Anesthesiologist Staffing Model Academic Trauma Center

[Soparklion]

---

Members don't see this ad.

I work at a large academic medical center that staffs multiple anesthesiologists 24/7. Our particular issue is call. We have a trauma call anesthesiologist in house to staff from 7p-7a x7days per week.
Cardiac anesthesia staffs 7p-7a as well via home call.
Transplant anesthesia staffs 7p-7a, also via home call.

The issue that we have is that the in-house provider is running ORs for 80% of their shift while the Cardiac and Transplant specialists are carrying a pager and at home for 80% of their 'shift'. The work is obviously not equal. I am interested to hear how other groups have addressed this same problem.

 

[Noyac]

Pay them one fee for carrying the page and compensate additionally for time in the OR.
FOR EXAMPLE:
Everyone gets $1500/call
Additionally they get $125/ 15min in the OR. ( 1hr would be $500).

This way people would be begging for the trauma call.

 

[somedumbDO]

Pay them one fee for carrying the page and compensate additionally for time in the OR.
FOR EXAMPLE:
Everyone gets $1500/call
Additionally they get $125/ 15min in the OR. ( 1hr would be $500).

This way people would be begging for the trauma call.

I would take this job!

 

[ZzzPlz]

...and beg for a bus crash every call night.

 

[Masseter Spasm]

This is one of the fundamental flaws of academic groups: some faculty feel like they don't get paid for clinical (revenue-generating) work. If you do not incentivize clinical work, the only incentive is to avoid clinical work, especially the work that people dislike the most (i.e. working nights, holidays, and weekends.)

Along the lines of what Noyac suggested:
Treat all weekdays like a regular work day
Determine a time after which a regular work day "ends" (5 p.m.? 7 p.m.? etc.)
Call would refer to anytime after that designated time on a weekday or anytime on a weekend/holiday
Anyone working "in house" during those times gets paid the same hourly rate regardless of specialty
Anyone at home but at risk of being called in from home (beeper call) gets paid an hourly rate much lower than the "in house" rate
You could later adjust the hourly rate for beeper call based on likelihood of being called in from home, if you collect data.

 

[deleted171991]

They know exactly how they should incentivize people. Except, then, how could they "reward" their friends for doing basically nothing, beyond carrying a pager?

No, no, no. Equal pay for equal work is a very anti-capitalist idea. 😉

 

[Ronin786]

Why not just rotate the overnight trauma call? Have everybody in the call pool take trauma call in house. If a transplant/CV case comes in then the trauma call will come in and cover trauma.

 

[nimbus]

Why not just rotate the overnight trauma call? Have everybody in the call pool take trauma call in house. If a transplant/CV case comes in then the trauma call will come in and cover trauma.

The heart and transplant guys probably take a high frequency of call and probably signed up for no inhouse call.

 

[IlDestriero]

We incentivize late shifts and in house call. Transplant, pain, etc. home call get paid as well, but less than the overnight call. They usually take call a week at a time and have far more more call burden than me. That's fine by me. It works for us.

 

[sevoflurane]

I work at a large academic medical center that staffs multiple anesthesiologists 24/7. Our particular issue is call. We have a trauma call anesthesiologist in house to staff from 7p-7a x7days per week.
Cardiac anesthesia staffs 7p-7a as well via home call.
Transplant anesthesia staffs 7p-7a, also via home call.

The issue that we have is that the in-house provider is running ORs for 80% of their shift while the Cardiac and Transplant specialists are carrying a pager and at home for 80% of their 'shift'. The work is obviously not equal. I am interested to hear how other groups have addressed this same problem.

Liker IlD said. In house gets more of a stipend. Home call gets less. After that, you are productivity based. I think most partners would agree to this.

Simple and clean.

 

[sleepallday]

Why don't you have all the sub-specialities rotate taking in-house call. That seems most fair and everyone gets paid the same. For example on monday the trauma guy would take in-house call. 2nd call would be the cardiac and 3rd call would be transplant. Then tuesday cardiac is in-house, 2nd call is transplant, and 3rd call in the trauma guy, etc.

This is how every place I've been has done it.

 

[nimbus]

Why don't you have all the sub-specialities rotate taking in-house call. That seems most fair and everyone gets paid the same. For example on monday the trauma guy would take in-house call. 2nd call would be the cardiac and 3rd call would be transplant. Then tuesday cardiac is in-house, 2nd call is transplant, and 3rd call in the trauma guy, etc.

This is how every place I've been has done it.

In that scenario, the trauma guy will end up with more days with no call obligation. Usually there are much smaller pools of people taking transplant and cardiac call, so they have to take more frequent call. The cardiac and transplant guys are still on call, just not in house. The trauma guy will have more days to go party or go surfing. The other guys can't. There should be some compensation for that.

 

[Soparklion]

Why not just rotate the overnight trauma call? Have everybody in the call pool take trauma call in house. If a transplant/CV case comes in then the trauma call will come in and cover trauma.

The issue with that rotation is that the ratios of Trauma call pool to Cardiac call pool to Transplant call pool is something like 2:1:1.

 

[Soparklion]

In that scenario, the trauma guy will end up with more days with no call obligation. Usually there are much smaller pools of people taking transplant and cardiac call, so they have to take more frequent call. The cardiac and transplant guys are still on call, just not in house. The trauma guy will have more days to go party or go surfing. The other guys can't. There should be some compensation for that.

and the $/hr for inhouse versus home call has created quite a 'discussion'...