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Incresingly unfair hospital call

Home Practice Management Incresingly unfair hospital call

  • childay childay 
    Participant
    Status: Physician
    Posts: 1081
    Joined: 01/09/2016

    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.

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    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.

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    Screw that nonsense.  I don’t get “paid” for call but I do have a stipend.  We pay our other providers (APRNs) for overnight call and for weekends.  No doubt you could find a weekend only inpatient job.  I know an APRN around here who travels for that purpose

    #227465 Reply
    Avatar Eye3md 
    Participant
    Status: Physician
    Posts: 80
    Joined: 12/01/2017

    Our local hospital refused to pay one of the ophthalmoloy groups for call coverage. Not that ophthalmoloy is a big deal but when you need us, you need us.  The ophthalmoloy group eventually gave notice they were dropping hospital call. This left the hospital uncovered 2 out of 3 nights. Now, the stupid hospital has been trying to get locums coverage, so they end up paying more per week than what they would have paid if they’d negotiated in good faith with the group.

     

    You should either take A LOT less call, stop taking call, or be paid for your call. As long as you are making money for the hospital, or providing a “free” service so they don’t have to pay, they will use you as long as possible. And have no concern about doing it. Right now, you are being used badly!!!

    q-school q-school 
    Participant
    Status: Physician
    Posts: 2640
    Joined: 05/07/2017

    you may have mentioned it and i missed-

    is the senior partner getting paid to be chief of department?

    is there some external incentive they have to keep your group running this way?

    i don’t think it is a requirement to be paid for call, but if the call burden is ruining the basic practice then something will give eventually–just a question of time.

     

     

    #227982 Reply
    Avatar Jackmomma 
    Participant
    Status: Physician
    Posts: 37
    Joined: 01/26/2016

    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.

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    sounds increasingly toxic. i would basically take the bull by the horns and politely but firmly raise the concerns you have and see if there is a feasible action plan to get call better. Call is terrible for all specialties and it only gets worse as we get older and realize life is ticking away.

    If you cannot get an action plan I’d frankly just leave and move on. if call is that toxic it may be time to look at academia or something similar so call is much much better. Finances is one thing but if your life is miserable it doesn’t matter how much you make, if you can’t enjoy it.

     

    #230135 Reply
    Liked by q-school, Tim, Eye3md
    Avatar Allixi 
    Participant
    Status: Physician
    Posts: 125
    Joined: 03/16/2016

    Sounds like the call being brutal is just a symptom.

    The real disease is that your group has lost half its members, with no replacements. Are you guys not recruiting, or unable to get people to join?

    This problem may resolve on its own if you have a lot of people coming back shortly. If not, then you’ll have increasing leverage to make demands as your group continues shrinking.

    #230533 Reply
    Avatar kayli69 
    Participant
    Status: Physician
    Posts: 15
    Joined: 04/20/2017

    Thank you everyone for your replies.  To clarify:

    -yes, my Sr partner receives a stipend to be Chief of the dept.  This is a huge conflict of interest as far as I am concerned

    -we cannot recruit more people for our group as we are maxed out space wise.  We have lost several docs in solo practice that were part of our shared call group

    -serving the hospital gives me ZERO in patient referrals down the line.  We each have our own network of PCPs that refer to each of us and call has absolutly zero bearing on these referrals

     

    To further pour salt on a wound, I just received my $700 fee for 6 months of parking at the hospital, which I work at for free

     

    I have proposed to my group we limit our call to 4 weeks each, which would providde a total of 32 weeks of coverage.  It is up to the hospital to figue out the rest.  I personally feel this is even being too generous, but it is a start and at least caps the call.  I know the Sr partner is going to resist this in every way possible, but everyone else in my group seem to be on board.  Hopefully they wont fold when he starts to resist the idea

    #230610 Reply
    CordMcNally CordMcNally 
    Participant
    Status: Physician
    Posts: 3052
    Joined: 01/03/2017

    Senior partner has basically zero leverage in this situation. I would meet with the other partners not named Senior Partner and all get on the same page. I feel that doing any additional call for free is being too nice. This kind of ties into the thread about why physicians won’t unionize…we let people take advantage of us. This free call arrangement is going to ruin your group.

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

    #230624 Reply
    Liked by Eye3md, Zaphod
    Zaphod Zaphod 
    Participant
    Status: Physician, Small Business Owner
    Posts: 6336
    Joined: 01/12/2016

    Just stop taking call period. What does it do for you? You may get that meeting you were looking for. Doesnt make sense at all.

    #230815 Reply
    Liked by Eye3md, EndoRobert, Tim
    q-school q-school 
    Participant
    Status: Physician
    Posts: 2640
    Joined: 05/07/2017

     This free call arrangement is going to ruin your group.

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    too late.  🙁

     

    #230913 Reply
    Liked by Zaphod, pulmdoc
    Avatar jacoavlu 
    Moderator
    Status: Physician, Small Business Owner
    Posts: 2465
    Joined: 03/01/2018

    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.

    is your practice overhead seriously 15k/wk = 780k/yr = 6.2M/yr for 8 docs ???

     

    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.

    Click to expand…

    You said your partners are on board with a 4wk call/yr proposal. Do they feel as strongly as you? If not, you have to ask yourself why? Is there some aspect of the situation you’re not understanding?

    But if others feel the same (as I would) then is your group democratic, or a dictatorship? As others have rightfully said this could implode your group. Unfairness (real or perceived) within a group is a cancer.

    Are other specialties at same hospital paid for call coverage? If not, then it would be a very big hill to climb to get call paid. What about other hospitals in your area?

    A suggestion to stop taking call has been made. This could mean loss of hospital privileges, depending on bylaws of the facility. This may not matter to you, it sure seems you’d be better off in clinic and doing procedures elsewhere. But your employment contract with your group may mandate that you maintain privileges.

    How your partners feel about this is critical.

    The Finance Buff's solo 401k contribution spreadsheet: https://goo.gl/6cZKVA

    #230917 Reply
    Liked by Zaphod, q-school

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