I tend to think that having peds and OB in one's practice would increase the chances of being called at home or late at night. Is there any truth to this?
How does FP call compare to general IM call?
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Call (regardless of specialty) after training is however the way you design it and it all depends on what you do and how you set it up.
The most straight forward in what I've seen is the pure outpatient practice that uses hospitalists with no OB. If you have 5 docs in your practice, you may be on telephone call for the group 1 in every 5 nights and/or 1 in every 5 weekends, for example. Or, you can design it where you take telephone call for your own patients every weeknight, but share weekend telephone call with your group. This is probably the same for your adult and pediatric population.
If you do inpatient and outpatient work, your group may decide that you cover your own call for your own inpatients from the hospital or you cover for the group. As far as hospital call for admissions, it depends on the ER call list that the hospital sets up. It would make sense that if you're going to be on ER call for admits for the hospital that you may as well set up telephone call for your group the same time you're on call for the hospital, but that just depends on how you're set up per above.
You can choose to set up call daily (i.e. q5 days/nights) or set up call weekly (i.e. q5 weeks for 1 week at a time).
Lastly, if you do outpatient, inpatient, and add in OB, it would depend on what you're arrangement is. Some places will set up where you take your own OB call/deliveries for your practice and you're in rotation of with the hospital for drop-in OB's. Some places have an arrangement where you use a Laborist to take your deliveries. Some places will rotate who does the inpatient work/deliveries.
So, from what I've seen, there's no answer to your question because it depends on how many doctors are in your practice , how many doctors in your practice do what you do, how many doctors are in rotation for the hospital, and how you set it up. It's very possible that you can have more/less call than an IM doc or more/less intense call than an IM doc.
The most straight forward in what I've seen is the pure outpatient practice that uses hospitalists with no OB. If you have 5 docs in your practice, you may be on telephone call for the group 1 in every 5 nights and/or 1 in every 5 weekends, for example. Or, you can design it where you take telephone call for your own patients every weeknight, but share weekend telephone call with your group. This is probably the same for your adult and pediatric population.
If you do inpatient and outpatient work, your group may decide that you cover your own call for your own inpatients from the hospital or you cover for the group. As far as hospital call for admissions, it depends on the ER call list that the hospital sets up. It would make sense that if you're going to be on ER call for admits for the hospital that you may as well set up telephone call for your group the same time you're on call for the hospital, but that just depends on how you're set up per above.
You can choose to set up call daily (i.e. q5 days/nights) or set up call weekly (i.e. q5 weeks for 1 week at a time).
Lastly, if you do outpatient, inpatient, and add in OB, it would depend on what you're arrangement is. Some places will set up where you take your own OB call/deliveries for your practice and you're in rotation of with the hospital for drop-in OB's. Some places have an arrangement where you use a Laborist to take your deliveries. Some places will rotate who does the inpatient work/deliveries.
So, from what I've seen, there's no answer to your question because it depends on how many doctors are in your practice , how many doctors in your practice do what you do, how many doctors are in rotation for the hospital, and how you set it up. It's very possible that you can have more/less call than an IM doc or more/less intense call than an IM doc.
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I'll share this. I work for a doctor in a family practice clinic and there is one other doctor. Neither one of them is ever on call because our local hospital utilizes hospitalists (who are paid by all the FP docs in town who wish to participate and do not wish to be called for their clinic patients being admitted to hospital) - the only catch is that you have to cover 2 weekends per year (rounds and call) in order to be eligible to participate.
In short, the FP docs do strictly outpatient and the hospitalists do strictly inpatient with the exception of the weekends covered by FP docs.
In short, the FP docs do strictly outpatient and the hospitalists do strictly inpatient with the exception of the weekends covered by FP docs.
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I would be interested in further information on the arrangement you describe. I suspect it is different then your understand as it sounds like a "Stark" violation that the FP/FM doctors are paying the hospitalists. The hospitalists would in theory be getting paid on their patients in the hospital. It may be possible that the hospitalists get a small stipend for call if no patients present, but once a patient presents, no stipend just direct billing.... But, even that sounds like it might be a little difficult. The general description you give reads a little too close to a ~kick-back system.
D
deleted87716
As lowbudget has said, there's no single answer, as there are a million variations depending on practice type and individual preferences.
Suffice it to say that most insurers and hospitals will require you to provide after-hours coverage of some kind, regardless of whether or not you admit patients to the hospital. You can't just have your answering service direct everyone to the ER. That's bad medicine, anyway. Some physicians use nurse-based triage services or midlevels as front ends, some take call themselves. There's lots of variability.
As for call frequency and volume, this has far more to do with the individual practice styles of the physicians in the call group and the size of the call group itself than whether a doctor is IM, peds, or FP.
The more accessible you are during office hours, and the better job you do educating your patients on what to expect and what to do, the fewer calls you'll get after hours.
Suffice it to say that most insurers and hospitals will require you to provide after-hours coverage of some kind, regardless of whether or not you admit patients to the hospital. You can't just have your answering service direct everyone to the ER. That's bad medicine, anyway. Some physicians use nurse-based triage services or midlevels as front ends, some take call themselves. There's lots of variability.
As for call frequency and volume, this has far more to do with the individual practice styles of the physicians in the call group and the size of the call group itself than whether a doctor is IM, peds, or FP.
The more accessible you are during office hours, and the better job you do educating your patients on what to expect and what to do, the fewer calls you'll get after hours.
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Sorry Jack - realized what I typed after the fact - the hospitalists are paid by the hospital, but to participate and have them take care of your patients in the hospital requires you take call 2 weekends out of the year.
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This is a very good practice pearl to remember. Giving people directions on when to let things ride, when to call you and when to just come in takes 2-3 minutes after each visit, but will save you a 15 minute phone call on the back end.
Having secure email capabilities through your EMR helps communicating lab results and answering simple medical questions and reduces your time playing phone tag.
For the time being, you'll notice that outpatient practice & communication technologies are way ahead of inpatient technologies. In the age of texting, it still boggles my mind why hospitals still use the 15 minute delaying pager system.
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How comfortable are FPs allowing midlevels to take after hours call? What about after hours admits? In the rural area in which I am located I have noticed that some FPs have the NP also handle after-hours admits.
Which brings me to question 2. If you have a mid-level working in your office, do they have their own "patients"? In other words, at the 5 person practice I shadowed at as an undergrad and will rotate through as part of a rural med feeder program, I noticed that the 5 physicians maintained their own patient lists (each person had one day of the week M-F off and took call one day per week and rotated the weekends). The NP would see patients who came in off Dr. X's list if it fell on Dr. X's day off. Is this at all common?
Which brings me to question 2. If you have a mid-level working in your office, do they have their own "patients"? In other words, at the 5 person practice I shadowed at as an undergrad and will rotate through as part of a rural med feeder program, I noticed that the 5 physicians maintained their own patient lists (each person had one day of the week M-F off and took call one day per week and rotated the weekends). The NP would see patients who came in off Dr. X's list if it fell on Dr. X's day off. Is this at all common?
D
deleted87716
Again, lots of variability. I don't work with midlevels, although some of the offices in our group have them. AFAIK, none of them have their midlevels take call or do admissions. Most of the midlevels have their own patients in addition to doing acute care for the other docs in their office.
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It depends on your skills, their skills, mutual trust (& your guts and ability to hold them accountable), and ability to communicate. I imagine the relationship will evolves with time where your level of comfort today may be different from 5-10 years of working together.
You can use midlevels however the way you want and think is appropriate, if you're the boss. One practice used midlevels for phone triage and after-hour calls, another used midlevels for "walk-ins" or "acutes". Others, like you said, will use them as x-covers. Others will use them for home visits.
I don't know any traditional inpatient-outpatient docs who use midlevels for admissions, personally; but I do know of a FM/IM hospitalist group in my hospital that uses NP's & PA's to "pre-round" & write notes.
You can use midlevels however you want for the time being if you're the one who hired them & supervise them... and I guess that's what their beef is. That they don't want to be "used" but instead want to be independent.
