Call pay

[HighPriest]

For those of you out there getting paid for call:

If you’re willing to divulge, how much are you being offered? Is it per night, for excess call only, or “activation” call?

I’m just trying to get a general consensus. Happy to field PMs if you prefer.

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[Wordead]

1000/night flat. In case you weren't aware the AAO had a survey recently and I think they released the results. I didn't realize how many people were taking unpaid call (ridiculous).

 

[HighPriest]

Yeah, I’ve seen it. It’s very common for people not to get paid for call. I’m just always curious how my deal stacks up and I didn’t see that in the report. Could have missed it.

 

[ThoracicGuy]

 

[HighPriest]

View attachment 393159

Yeah, but like, just a little, man.

 

[ThoracicGuy]

Yeah, but like, just a little, man.

So it's like just a tip?

 

[HighPriest]

So it's like just a tip?

For a job well done

 

[Wordead]

View attachment 393159

I don't really understand how thoracic surgeons wouldn't get paid for call. They need you for trauma and all the inpatient nonsense. I guess it's harder for you guys to F off to a surgery center and do mostly outpatient. That's what a lot of private practice ENTs do these days, but a lot of our surgeries are outpatient so we don't necessarily need admitting privileges.

 

[HighPriest]

I don't really understand how thoracic surgeons wouldn't get paid for call. They need you for trauma and all the inpatient nonsense. I guess it's harder for you guys to F off to a surgery center and do mostly outpatient. That's what a lot of private practice ENTs do these days, but a lot of our surgeries are outpatient so we don't necessarily need admitting privileges.

Our general surgeons and ortho guys get call pay. Our GI docs get call pay. Or urologists and podiatrists get call pay.

Honestly? This is an issue with the system taking advantage of the fact that we have all just taken call in the past for nothing but what we bill (assuming we get paid for that at all). It’s antiquated. It’s a different system today than it was when physicians had 100% anonymity and better pay.

Your time is worth something. You should charge for it if you can.

They can say “what about the patient” until they’re blue in the face and the answer is: I do everything I possibly can for the patient. But not for free. Unless I’m getting a tax write off for my time, or working pro bono for a charity. The hospital sure as $&@t isn’t providing free care. If you want someone sitting by the phone all night and all weekend, that takes time out of their life and that time has a price.

If you’re salaried? Sure. You get paid for a year of work. But you should negotiate your call burden in to that if you can.

 

[operaman]

I’m employed so a certain amount of call is baked in to my contract. They tried to make call a condition of OR privileges awhile back before I got here, but literally every ent in town gave up their privileges so the hospital backed down. So now it’s just us employed folks.

Additional days are $900 per 24h I believe, plus wRVU billings. That’s a level 1 trauma center, biggest shop in town, but just ent call, no facial trauma. Hospitalist admits everything, and there’s an in house airway team. I probably go in on call overnight 2-3 times a year.

Even so, there’s no reasonable amount of money that would make me take more call. I’d even be happy to forfeit some salary to take no call at all.

 

[Pir8DeacDoc]

1000/night flat. In case you weren't aware the AAO had a survey recently and I think they released the results. I didn't realize how many people were taking unpaid call (ridiculous).

In theory I don't get paid for call. I'm told by administration that the survey data they use to calculate my pay incorporates that into the final number. Though I am skeptical of that.
I'm not sure I've ever be paid for call in other situations either. They claim it's required to be on the medical staff- so I and my partners accepted that. luckily I've always practiced in low on call volume centers so it's been a pain but not overbearing.

 

[GreenHousePub]

podiatrists get call pay.

They can say “what about the patient” until they’re blue in the face and the answer is: I do everything I possibly can for the patient. But not for free.

Not at my hospital. Which is why I flat out refused.

Your response is exactly what I said as well. The calls stopped coming.

 

[HighPriest]

I mean, is that a good thing or a bad thing?

I’m not saying that all hospitals are doing this. I’m saying that as time goes on they’re going to have to if they want to compete with the places that do.

They can write it in to base pay if you’re an employee. That’s fine. But then make sure that’s reflected in how you stack up based upon MGMA.

There are so many things you’re going to miss in life because you’re on call, even if it isn’t a busy call. It’s ludicrous to say that’s just a pill you swallow for nothing. It made some sense 30 years ago when everyone made more and had respect and autonomy.

 

[Pir8DeacDoc]

I mean, is that a good thing or a bad thing?

I’m not saying that all hospitals are doing this. I’m saying that as time goes on they’re going to have to if they want to compete with the places that do.

They can write it in to base pay if you’re an employee. That’s fine. But then make sure that’s reflected in how you stack up based upon MGMA.

There are so many things you’re going to miss in life because you’re on call, even if it isn’t a busy call. It’s ludicrous to say that’s just a pill you swallow for nothing. It made some sense 30 years ago when everyone made more and had respect and autonomy.

I can't recall if you're employed or PP. I've done both. If employed, how do you account for on call in your pay scheme? If private, did you have to negotiate for call pay or did they offer?

I see a lot of the call pay stuff based on people that might live in bigger areas with more hospital options. I've always mostly practiced in pseudo-rural areas. If you have a practice in a certain area and there is only one hospital and possibly one surgery center (that requires admitting privileges at a hospital to be on staff), what exact leverage do you have? You could threaten to take your cases and drive 45 minutes away to the next facility, but who wants to do that long term? I hate being on call, especially while we wait for a new doc coming in July. But in rural areas they somewhat have us over a barrel. Thoughts?

 

[Wordead]

I can't recall if you're employed or PP. I've done both. If employed, how do you account for on call in your pay scheme? If private, did you have to negotiate for call pay or did they offer?

I see a lot of the call pay stuff based on people that might live in bigger areas with more hospital options. I've always mostly practiced in pseudo-rural areas. If you have a practice in a certain area and there is only one hospital and possibly one surgery center (that requires admitting privileges at a hospital to be on staff), what exact leverage do you have? You could threaten to take your cases and drive 45 minutes away to the next facility, but who wants to do that long term? I hate being on call, especially while we wait for a new doc coming in July. But in rural areas they somewhat have us over a barrel. Thoughts?

But if you're rural, how many ENTs are in your area? How many taking call? It doesn't sound like they could easily replace you. Are there other private practice surgical subspecialists in your area that would be willing to go in on a surgery center?

I've had conversations with rural ENTs - one guy said he was the only ENT for a 50-100 mile radius and was getting squeezed by UHC on reimbursement. I didn't really understand - just drop the insurance and make the patients drive and tell them why. I don't know your situation, but do you have more leverage than you think? Also if you pull out, are all the other ENTs in the call pool going to just take more frequent call? If everyone drops at once -> hospital is screwed -> you will get call pay.

Just my 2 cents.

 

[Pir8DeacDoc]

But if you're rural, how many ENTs are in your area? How many taking call? It doesn't sound like they could easily replace you. Are there other private practice surgical subspecialists in your area that would be willing to go in on a surgery center?

I've had conversations with rural ENTs - one guy said he was the only ENT for a 50-100 mile radius and was getting squeezed by UHC on reimbursement. I didn't really understand - just drop the insurance and make the patients drive and tell them why. I don't know your situation, but do you have more leverage than you think? Also if you pull out, are all the other ENTs in the call pool going to just take more frequent call? If everyone drops at once -> hospital is screwed -> you will get call pay.

Just my 2 cents.

Couple of thoughts.

- I previously worked in a place with one surgery center and one hospital for about 40 minutes in any direction. To be on staff at the surgery center you had to have admitting privileges at a hospital. And the hospital required all medical staff with admitting privileges to take call. I also couldn't imagine doing surgery and not having a place for patients if they have a complication (hematoma, tonsil bleed, etc). So we felt like we were over a barrel.

- Now I am in an employed position and the hospital uses survey data which apparently takes into account total compensation (i.e. uses call pay to make a determination on our wRVU pay). They have been kind enough to get a locums one weekend a month until we get our new doc in July.

Apparently there are a lot of places so happy to have your business that they aren't strict on call. But for me, I've been in places where they make damn sure the ER has coverage and they tie in our call responsibilities to our medical staff/admitting privileges.

 

[operaman]

When they tried to make call a condition of privileges here before they had docs employed, there was mass revolt immediately with all the docs terminating their privileges. We have limited hospitals here but enough that docs have some options. Plus our demand is so insane that everyone just referred out anything that couldn’t be done in office or in a simple surgery center. I think the call policy only lasted a few weeks.

 

[Wordead]

Couple of thoughts.

- I previously worked in a place with one surgery center and one hospital for about 40 minutes in any direction. To be on staff at the surgery center you had to have admitting privileges at a hospital. And the hospital required all medical staff with admitting privileges to take call. I also couldn't imagine doing surgery and not having a place for patients if they have a complication (hematoma, tonsil bleed, etc). So we felt like we were over a barrel.

- Now I am in an employed position and the hospital uses survey data which apparently takes into account total compensation (i.e. uses call pay to make a determination on our wRVU pay). They have been kind enough to get a locums one weekend a month until we get our new doc in July.

Apparently there are a lot of places so happy to have your business that they aren't strict on call. But for me, I've been in places where they make damn sure the ER has coverage and they tie in our call responsibilities to our medical staff/admitting privileges.

If you're employed and already have a contract I think there's not much you can do unfortunately unless you re-negotiate contract or are willing to walk away.

In my area, there are several non-hospital associated surgery centers. One is a partnership of private practice docs - ortho, uro, ent, podiatry, ophtho. I think there is a sense of "we need to not be gobbled up by the hospitals" and they support each other to keep the ASC viable and thus none of them are forced to take ER call. If you ever leave the employed position it's something you could look into - the OPPS arm of the academy I found to be a valuable resource for this.

Regarding the no place for complications - I get it, and it sucks feeling like you are dumping but if you have a couple bleeds/hematomas a year that end up in that hospital's ER and the on call ENT has to take care of it - oh well. I have to clean these up a few times a year on call and I don't think I ever resented the community guy for his complication ending up in my lap, I'm getting paid to do so.

 

[Lexicon0]

1000/night flat. In case you weren't aware the AAO had a survey recently and I think they released the results. I didn't realize how many people were taking unpaid call (ridiculous).

Do you happen to know where in the AAO survey (I think you're referring to the annual workforce survey) I could find any call compensation numbers? Or any other source for that matter? I'm looking to negotiate fair call pay and I'm having trouble finding any sources to back up requesting $1000/night.