You're a surgeon and you have a private practice. You need a facility to do your operations. You have a contract with your local hospital they give you hospital privileges and you get on their call rotation. Is this how it works?
Usually.
When in private practice, you will apply to hospital(s) for staff privileges. Some of those hospitals will require call and for other (and for certain specialties), call is courtesy. The latter means that you can be called for a consultation but refuse it at any time, or you can request to specifically be put on a call schedule; its your choice. Many hospitals adopted courtesy call when they realized that mandating call was a way to lose staff to other hospitals which didn't mandate it. However, call is a good source of referrals and business.
Not all specialties have a "contract" with the hospital. A certain anesthesia group may have a contract to provide anesthesia services, or a GS group to cover the ED but most of the time in private practice, you are not contracted with or by the hospital to provide services. Any required call simply comes as a stipulation of staff privileges and that will vary by hospital and specialty.
As noted above, there are certain requirements for accreditation for hospitals. A Level 1 Trauma center must have a trauma/GS, Neurosurgeon, Ortho etc on staff and available 24/7. Many times these are employed physicians and not in private practice, so call is handled differently (essentially it will be a requirement of employment).
The way call works in my group is that the 6 of us divy up the office call (i.e., patients who call in after hours/weekends/holidays with questions or problems) evenly. We all have operating and admitting privileges at different hospitals, none of which require call for our specialty. If I'm on call that night and receive a call from a hospital I don't go to, I defer to my partner who does; because call is courtesy, we can refuse a new consultation if we wanted (but never do because that's bad for referrals).
