Call Responsibilities

[Desk_Jockey]

Hoping to do Family Medicine without any hospital responsibilities. For FP docs who do outpatient only, how common is it for them to not take any calls? Is there a significant pay cut associated with this?

Thanks for any input!

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[smq123]

So you have to understand that almost all FM doctors, even those who are outpatient only, take call in some form or another.

Now, if you are in an outpatient practice, without hospital privileges, then you will usually only take telephone call from home - i.e. the answering service calls you if a patient wants to speak to someone after hours, but you don't have to go anywhere. You might have to speak to a patient now and then, but not necessarily all the time.

It is quite common, nowadays, for FM doctors who are outpatient only and have no hospital responsibilities. There will be a pay cut, of course, but how much depends on a variety of factors.

 

[Desk_Jockey]

Thanks for the response!

As far as taking patient calls go: how often do most physicians w/o hospital responsibilities end up having to take calls at home? If you're a part of a group practice, how many nights a week are most physicians on call?

I know that there is a lot of variance with this depending on how practices are set up. I'm just trying to get a feel for how much I'll need to be tied to my phone during the weekends and how much this will take away from my time with family and weekend libations.

 

[JustPlainBill]

Really depends on the practice -- currently I'm in a 10 physician, 6 PA practice so I usually get weekend call every 10 weekends and every 10 days for weekday call -- and usually it's about med refills that didn't get sent in -- for medical problems, that's going to depend -- I've had everything from UTIs in another state to chest pain with palpitations wanting to know what to do to hypotension with starting a new med --- I'm still green so I treat some simple stuff and will ask some questions in such a way that a positive response tells me they're fishing for whatever med they want -- the more serious stuff is "go to the ER" -- everyone has to make a follow up appointment, I always document in the chart (VPN at home) and tell the PCPs about it Monday morning as a courtesy.

Really no big deal -- certainly not like residency call with all the BS that went on there -- and in no way like night float --

And to speak to your question, I've handled calls out at Tex-mex restaurants, while driving in the car, etc. Really no big deal. Most people are ok if you tell them that you're out with the family but going to be home soon, can you call them back -- and ultimately, "Go to the ER and/or urgent care to get checked out" is a valid answer -- may not be the one they want, but it's a valid answer.

 

[Desk_Jockey]

Cool, thanks or laying that out for me.

I like the idea of the flexibility added by a group practice, but does that take away from your continuity with patients? About what percentage of the patients that you see in a day are the other physician's patients?

 

[smq123]

Cool, thanks or laying that out for me.

I like the idea of the flexibility added by a group practice, but does that take away from your continuity with patients? About what percentage of the patients that you see in a day are the other physician's patients?

It depends on how popular you are. ;-)

I usually see about 75-80% continuity patients. If they like you, they'll ask to follow up with you.

Sent from my Nexus 5X using SDN mobile

 

[JustPlainBill]

Cool, thanks or laying that out for me.

I like the idea of the flexibility added by a group practice, but does that take away from your continuity with patients? About what percentage of the patients that you see in a day are the other physician's patients?

Ok, look -- continuity patients and "getting to know people and develop relationships" is really overrated. It may have been ok for a small town doc 30 years ago when we still delivered babies, did minor surgeries and that sort of stuff but now, unless you're just a really great doc (like BlueDog), they'll stay with you as long as you're on their insurance plan, end of story. And don't think that you can't/won't get sued by one of your continuity patients. In a freakin' heartbeat. yeah, I've got a few continuity but right now, and recall I'm 9 months into my first stable, non-UC practice so take it with a grain of salt, I'm the guy that sees "on-call" patients, meaning the ones that couldn't get in to see their doc, didn't like the answer they were given, didn't want to wait the 7 days for follow up or thought because I was the new guy, I'd have the "magic wand" answer for a problem that's been worked up by virtually every partner in the practice, most of whom have been doing this since I was in my first career as an engineer in 1985, or are the psych, non-adherent patients that "fire" doctors they don't like (i.e. ones that tell them to take the meds as they're prescribed, not just when you feel like it).

Nowadays, it's about doing the best you can for the patient in front of you, hoping they'll comply and documenting to cover your behind if they don't and going home at the end of the day without an entire day's notes to write, most of your labs done and most of your FMLA/disability/I saw you on Thursday for a minor back spasm, took friday off and now want a note for work covering me from thursday to monday, doc paperwork done.

Am I angry and burned out -- probably but I still haven't learned that I'm not supposed to let what patients do or don't do get to me and it's the same for all the docs out there -- the last vestiges of my idealism are being crushed against the pavement....

but hey, at least I'm in the wave pool at the local water park with my children on July 4th, rather than stuck in an ER or OR because I chose ER or surgery as a profession. And it is fun to watch the specialists come by the clinic and try to schmooze us FPs after abusing us in residency and talking down/talking trash all that time --- yep, different story in real life when they NEED our referrals to maintain the lifestyle ---

So, sorry for derailing the topic but I thought you needed to know....

And I'm seeing about 25% new/my patients and 75% "on-call" which is supposed to be acute visits but the call center can't seem to understand that DM/HTN/HLD f/u IS NOT AN ACUTE PROBLEM! ---

Ahh, I feel so much better now.....

 

[smq123]

Ok, look -- continuity patients and "getting to know people and develop relationships" is really overrated.

I couldn't disagree more.

I'm not a particularly great doctor or anything special. I work in an urban community health center, with a patient population that is....challenging, let's say. But I do have a lot of patients that I have gotten to know over the years, and they stay with me because they genuinely want a doctor who knows them. This has nothing to do with insurance - heck, I have some patients who have moved, but still drive 40 minutes to see me. They have told me that they would miss having me as their doctor, and, while it may sound incredible to you, the feeling is mutual. I love having continuity patients and would miss that opportunity to develop those relationships. Sure, it's not always easy, but which relationship is? It can be tremendously rewarding, though.

 

[deleted87716]

I'm 9 months into my first stable, non-UC practice so take it with a grain of salt, I'm the guy that sees "on-call" patients, meaning the ones that couldn't get in to see their doc...I'm seeing about 25% new/my patients and 75% "on-call" which is supposed to be acute visits but the call center can't seem to understand that DM/HTN/HLD f/u IS NOT AN ACUTE PROBLEM!

Personally, I think the idea of an "on-call" doc during office hours is flawed. It's a symptom of a larger problem, which is either practice inefficiency or overload (probably both). In my practice, the only time we see somebody else's patient is if they're out of the office and it's an urgent problem for which the patient is unwilling to wait for an appointment with their PCP (which is typically the following day). In other words, it doesn't happen much. I'm off on Wednesdays most of the time, so it's not unusual for one of my two partners to see 1-2 of my patients on my day off. When we're in the office, we'll see our own patients. We have same-day appointments held daily, so it's rare that we're completely booked and have to actually work somebody into the schedule without an appointment slot available.

As for call after hours, we're in a call group with two other practices in our group (total of 11 docs), so that means I take phone call from home once every 11 weekdays and every 11 weekends (weekends are Friday-Sunday). The call volume is minimal (0-2 calls on a weekday, 2-6 on a weekend). It's nothing.

It was a lot worse when I first started practice 15 years ago. At that time, the office I was with was in the (bad) habit of treating a lot of simple complaints over the phone, so we'd get tons of calls from people wanting antibiotics for their "bronchitis" and "sinus infections" (all of which were viral, of course). People would also routinely get short-term Rx's for opioids and muscle relaxants for things like acute back pain, sleep aids for insomnia, benzos for anxiety, etc. One of the other newer partners and I felt strongly enough about it that we basically stopped doing it (treating people over the phone) except in rare (legitimate) instances. We'd recommend self-care using OTC options, or tell them to go to urgent care if they didn't want to wait for an appointment with their PCP. Some patients were pissed in the beginning, of course, but gradually the call volumes dropped off. We also stopped providing routine med refills after hours, and instituted a strict "no controlled substances EVER" policy. Voila. Call is a breeze now.

As I've said many times, your practice becomes what you make it. If you're in a group, you'll have to work to gain consensus, so it's harder. But, it can be done.

 

[VA Hopeful Dr]

I couldn't disagree more.

I'm not a particularly great doctor or anything special. I work in an urban community health center, with a patient population that is....challenging, let's say. But I do have a lot of patients that I have gotten to know over the years, and they stay with me because they genuinely want a doctor who knows them. This has nothing to do with insurance - heck, I have some patients who have moved, but still drive 40 minutes to see me. They have told me that they would miss having me as their doctor, and, while it may sound incredible to you, the feeling is mutual. I love having continuity patients and would miss that opportunity to develop those relationships. Sure, it's not always easy, but which relationship is? It can be tremendously rewarding, though.

Agree completely. My first year out I was in a hospital-owned practice. Had probably 200 patients when I announced I was leaving town. At least 25% of those patients made appointments purely to say goodbye and that they'd miss me. Seriously, didn't refill meds or talk about anything medical. Instead it was "do you have a house yet?" or "man, Columbia is sure hot - you're going to miss us come July".

And now that I do cash-only, there is still quite a bit of patient loyalty. Not infrequently my patients will either qualify for Medicaid or their job finally offers affordable insurance. A good 1/3rd of those patients stick around anyway.

 

[JustPlainBill]

After reading the replies of people I respect, you guys/gals are probably right -- I'm not in a good place right now, lots of personal/professional chaos going on -- just got bought out by "investors" and things are changing with a bit of a heavy hand -- instead of building a practice, I'm in a "temporary" situation that's supposed to have been no more than 3-6 months since Feb. 2015. It's always not a good time to discuss the situation and a quick "we'll talk next week. It'll take maybe another 3-6 months" is all I get.

right now, with me being the "on-call" guy, I have virtually no continuity and am pretty much running an urgent care for the practice which sucks. Which means that I probably shot off my mouth about something I had no experience with and I owe everyone an apology -- sorry about that.

My comments about call were the way it is which is pretty doggone chill. If I could just get the clinic situation sorted out with what was promised, it'd probably be a little better.

Anyway, I now return you back to your regularly scheduled thread.....

 

[VA Hopeful Dr]

After reading the replies of people I respect, you guys/gals are probably right -- I'm not in a good place right now, lots of personal/professional chaos going on -- just got bought out by "investors" and things are changing with a bit of a heavy hand -- instead of building a practice, I'm in a "temporary" situation that's supposed to have been no more than 3-6 months since Feb. 2015. It's always not a good time to discuss the situation and a quick "we'll talk next week. It'll take maybe another 3-6 months" is all I get.

right now, with me being the "on-call" guy, I have virtually no continuity and am pretty much running an urgent care for the practice which sucks. Which means that I probably shot off my mouth about something I had no experience with and I owe everyone an apology -- sorry about that.

My comments about call were the way it is which is pretty doggone chill. If I could just get the clinic situation sorted out with what was promised, it'd probably be a little better.

Anyway, I now return you back to your regularly scheduled thread.....

It always sucks to be caught in the middle of a big change like that, especially early on in a job.

 

[Doctor4Life1769]

Continuity is great.
I'm 2 weeks away from my final day from residency clinic and I see "acutes" for when PCP aren't available etc to fill up my time slots.

A decent number of these patients want to follow me and fire their PCPs. I convince them to stay and just reassign with a new resident especially if they don't have commercial insurance. If they do, well welcome aboard!

 

[Bacchus]

I'm in a practice with 6 others. Q7wk call. We take home call a week at a time averaging 10-15 calls for the week. The week you're on call you see patients 8-12 on Sat.

 

[Shinken]

and instituted a strict "no controlled substances EVER" policy. Voila. Call is a breeze now.

My partner and I did exactly this when we "inherited" an established practice from two retiring physicians. Best decision ever. No more Friday 11PM pages at home because "my Percocet just ran out and my back is killing me!"

JustPlainBill, I'm with you. I love family medicine...but patients can be really annoying. Compassion fatigue is definitely real and I'm suffering though it.

 

[Doctor4Life1769]

We take 1 call (weekday) a week and 1 weekend per month. If more physicians get added on it'll be less call frequency.

 

[Shinken]

To answer the OP's question, I'm on call 24-7. I don't participate in the call group for my practice because when I did, I would only be on call one weekend out of every month, but that weekend I would get slammed with pages (even in the middle of the night), since I was handling other doc's patients. Now that I'm on my own and technically on call at all times, every day, every weekend, I rarely get paged. I average about a page every 2-3 months, and typically during the day on weekends, rarely at night.

Advantages of not belonging to a call group is that every page is from one of your patients, so you know them and their history. Also, you can educate patients if they page you inappropriately so it doesn't happen again.

My advice to the OP would be:

- Try to join a practice that does not require you to belong to a call group.

- Avoid joining a call group when other docs work at nursing homes. Nursing home "nurses" will page you at any time for trivial crap.

- Corollary to the above: if you want to severely cut down on the number of pages, don't see nursing home patients (if you don't do any hospital work, you will also cut down considerably on the number of pages).

- If a doc is in a bind and needs someone to cover for him, do it. You'll need someone to cover for you if you're ever in a bind. You don't want to be the guy that's on his own with call and then find out that nobody wants to cover for you.

 

[JustPlainBill]

...

- Avoid joining a call group when other docs work at nursing homes. Nursing home "nurses" will page you at any time for trivial crap.

....

Learned this the hard way -- first practice out of residency was at a small critical access hospital in NTex. Hospital had 6 physicians, 2 of which saw patients in nursing homes, another barely maintained clinic and just wanted to do ER work, one who was the main driving force in the hospital in it's heyday and another was a surgeon who they kept trying to get to take more and more difficult cases with no real post surgical care to speak of and no ICU (they had what they called an ICU which was more of a step down unit) -- anyway, the 2 nursing home physicians caused 90% of the calls --- they knew their patients but the rest of us didn't -- the nursing home nurses always wanted me to dispense ABX/pain meds/Haldol over the phone and I would sometimes have to fight with them and let them know I didn't know the patient and based on what they described, the patient needed to be checked out.

I once actually got a page at midnight to renew an order for "Vitamin D and Omega 3 Fish oil" -- when I asked what time the patient had returned from the hospital, I was told 9pm. I asked to speak with the supervisor and was told they weren't there, they were home asleep. Right, so please have them page me, right now..... long pause --- ok; So I wait 15 minutes with no page...I called back and asked if they had spoken with the supervisor --- about that time, my pager goes off so I hang up and call the number back --- first words out of the supervisor's mouth were,"I'm so sorry doctor, she's new to us" -- I calmly and politely told her that some training was probably in order and the supervisor agreed ----

I don't get involved with nursing homes since that's not the life I want -- your mileage may vary...