall median: 108 minutes. Nearly two hours per consult, spent waiting for the answer.

Three patterns stand out.

First, the psychiatry paradox. Behavioral health accounts for only about 7% of consults — yet carries the longest wait of any specialty at 196 minutes. It is also the specialty with the most severe boarding crisis in the country: roughly 1 in 10 mental-health ED visits among Medicaid-covered youth ends in boarding for 3–7 days. The patients who wait longest for an answer are the ones who then wait longest for a bed. The delay compounds.

Second, the slowest specialties are the hardest to staff. Cardiology, neurology, neurosurgery, ENT, ophthalmology, orthopedics — the longest waits cluster around exactly the specialties hospitals struggle most to keep on call. In a national survey of 442 ED directors, 74% reported inadequate specialist on-call coverage, with the worst gaps in neurosurgery, hand surgery, orthopedics, ENT, and ophthalmology. These are the overnight specialties: the volume doesn't justify a full-time body at 2am, so the ED calls — and waits.

Third, the measurement gap. A median of 108 minutes per consult, unmeasured nationally. Emergency medicine has spent decades optimizing everything up to the consult order, with no national clock on the 108 minutes after it. What gets measured gets managed; the consult-to-answer interval is neither.

The data has limits. This is a single academic hospital where every admission requires a consult, which inflates the internal-medicine share. Other studies put orthopedics as high as 25% and psychiatry as high as 15% of consults. But the direction holds: a large share of ED visits stall on a specialist's answer, the answer takes hours, and the slowest answers belong to the hardest-to-staff specialties.

The implication is geometric. Every shortage program tries to move the physician to the patient. But in this table, the physician isn't the bottleneck — the answer is. A cardiology consult that takes 164 minutes doesn't require relocating a cardiologist to the county. It requires the question to reach a cardiologist faster and the answer to come back sooner. The specialist stays put. The patient stays put. Only the consult moves.

That is the infrastructure thesis behind ConsultBridge: e-consult networks that move answers, not people, into the places and moments where the wait is longest.

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