Being on call

[speter33]

I'm wondering does every doctor have to be on call? Let's say your are a pediatrician or a family doctor owning your own practice do you still have to be on call?

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[Amy]

After your residency, no.

 

[huktonfonix]

Call really depends on how you practice. As a private physician, you may not have "in house" call per se, but you will be responsible for dealing with taking phone calls at home. If you want time completely without patient responsibilities join a group or HMO. Either way, you'll have someone else covering so you can be off. Of course this means you;ll have to take call every 4-10 night depending on the size of your group.

 

[ckent]

I've actually wondered about this too, for out-patient physicians. If you don't want to ever be on call, can't you tell all of your patients just to go to the ER if they have a problem after hours? I asked a physician about this, and he told me that it was bad for business, because people always expect their physician or someone covering for their physician to be on call and show up at the ER if something happened to them. I would never expect my out-patient physician to show up after hours if anything ever happened to me though, but I don't have a real primary care physician.

 

[kcrd]

Can't you hire a hospitalist practice to take your call?

 

[DrQuinn]

Originally posted by ckent
I've actually wondered about this too, for out-patient physicians. If you don't want to ever be on call, can't you tell all of your patients just to go to the ER if they have a problem after hours? I asked a physician about this, and he told me that it was bad for business, because people always expect their physician or someone covering for their physician to be on call and show up at the ER if something happened to them. I would never expect my out-patient physician to show up after hours if anything ever happened to me though, but I don't have a real primary care physician.

A lot of times, you have FPs take call every couple of weeks, if you are in a practice. Dr. A takes call the first week of the month for all the patients in the practice, and Dr. B takes call the second week, etc, so that way you get some weeks where you are not on call.

If a patient comes into the ED, we (as the ED physicians) usually contact you (or whoever is answering for your service) and see if you concur with our diagnosis and plan (or just let you decide).

Q, DO

 

[ckent]

Originally posted by QuinnNSU
A lot of times, you have FPs take call every couple of weeks, if you are in a practice. Dr. A takes call the first week of the month for all the patients in the practice, and Dr. B takes call the second week, etc, so that way you get some weeks where you are not on call.

If a patient comes into the ED, we (as the ED physicians) usually contact you (or whoever is answering for your service) and see if you concur with our diagnosis and plan (or just let you decide).

Q, DO

What if no one is there to pick up the phone/there is no answering service? My thought is that can't patients be admitted to floors and let hospitalists take care of everything without getting the PCP involved? Particularly if it is after hours.

 

[DrQuinn]

Remember that people get admitted all the time to the hospital without having a PCP... there is always medicine on call (for hospital priviliges). Usually most self-respective FP or PCP will have SOME sort of answering service. If we don't hear back from the PCP, we will probably be the patient advocate anyways and admit the pt.

Q, DO

 

[ent_doc]

Originally posted by ckent
I've actually wondered about this too, for out-patient physicians. If you don't want to ever be on call, can't you tell all of your patients just to go to the ER if they have a problem after hours? I asked a physician about this, and he told me that it was bad for business, because people always expect their physician or someone covering for their physician to be on call and show up at the ER if something happened to them. I would never expect my out-patient physician to show up after hours if anything ever happened to me though, but I don't have a real primary care physician.

This is for a specialty practice:

The practice I am rotating through right now in ENT has a nurse helpline to answer after-hour calls. They triage many issues, but have to contact the doctor for problems (post-tonsillectomy bleeding, etc). It is important to have an ENT attending available for questions, particularly in postoperative patients. Since this practice works out of a regional referral center, there are often questions from the primary hospitals about ENT issues. For example I had a call the other day from a doc about how to handle a submandibular gland sialoadenitis.

ENT private practice call involves coming into the ED for difficult epistaxis (nosebleeding), neck/peritonsillar abscesses, facial trauma, airway concerns, posttonsillectomy bleeding. Someone has to be able to deal with these issues.

In primary care, you may have hospitalists helping you out with inpatient issues, but someone from the practice should still be available to answer patient care questions

 

[Sessamoid]

For primary care docs, I do know of a few docs who have agreements with hospitalists to take all their hospital admissions. So it's not unheard of.

That said, I think it may be difficult to keep a loyal patient base if it becomes known that you abandon you patients the moment they need serious help. I'm not sure how these guys do it. You also will have little to no control over the type and quality of care your patients get when admitted.

Another downside is lack of intellectual stimulation. Maybe this isn't important to you, but sprains and strains get really boring very fast. I'd be pulling out my hair if I had to see only that all the time.

The other downside is financial. I'm not a primary care physician, so take this with a grain of salt, but to my knowledge hospital admissions pay pretty well in addition to being far more interesting than office work.

So there are lots of reasons that most physicians don't practice in a strictly outpatient setting. The exceptions to this rule are those that spend their careers working in "urgent care centers" or "walk-in clinics", where such discontinuity of care is expected. I suspect those docs are making considerably less money than the ones who admit their own patients to the hospital, and boredom would probably be a major problem.

 

[ERMudPhud]

There are a few primary care physicians in my area who make absolutely no effort to arrange for after hours coverage for their patients. When one of their patients comes to the ER at night and needs to be admitted they get admitted to whichever hospitalist group is on a night. The bigger problem is if their patient has some other issue that needs to be followed up as an outpatient. I have no one to contact so I just have to give the patient a written note about what my concerns are and hope their PCP will see it or I can have a copy of my note faxed to them but I suspect those just get filed by the secretary. Most of the primary care docs in town team up to cover each others practices at night so they don't take call that often. Furthermore almost all of them use hospitalist for admissions. Hospital admitting and rounding pays well if that is all you do but if you just have a few patients at a time in the hospital, especially if they are scattered at various hospitals, its not worth their time to go and round on them each day. The few PCP's who just have an answering machine that says go to the ER after hours are pretty universally looked down upon by everyone (ED docs, other PCP's, hospitalists).

 

[AJM]

For primary care, there are two different types of call -- one is the typical hospitalist call, that everyone is used to from their medicine wards experience, where someone needs to be available to admit patients of a practice to the hospital. Call in that sense is increasingly being covered by hospitalists, and has been discussed in previous posts. The other kind of call is the one used more frequently by the majority of primary care patients -- the phone advice call. The vast majority of primary care practices have a call system in place where there is someone from that practice or from a partner practice who will answer patient's questions over the telephone, and decide whether a patient needs to be seen right away in the ER, if it can wait, or if they need to call in a prescription, for example. Many larger practices employ an advice nurse who can answer most questions, and otherwise screen easier calls, but there has to be an on-call physician available to handle the more complex calls. Smaller practices on the other hand, will just have an answering service that will just page the physician on call.

If you become a primary care physician, and are in a practice with no after-hours telephone advice coverage, you will have many unhappy patients who will spend 8-10 hours in the ER unnecessarily because that will be the only place that can answer their after-hours or weekend concerns.

 

[Starflyr]

THe thing that happens at my FP site is that if a patient is admitted via the ER and hasnt been sent there specifically by the PCP, the hospitalists handle the first day/night of care, then refer the patient to the PCP - and the PCP oversees all hospital care from there on out - making rounds ~1x/day, and doing all the consults and discharge stuff, etc. i dont think that's a bad plan, personally.

Star

 

[doc05]

Originally posted by Starflyr
THe thing that happens at my FP site is that if a patient is admitted via the ER and hasnt been sent there specifically by the PCP, the hospitalists handle the first day/night of care, then refer the patient to the PCP - and the PCP oversees all hospital care from there on out - making rounds ~1x/day, and doing all the consults and discharge stuff, etc. i dont think that's a bad plan, personally.

Star

yes it is a bad plan. do you really think patients will be happy if they can never get in touch with their primary MD after hours? I suspect that this leads to a large number of dissatisfied patients, many of whom probably decide to see another doctor.