Call pay

[air bud]

I have more and more friends getting paid to take call at hospitals. Curious as to how much people are getting paid. Obviously it pales in comparison to Ortho. But I have friends getting anywhere from 250 to 400 a night non holiday. Maybe a little more on weekends. Also, for those that do, how did you negotiate this or discuss this when you are obviously overlapping with Ortho that would be able to take care of it if you didn't exist.

---

Members don't see this ad.

 

[Homo sapien]

this sounds like something that would be prevalent in more suburban or desperate rural areas than the mainstream things. I have attendings who take call who get paid for consults and things but not like - you are a partial employee paid X per shift to do lower extremity call

 

[GreenHousePub]

I know someone who makes their junior associates take call for the practice. Free. Every day. For their entire contract lol.

 

[DYK343]

If you work for a hospital directly you are not going to get paid to take call. Its part of your duties and would be written into your contract.

If you are solo and have no affiliation with the hospital other than using their OR and inpatient management you should be paid to take call. They want podiatry, especially for the diabetic stuff, and if you hold your ground you should be able to get paid for call. Everyone in town (DPMs) should refuse consults until you get a set paid call schedule.

All other surgical professions (who are solo providers and the hospital does not employ their specialty directly) get paid to take call. You should too.

 

[619]

Truth is, most non-hospital employed podiatrist that take (free) call for the hospital work for someone else, or part of a so called super group.

As an associate, you don't really have a say when the boss volunteers you on the hospital call roaster and the big lie they say is that it will help build up your clinic or you will get trauma cases from there to build up your surgical numbers. Nothing could be further from the truth. Most patients that frequent the ER have no insurance and most her headache to deal with even when they follow up with you in clinic. Even the big boss himself will not take call, will focus on clinic and out-patient surgery. I know because I used to work for a big group. I fell for it too. After a full day of clinic, you last thing you want is to head to the hospital to round on a patient or deal with anything ER.

I opened my own practice Oct 2020, currently solo and enjoying it. No way I am taking free call for the hospital, even at $400/night. It is not worth it. A good night sleep every single night is priceless. You can easily make $200-$400 from one new patient visit. I do take occasional floor consults at my current hospital but then I am quick to sign off if there is no surgical indication.

 

[dtrack22]

I know someone who makes their junior associates take call for the practice. Free. Every day. For their entire contract lol.

I had a contract like that. Even the owner's surgical patients were given my cell (well, I set up a google voice but that was on the practice's after-hours phone message and still went to my cell).

Everyone in town (DPMs) should refuse consults until you get a set paid call schedule.

This is what should be done but isn't. So in reality nobody is getting paid for call because they can always find a DPM or two willing to do it for free. Though I will say, I bet a majority of hospitals would just have ortho or gen surg cover foot stuff (who they are already paying to take call), before they start giving money to podiatrists. Especially because very few patients will actually require you to come in right away or that night. In residency one of our attendings was really close to getting paid to take call, it was a large hospital and ortho was sick and tired of foot pus. However, during discussions they found another local doc or two (and their associates) who were willing to do it without pay. Boom, no pay to take call. The hospital does directly pay the podiatrists medicare rates if the patient is unfunded or medicaid. But that's it.

No way I am taking free call for the hospital, even at $400/night.

I would gladly take call for $400 a day. But I can count on one hand the number of times I've actually had to go in after normal business hours to see a consult. Even at night, hospitalist admits and I see it the next day. But if I was at a larger hospital where the calls were more regular or patients were sicker or I was expected to come in any time the ED had a diabetic foot infection then yeah, $400 wouldn't be worth it.

 

[Pronation]

Cliff notes: If you work for another podiatrist, you will get screwed.

 

[DYK343]

I get paid to take call and I get paid well. I go in after hours and middle of the night.

General surgery and ortho love having us take call with them. They dont want anything to do with the foot around here. They are a large part of why we get paid to take call.

 

[DYK343]

This is what should be done but isn't. So in reality nobody is getting paid for call because they can always find a DPM or two willing to do it for free. Though I will say, I bet a majority of hospitals would just have ortho or gen surg cover foot stuff (who they are already paying to take call), before they start giving money to podiatrists. Especially because very few patients will actually require you to come in right away or that night. In residency one of our attendings was really close to getting paid to take call, it was a large hospital and ortho was sick and tired of foot pus. However, during discussions they found another local doc or two (and their associates) who were willing to do it without pay. Boom, no pay to take call. The hospital does directly pay the podiatrists medicare rates if the patient is unfunded or medicaid. But that's it.

In this situation I would let the other guys take call. Not worth waiting around for a set period of time if youre not getting paid to do so. Joke is on them/they are screwing themselves. I loathe my call week. its the worst week of the month. But I get paid well and I get a lot of cases/consults from it which just adds to the reimbursement.

My situation is not alone. I know other DPMs who take formal paid call.

If youre not getting paid dont go in.

 

[Steveington]

Sometimes it just takes asking. I was taking free call at a hospital and I let them know that I was going to stop taking call in 3 weeks, giving them time to find someone else if they wanted. I let them know that I could continue to take call, but would need to be paid for that time. At 2.5 weeks, we set up an agreement to pay me for call. It worked out nice for both parties

 

[air bud]

So I have decided to take unpaid call. I get all the foot/ankle stuff I want less ankle fx from my ortho partners when they are on call 20 days a month. I will choose when of the other 10 days I want to take call then will get everything. Otherwise I risk this potentially getting shipped out since they don't answer the phone when not on call. It's just me, two orthos in town. There are multiple larger reservations nearby and we have negotiated 250 percent of medicare so no way I am letting that stuff go, at least not right now when I am hungry. Just today I booked two TMAs and a revision TMA on IHS patients. The hospital is making me director of a wound care clinic and has upped the pay from 1k a month to 1800 a month for me to perform admin duties so they are saying that makes up for voluntary unpaid call. We can always go back and negotiate and decide to stop in the future but for now I just need to get my name out there and be available and be hungry.

Edit- I do have a friend that made about 60k last year taking call. Similar setup as me, rural him and a few orthos. He gets 400 a weekday and I think 800 a weekend day. It's pretty crazy but he is busy did about 6500 RVUs last year in a town of 15k. Also gets 55/65/70 RVUs per dollar at certain thresholds...

Speaking of which I know I get pessimistic on here, but I can think of 5 or6 friends I went to school with that are all making 350-500k a year. All graduated in top 10 percent of class, went to very good programs but jobs because of being studs not because of the name.or connections of their program. My co resident is working for an ortho group doing 20 cases a week, has his own surgical assist, operates 2.5 days a week...I am sure he is clearing 500 easy.

Edit 2 - yeah what dtrack said - my Hospital contract.iny other town includes 10 days of call (5 now that part time with them). I tried getting paid to take more but they told me to f off. I don't blame them since only got called in 2x in 3 years there.

 

[josebiwasabi]

i took unpaid call for a year and hated every day of it

 

[CutsWithFury]

I am hospital employed and I am not reimbursed for call. Ortho here gets some paid call but I don't. My base salary is above average for most hospital employed DPMs so I tend to tread lightly. I get ton of RVUs from all the crap from the ED and inpatient consults so it just adds to my bonus. Can't complain about that. It is a not a huge deal for me. I think it is very rare for private DPMs to get paid for call in metro areas as there is always another DPM willing to do it for free. In more rural areas it is a different story and your leverage to negotiate is stronger.

 

[heybrother]

I hope airbud's contract delivers as promised. I also hope the pieces don't become so intertwined that if you tell them I'm done it breaks other connections/things you worked for. I don't have any IHS experience but I feel like I was led to believe this can take a ...degree of dedication by the DPM.

Podiatry contracts have taught me you need a straight forward out.

I managed to wiggle out of taking call after bringing it back around why my partner doesn't. Because the only thing they called for was toenails. I give surgery patients and reasonable diabetic ulcer patients my phone number and I haven't regretted it yet.

Props to the 300-500k people, but I'm personally targeting the perfect 8-5 game. Focus on elective surgery. Talking with patients to offer more options. Affordable DME. A hard focus on practice overhead. Going after those things that eat 1% without you knowing it. Amusingly, 90% of the patients on my worst Medicare advantage plan were only on it because their former employer (school districts) put them on it. They all switched to a MA plan we have a 100% contract with. That combined with Covid resolving and the new E&M rules should already be lining this up to be a better year. I'm also finally having people ask for rearfoot surgery and I'm suddenly remembering that people who need rearfoot surgery are often fat.

If I accomplish what I hope to accomplish this year I need to pull the most necessary and important feat of all - making my MAs cut toenails. When dtrack first brought this up - I thought, why would I do that, I have the time. Now I know he was right and I am a fool. There's a potential lapidus waiting across the hallway and I'm in a room sweating, busting nails. My nurse should be busting nails and I should be booking a case.

Also, props to the 20 surgeries a week docs but jeez. I did a diabetic/rheumatoid/ulcer blowout case the other day. Gastroc/1st MPJ/pan met/hammertoe case the other day - 10 procedural total and I don't think any of it would have counted as unbundling. 3 hours non-stop and I was ready for a break. I have another almost identical one next week. I know everyone in residency had different variations of skin to skin, doing nothing, whatever, but when you make every decision it gets tiring.

 

[air bud]

I did run this by ortho partners and they support it. It's the right thing to do for the community and we can always play hardball if need to in the future. And again I will make a ton by making sure doesn't leave town. Ortho was asking CEO to pay me but they wouldn't budge at least now other than again increasing my admin salary for WCC. Anyways, yeah what Cutswith fury said, paid call in metro area NOT happening unless something crazy like Kaiser or negotiated as part of larger group.

 

[Scrantonicity]

I hope airbud's contract delivers as promised. I also hope the pieces don't become so intertwined that if you tell them I'm done it breaks other connections/things you worked for. I don't have any IHS experience but I feel like I was led to believe this can take a ...degree of dedication by the DPM.

Podiatry contracts have taught me you need a straight forward out.

I managed to wiggle out of taking call after bringing it back around why my partner doesn't. Because the only thing they called for was toenails. I give surgery patients and reasonable diabetic ulcer patients my phone number and I haven't regretted it yet.

Props to the 300-500k people, but I'm personally targeting the perfect 8-5 game. Focus on elective surgery. Talking with patients to offer more options. Affordable DME. A hard focus on practice overhead. Going after those things that eat 1% without you knowing it. Amusingly, 90% of the patients on my worst Medicare advantage plan were only on it because their former employer (school districts) put them on it. They all switched to a MA plan we have a 100% contract with. That combined with Covid resolving and the new E&M rules should already be lining this up to be a better year. I'm also finally having people ask for rearfoot surgery and I'm suddenly remembering that people who need rearfoot surgery are often fat.

If I accomplish what I hope to accomplish this year I need to pull the most necessary and important feat of all - making my MAs cut toenails. When dtrack first brought this up - I thought, why would I do that, I have the time. Now I know he was right and I am a fool. There's a potential lapidus waiting across the hallway and I'm in a room sweating, busting nails. My nurse should be busting nails and I should be booking a case.

Also, props to the 20 surgeries a week docs but jeez. I did a diabetic/rheumatoid/ulcer blowout case the other day. Gastroc/1st MPJ/pan met/hammertoe case the other day - 10 procedural total and I don't think any of it would have counted as unbundling. 3 hours non-stop and I was ready for a break. I have another almost identical one next week. I know everyone in residency had different variations of skin to skin, doing nothing, whatever, but when you make every decision it gets tiring.

I'm with you on the surgeries...not only is 20 surgeries a week a back-breaking task (maybe I'm just getting older, or I don't stand correctly, but 5-6 surgeries a week make my back hurt as it is)...what about all those post ops? I mean, if I had a nurse practitioner or a resident that could see all my post-ops and hear the complaints about swelling, maybe that would be OK. That must be how they do it? How do you have enough time to see them all, and work up new patients to keep the 20 surgeries/week going? And keep your sanity?

 

[GreenHousePub]

That's great to take call 20 days out of the month, do 50 surgeries a week, work 6am to 10pm everyday and make 500k.

But bear in mind how much of that you're gonna pay in alimony when your spouse finds someone else with a more reasonable schedule.

 

[dtrack22]

I'm with you on the surgeries...not only is 20 surgeries a week a back-breaking task (maybe I'm just getting older, or I don't stand correctly, but 5-6 surgeries a week make my back hurt as it is)

The back thing may be age...kidding. But 20 cases in a week is insanity. Even ortho here (rural so they are generalists who do everything from carpal tunnels to joints) doesn't do that many cases with 2 full days in the OR. I mean that's 3 full OR days, or 2 full OR days and add on cases almost daily, every week. You'd definitely need to have a PA or NP in the group to see post-ops because you could easily have 40-50 clinic appointments every week that are post-ops. Doesn't leave you much room for new patients or established patient visits. Hard to keep booking 20 cases (again, insanity and I would never do that even if I was able to) with all of those post-ops in your clinic. Unless you have horrible outcomes and are taking a lot of those people back for revisions...

I started my own clinic but have been approached by the local hospital to join their MSG in the ortho dept. I won't be compensated for call that I know of, but I'm only required to provide 10 days of coverage currently and don't see why that would change with employment if call isn't part of my compensation. And with it being rural, critical access, I can go a month without a single inpatient foot infection easily. There's only 25 beds and so they are routinely "full" and shipping stuff out to the bigger metro 30-40 miles away. So I don't mind for now, especially since the base salary is $305k with all of the benefits being on top of that number. I would take a couple hundred dollars per day for call since it really won't require me to actually do anything after hours. I'd be getting paid for the inconvenience of not making personal/family plans on call days, not for actually doing a significant amount of after-hours work.

 

[air bud]

I'd be getting paid for the inconvenience of not making personal/family plans on call days, not for actually doing a significant amount of after-hours work.

This is often the reality. I had three, yes three inpatients in 3 years in my Hospital gig. In my new position two hours away but a VERY different patient population I had three inpatients in my first 10 days. So if you are getting paid to not do stuff you want and wait by the phone then not worth it. But if you are getting paid and then getting procedures out of it then worth it.

 

[dtrack22]

In my new position two hours away but a VERY different patient population I had three inpatients in my first 10 days

That’s what happens when you live by the rez

 

[DYK343]

Once youre established you gotta argue for call pay.

Once you get established and the general surgeons, ortho, and ER docs love having you around they will argue on your behalf because no one likes sucking puss in the middle of the night and the ER wants someone reliable to answer the phone.

I wont sit around and wait by the phone for free. I understand all our situations are different. Youre still making $$$ but you should also be compensated for your time lost with your family, plans, vacation, holidays spent home, etc, etc.

 

[Feli]

I am hospital employed and I am not reimbursed for call. Ortho here gets some paid call but I don't. My base salary is above average for most hospital employed DPMs so I tend to tread lightly. I get ton of RVUs from all the crap from the ED and inpatient consults so it just adds to my bonus. Can't complain about that. It is a not a huge deal for me. I think it is very rare for private DPMs to get paid for call in metro areas as there is always another DPM willing to do it for free. In more rural areas it is a different story and your leverage to negotiate is stronger.

Yes, this has always been my experience. ^^

The hospital-employed docs won't get paid for call in general (just rolled into salary... gets RVUs if you're lucky). PP in metro probably won't be offered paid call (local residency program, hosp employed docs, or PP podiatrist trying to grow will take call/consults for free or have it as a required part of their job). I agree that podiatry PP/MSG/ortho group in rural could try to get paid for it... might work, might not (probably depends if the hospital has employed docs already taking it).

For me (rural salary IHS), I'm on call as part of my salary, and I probably would have gotten less salary or no offer at all if I didn't want to take call. They end up sending me the lion's share of the trauma/RRA - whether I'm on call or not, it still mostly ends up splinted and f/u with me for eval and scheduling. The only difference with my being actually on-call is that I might have a couple to round on or might need to do I&D or TMA or whatever early/late for gas or abscess. The hospital is tiny and call is probably only 5% or 10% the difficulty (frequency/acuity) of being on call in a metro during residency or afterwards at medium/large hospitals and even trauma centers, though. I think I have more call weeks with no OR case than with one... still plenty of mtb or hikes or other stuff on the weekend without much worry. I tend to not react anymore when there is a call for a "really bad one" out rural... it's all relative I suppose. Personally, I would only ask for more $ for taking call if I found out they or a nearby facility had a DPM (non-admin) who wasn't taking call and made same/more salary or that doc opting out also put me on call more. It is just not a big concern, though.

The best advice for anyone who is hospital employee with on-call is to train the ER early and often to only to call you for stuff that needs real decision help on admit vs clinic or things that likely need OR surgery. Even 90% of their obvious DM infection admits can go upstairs on IV antibiotics and you can see those in the morning. If anyone goes in to ER for minimally displaced ankle fx or spider bites or BB/pellet/22 gun soft tissue injuries or met fractures or stuff like that, then that needs to get fixed asap to protect your sleep. I made that mistake early after residency to go greet and splint fractures to gain referrals, and it leads to a lot of wasted time and just more calls for minor nonsense (usually pts with crummy insurance payer if you're PP also). You have to be tactful, but tell them you are happy to help yet need your sleep/energy for office, you have many office patients waiting for the same complaints, and you can do a better job in the office since you have all of your tools/supplies... so just f/u those pts there. That can be tough sledding with a lot of ER midlevels who want to call for every infected ingrown or Charcot ("cellulitis"!) or gout or severe tinea or chronic DM ulcer or even ganglions and various clinic f/u stuff they legitimately believe to be borderline admits or "I was hoping you might want to just come in and do the procedure... it looks kinda bad" in urgent/minor ER at 11pm.

 

[ExperiencedDPM]

I'm with you on the surgeries...not only is 20 surgeries a week a back-breaking task (maybe I'm just getting older, or I don't stand correctly, but 5-6 surgeries a week make my back hurt as it is)...what about all those post ops? I mean, if I had a nurse practitioner or a resident that could see all my post-ops and hear the complaints about swelling, maybe that would be OK. That must be how they do it? How do you have enough time to see them all, and work up new patients to keep the 20 surgeries/week going? And keep your sanity?

Exactly

 

[Pronation]

That's great to take call 20 days out of the month, do 50 surgeries a week, work 6am to 10pm everyday and make 500k.

But bear in mind how much of that you're gonna pay in alimony when your spouse finds someone else with a more reasonable schedule.

So what you're saying is that it makes more economical sense to have 3-4 girlfriends at a time then?

 

[GreenHousePub]

So what you're saying is that it makes more economical sense to have 3-4 girlfriends at a time then?

As long as you aren't in a common law state