My group now covers 5 hospitals and has peripheral coverage relationships with 2 more. That's a lot of shifts every day and the odds that someone is sick or otherwise can't show up have gotten too high. Long story short we've had to adopt an on call system. We take money out of our fee for service pool and pay the docs who are on call a daily fee that they get if they are called in or not. It works out where if you take about 1 call a month you break even although you do have the coverage responsibility. For many of us the absence of call in EM was one of the attractions. But I now know of lots of EM groups that have some form of on call responsibility. How many others have jobs or are looking at jobs with call?