In house call vs Home call?

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urge

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What is worse in your opinion?

I used to take in house call and thought that not having to sleep in the hospital would be much better. Now I take home call but get pretty mad when the pager goes off. If it's a long case I get upset that I would be there forever and might as well be in house. If it's a short case I get upset about driving back and forth for 20 min case.

To top it off, you don't get the respect, if you will, of being on call (including compensation). People just assume you are off despite spending over 10 hrs in the hospital when called.

The in house people watch tv and sleep all day and night but somehow that is hard work.

What say you?

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What is worse in your opinion?

I used to take in house call and thought that not having to sleep in the hospital would be much better. Now I take home call but get pretty mad when the pager goes off. If it's a long case I get upset that I would be there forever and might as well be in house. If it's a short case I get upset about driving back and forth for 20 min case.

To top it off, you don't get the respect, if you will, of being on call (including compensation). People just assume you are off despite spending over 10 hrs in the hospital when called.

The in house people watch tv and sleep all day and night but somehow that is hard work.

What say you?


If you average only one phone call at night per call then staying home makes sense. If you get an average of 1-2 cases per night shift at the hospital then getting credit for the shift is a better idea which means in house call.

The worst situation is averaging at least one case per call shift ( after midnight) and not getting any compensation for it like the post call day off.
 
Have both in house call and home back up call. Would rather trade all my backup calls for in-house overnight call. I agree that people respect the in-house call much more than the call from home. I hate the fear and restriction of having to respond to calls. When i am home I want to be home and off the clock mentally.
 
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I have worked at multiple hospitals with both systems. To me, it depends on intensity of call, and whether you get the post call day off or not. Being paid to sleep in house and getting the next day off is great work-if you can get it. Doesn't work out that way to often though. First out next day or sometimes called off work after home call with minimal activity on call for less pay ain't bad either, is a much more common scenario.
As far as the respect factor goes, I feel that is more a function of the types of cases that the institution does rather than the amount of work.
 
Just depends on how things are set up.

I love home call in our current system. Often times, I go home between 5-8pm on primary and sleep in my own bed the rest of the night. If I get called in for an epidural, that is an automatic $500 in my pocket. Appy two hours later... same deal. 2 call ins = $1000 + whatever I made during the day + call fee. If it's a long case, there is additional compensation after the first 2 hours. It is psychologically a better system than dividing everything up equally and hoping things will work out fairly in the end.
Our surgeons are good at bringing in the appy's at 6:00am (to be done before scheduled cases so the entire team can get rest). Same goes for C/R's and cystos.
All that being said, I've had a couple of really long runs as I am always available post-call until 3pm. It's basically a permutation of eat what you kill with a blended unit system +call/call-in fee. Having surgeons that don't like working in the middle of the night helps the entire OR morale.
IMHO, sleeping in the hospital is no fun. I'd rather go home, hang out with the wife and 4 legged children as well as decompress in my own quarters. In my current system I'm actually glad to get 1-2 call ins. It's not like it's something for nothing.
My commute is 10 minutes... so that makes all the difference in the world.
 
Just depends on how things are set up.

I love home call in our current system. Often times, I go home between 5-8pm on primary and sleep in my own bed the rest of the night. If I get called in for an epidural, that is an automatic $500 in my pocket. Appy two hours later... same deal. 2 call ins = $1000 + whatever I made during the day + call fee. If it's a long case, there is additional compensation after the first 2 hours. It is psychologically a better system than dividing everything up equally and hoping things will work out fairly in the end.
Our surgeons are good at bringing in the appy's at 6:00am (to be done before scheduled cases so the entire team can get rest). Same goes for C/R's and cystos.
All that being said, I've had a couple of really long runs as I am always available post-call until 3pm. It's basically a permutation of eat what you kill with a blended unit system +call/call-in fee. Having surgeons that don't like working in the middle of the night helps the entire OR morale.
IMHO, sleeping in the hospital is no fun. I'd rather go home, hang out with the wife and 4 legged children as well as decompress in my own quarters. In my current system I'm actually glad to get 1-2 call ins. It's not like it's something for nothing.
My commute is 10 minutes... so that makes all the difference in the world.

Great system. I agree about sleeping at home whenever possible.
 
Got called twice this weekend so far. 30 min on Saturday, 9 hrs on Sunday. Had to abandon wife at a restaurant on Saturday for a stupid case. My compensation is no where near as good as sevo's.
 
Just depends on how things are set up.

I love home call in our current system. Often times, I go home between 5-8pm on primary and sleep in my own bed the rest of the night. If I get called in for an epidural, that is an automatic $500 in my pocket. Appy two hours later... same deal. 2 call ins = $1000 + whatever I made during the day + call fee. If it's a long case, there is additional compensation after the first 2 hours. It is psychologically a better system than dividing everything up equally and hoping things will work out fairly in the end.
Our surgeons are good at bringing in the appy's at 6:00am (to be done before scheduled cases so the entire team can get rest). Same goes for C/R's and cystos.
All that being said, I've had a couple of really long runs as I am always available post-call until 3pm. It's basically a permutation of eat what you kill with a blended unit system +call/call-in fee. Having surgeons that don't like working in the middle of the night helps the entire OR morale.
IMHO, sleeping in the hospital is no fun. I'd rather go home, hang out with the wife and 4 legged children as well as decompress in my own quarters. In my current system I'm actually glad to get 1-2 call ins. It's not like it's something for nothing.
My commute is 10 minutes... so that makes all the difference in the world.

$500 per epidural?

50-60% of ob population is usually self pay (no pay) or Medicaid. In the big cities you get hosed on ob call if fee for service. Hospitals are demanding more and more coverage and not compensating.

Looks like you guys have a much better deal.
 
Call in for whatever reason... epidural, appy, ex-lap, AAA, etc... This comes out of a "call pool". During the day, an epidural is a much lower fee.
Call-in after hours is a different beast. We get hosed on VBACs... cuz we need to stay in house 'till delivery. Fortunately they are not common.
 
I'm happy to be in house. We get a post call day, have a quiet call room, and I don't have to waste a half hour driving in half asleep on a highway full of drunks. Even when I was home call, I used to come in late and sleep there to avoid the hassle.
 
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We take "home call" starting at 7p. However, I usually come in and just crash at the hospital since we cover 3 facilities, one of which is a major heart referral center and another is a major stroke referral center. Middle if the night calls are often true emergencies.
 
I am at a small, military hospital, and we do a home call system. There is a CRNA in house to handle things like preops and IV starts, but any case requires that they call us in. Whether we went home at 5pm and didn't get called back, or worked all night, the next day is off. Weekends can be long, with the Friday call guy covering Saturday and Sunday from home, with Monday off. To compensate for the possibility of working all weekend, we get the next Thursday call, so we are post-call Friday and off the rest of the weekend. Holidays are similar, but we are given an extra day or two off somewhere in the month if its a longer holiday (the Thanksgiving guy is on the hook from 0630 Thursday through 0630 Monday). We're not terribly busy, and do no OB, so its not bad.
 
Call in for whatever reason... epidural, appy, ex-lap, AAA, etc... This comes out of a "call pool". During the day, an epidural is a much lower fee.
Call-in after hours is a different beast. We get hosed on VBACs... cuz we need to stay in house 'till delivery. Fortunately they are not common.

Where does the "call pool" come from? Hospital stipend, patient collections, or????. Just curious how other groups do it.

Regardless, seems like a good system. Makes getting up and going in much more palatable.
 
We have a "call pool." It works like this.

Monthly gross procedes come into the practice. Pratice expenses and call stipends are subtracted from this and are payed out first. The remaining income is divided by the total number of units generated by the practice in that month. That gives you a per unit blended value. Individual compensation is the sum of call stipend plus the product of the individual unit production times the blended value.

Since income is determined by both number of calls taken and unit production, a healthy marketplace is maintained for trading both call and late rows. We try to place a value on call that promotes a market for it. We keep it valuable enough that people want to work it and the hungrier guys want more of it, but not so valuable that no one will give it up.

We pay stipends for trauma call, OB call, cardiac call, and a backup call position. We have a daytime Anesthesia in Charge position that covers OB and coordinates the scheduling etc. There is a stipend for this position as well. We pay a small stipend to our executive officers and a very small stipend for meeting attendance.

- pod
 
$500 per epidural?

50-60% of ob population is usually self pay (no pay) or Medicaid. In the big cities you get hosed on ob call if fee for service. Hospitals are demanding more and more coverage and not compensating.

Looks like you guys have a much better deal.

CMS pays $980 for an epidural in my area. It is felt that even Medicaid patients deserve pain relief during the labor of their unpaid for kid and future ward of the state.
 
Home call but postcall day off. Really like it. Get called in 50% of the time though. Academic children's hospital.
 
I felt so much worse after night float compared to q4 overnight call with post call day.


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Hmmm. q4 call or qwhatever call vs. 2 weeks of night float a year with 16 days off to follow each night float.
 
Hmmm. q4 call or qwhatever call vs. 2 weeks of night float a year with 16 days off to follow each night float.

Arguably a different animal than what I'm experiencing now (and I stand by my original statement, currently I very much prefer traditional call), I do wonder how common is it to have that much time off following a string of nights.
 
Periopdoc... Thanks for explanation. Very rational system.


Wrt night float.....it depends on how much you need to be up. If you are up all night, every night, it would really mess with your sleep cycle. If not, it could be no big deal.
 
Periopdoc... Thanks for explanation. Very rational system.


Wrt night float.....it depends on how much you need to be up. If you are up all night, every night, it would really mess with your sleep cycle. If not, it could be no big deal.

Our night float you are expected to be awake and working. Tasks are specifically left for you to complete, it isn't just admissions and putting out fires.

Call doesn't have the same expectation. So if it's slow you can lie down and try to get some sleep.


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