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Incresingly unfair hospital call

Home Practice Management Incresingly unfair hospital call

  • Avatar kayli69 
    Participant
    Status: Physician
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    Joined: 04/20/2017
    Earnest refinancing bonus

    Private practice procedure oriented medical specialty serving a university affiliated community hospital.  When on call, we cancel all of our outpt clinic as well as our procedures in our surgery center as call is so busy and unpredictable.  When on call, we each provide 24/7 inpt consult and emergency call for one week at a time and basically are at the hospital form 7:30-5  We get nothing from the hospital for doing this, only our proffesional fees which does not amount to much as most of the patients are Medicaid or uninsured.  In fact, while on call for a full week several months ago i collected $3000 for a full week–which is basically nothing.  In the meantime, I am still repsonsible to pay practice overhead which amounts to around 15k per week.

    There used to be 16 docs in our call group.  Over the last 5 years this has dwindled to 8 because of retirements, illness etc.  Call used to be infrequent and manageable at 3x per year but now has increased to close to 7- 8 weeks per year.  This amounts to 8 weeks away from my patients with little to know reimbursement and full overhead expense!  What used to be a managemable burden has become a huge thorn in my side

    Complicating the issue is that the senior partner in my group serves as chief of our department for the hospital, and he has been unwilling to negotiate any change to our call.  Instead, he just volunteers himself and our group to make up the increased call over the years.  I see his position at the hospital and Sr partner of our group as a HUGE confilct of interest

    Call is without a doubt the worst part of my life.  We are called in at all hours of the night for emergencies, I can spend the entire weekend and holidays at the hospital, and my schedule for the week is completely unpredictable.  It is miserable and makes it very difficult to reun a private practice

    So in summary, my group is providing 24/7 emergency coverage, consult coverage, and followup for pts at he hospital for a week at a time for no added reimbursment/basically free with no stipend from the hospital while still needing to pay full overhead for our private practice.  Call has now increased to 8 weeks per year where I am away from my private practice and is completely miserable. Change is heavily resisted by the Sr partner in my group who also serves as Chief of the dept at the hospital.  Is this situation normal and how would you approach this.

    #227141 Reply
    q-school q-school 
    Participant
    Status: Physician
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    Joined: 05/07/2017

    either change senior partners mind about negotiating call pay, convince him to hire 8 more physicians, convince him to sell practice to hospital and go on employment model, or move.

    situation not normal, but over years, hospitals have paid less and less call pay.

    call is always worst part of life and the reason why people retire.

    sorry to be blunt, i actually hope you come up with better solutions than these.

    i’m not sure that anything other than adding docs helps with the misery of call.  money is a short term salve to the problem of the pain of call.

     

    #227143 Reply
    CordMcNally CordMcNally 
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    Status: Physician
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    Joined: 01/03/2017

    Is he the only senior partner? Are the rest of you in the same boat? If so, you certainly have some leverage, however, you’ll need to approach it correctly.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #227146 Reply
    Liked by q-school
    ACN ACN 
    Moderator
    Status: Physician
    Posts: 669
    Joined: 01/08/2016

    We recently had a similar situation on our hospital, albeit no one was cancelling clinic or surgeries (unless true emergency).  Our group president continued to talk with hospital admin about call pay.  We now receive call pay after years of negotiating but lot stronger negotiations in the last 6 months.  The hospital doesn’t want to pay because then it sets a precedent to pay other specialties.

    If you're ever having a bad day, just remember in 1976 Ronald Wayne sold his 10% stake in Apple for $2,300.

    #227154 Reply
    Dreamgiver Dreamgiver 
    Participant
    Status: Physician
    Posts: 894
    Joined: 03/09/2017

    It seems hospitals everywhere are increasing squeezing out call stipends while jacking up facility fees. No, your situation is not normal. Remember, you hold the cards. Walk to the hospital across the street, they’d love to have nice busy OR days with your patients. Once you are close to an agreement, go back to your hospital and negotiate away. It will become a win win situation.

    #227156 Reply
    Avatar SValleyMD 
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    Status: Physician
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    Joined: 05/12/2016

    I would clarify that you don’t hold the cards but your group sure does… get the other 6 partners on the same page and go above your senior doc or kick him to the curb.. otherwise your options are limited imo.

    MPMD MPMD 
    Participant
    Status: Physician
    Posts: 2606
    Joined: 05/01/2017

    We recently had a similar situation on our hospital, albeit no one was cancelling clinic or surgeries (unless true emergency).  Our group president continued to talk with hospital admin about call pay.  We now receive call pay after years of negotiating but lot stronger negotiations in the last 6 months.  The hospital doesn’t want to pay because then it sets a precedent to pay other specialties.

    Click to expand…

    Perish the thought.

    Being on call is not my world but… Being on call w/o pay would be a difficult pill to swallow. Esp w/ a bad payer mix.

    #227215 Reply
    The White Coat Investor The White Coat Investor 
    Keymaster
    Status: Physician
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    Joined: 05/13/2011

    I hate gaps in the call schedule, but I don’t blame doctors who want to be paid for their work. If hospitals can’t afford to pay docs to take call, there are too many hospitals offering the same services and they should be regionalized.

    Site/Forum Owner, Emergency Physician, Blogger, and author of The White Coat Investor: A Doctor's Guide to Personal Finance and Investing
    Helping Those Who Wear The White Coat Get A "Fair Shake" on Wall Street since 2011

    #227292 Reply
    Liked by Eye3md, MPMD
    Avatar southernerdoc 
    Participant
    Status: Physician
    Posts: 79
    Joined: 03/10/2019

    You really need to negotiate a better rate or just stop taking call.  If that means affiliating with an outpatient surgery facility or another hospital, then sobeit.

     

    Our hand surgeons have a sweet gig.  They get paid $1500 per 24-hour call, aren’t required to not have their clinic, and over the past year were called in to see patients only 23 times.  The majority of partial amputations are dealt with by us.  A lot of the forearm stuff gets dealt with by the orthopaedic surgeon.

     

    Suddenly I’m realizing I should’ve been a hand surgeon that was on call 24/7/365 with no clinic!

    #227298 Reply
    Liked by hatton1
    MPMD MPMD 
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    Status: Physician
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    Joined: 05/01/2017

    You really need to negotiate a better rate or just stop taking call.  If that means affiliating with an outpatient surgery facility or another hospital, then sobeit.

     

    Our hand surgeons have a sweet gig.  They get paid $1500 per 24-hour call, aren’t required to not have their clinic, and over the past year were called in to see patients only 23 times.  The majority of partial amputations are dealt with by us.  A lot of the forearm stuff gets dealt with by the orthopaedic surgeon.

     

    Suddenly I’m realizing I should’ve been a hand surgeon that was on call 24/7/365 with no clinic!

    Click to expand…

    Yeah hand is one of those things you barely need on call. So much can be taken care of with irrigation, loose repair, a splint, and some abx.

    I mean what does a hand surgeon really need to come in for? Flexor tenosynovitis maybe? Just about everything else can wait until morning if not a few days later? The last time I had to call a hand surgeon in was when someone shot their thumb off and there was just nothing to piece back together/I couldn’t dig all of the fragments of the bullet jacket out of it.

    I’m not a hand surgeon but I’m always kind of impressed by how resilient the hand is with appropriate treatment and PT/OT.

    #227312 Reply
    abds abds 
    Participant
    Status: Physician
    Posts: 249
    Joined: 01/16/2017

    You have 3 options:

    1. Stop taking call.

    2. Negotiate an appropriate stipend.

    3. Suck it up.

    #227339 Reply
    Avatar DCdoc 
    Participant
    Status: Physician
    Posts: 607
    Joined: 06/14/2016

    How much work does the hospital directly funnel you and what is the dollar amount of that direct-referred work? That’s an indirect payment for call. If your group stops taking call, those patients could be funneled to a different group. People above have been blunt, but call payment isn’t always as black/white. If 50% of your practice is referrals from the health system (which could go to another group if you stop doing call) that’s very different than 5%. I’ve never heard of a group blocking out an entire week, with no “normal” patients when on call. Is it really that busy on call you can’t see even 1/2 day of patients? What field is this? Seems very odd to me.

    #227348 Reply
    Liked by hatton1, abds
    Avatar gvs.psych 
    Participant
    Status: Resident
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    Joined: 12/01/2016

    Interestingly, psychiatry must be one area where call is a lucrative opportunity. Psychiatrists mostly don’t want to work weekends, but hospitals can’t keep psych units open without having psychiatrists see patients every single day. So we are constantly getting little bits of money to be ‘on call’ for services in some capacity. Granted this is balanced by having less capacity to generate revenue in other ways. I think our call is probably 1/4 of my income.

    #227352 Reply
    Liked by childay
    Avatar MaxPower 
    Participant
    Status: Physician
    Posts: 373
    Joined: 02/22/2016

    You guys must work in low acuity ERs to say that hand surgery doesn’t have to come in for anything. Flexor tenosynovitis, hand and forearm abscesses (thanks IVDA), crush injuries to the hand, partial amputations with table saws/rip saws, firework injuries, industrial/farming accidents, open fractures, compartment syndrome, artery lacerations in the wrist, spaghetti wrists, etc.

    And when you get called in for just about any of those things it’s going to be a while. I recently had a lady get her hand pulled into a meat cuber. Crushed her middle and ring fingers with multiple fractures in each of the middle and proximal phalanges. Nerve lacerations and over 50 cm of laceration to repair on those fingers and the hand. Then there was the fireworks guy who blew off his thumb at the MP joint, and skeletonized his small, ring, and middle fingers to the PIP joints. Only digit minimally affected was the index finger.

    And then replants take hours. Yeah these things don’t happen every day, but they happen often enough to make call miserable. And that’s part of what you’re being reimbursed to take call for—the times when a disaster like that completely destroys your day (or night).

    For the OP, the only chance you’ve got is to get together with the rest of your group, aside from the senior guy that is hosing you, and see if everyone else feels the same way and then come up with a plan that you can present to the senior guy.

    #227356 Reply
    Lithium Lithium 
    Participant
    Status: Physician
    Posts: 1228
    Joined: 02/15/2016

    Interestingly, psychiatry must be one area where call is a lucrative opportunity. Psychiatrists mostly don’t want to work weekends, but hospitals can’t keep psych units open without having psychiatrists see patients every single day. So we are constantly getting little bits of money to be ‘on call’ for services in some capacity. Granted this is balanced by having less capacity to generate revenue in other ways. I think our call is probably 1/4 of my income.

    Click to expand…

    I’m leaving my job in large part because call was reinstated with no increase in pay.  I would love to be the doc who is contracted to work weekends just to keep the employed docs like me from quitting.  No admin, no UR, no hand washing audits, no JCAHO visits, no stupid meetings, no crowded parking lots, no rush hour.  Overnight call, on the other hand, is the absolute pits, especially when you don’t get paid for it.

    #227359 Reply

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