I don't like being on call, but I do think we need to prepare for the unpredictability of life. If you have no call system & your relief doesn't show up after an overnight, then guess whose 10p-6a just turned into a 10p-4p?
As a resident, we had a call system. Where I'm an attending, we do not have a call system. I would like to change both.
Where I did residency, 3-4 residents were on call for the month. While on call you didn't necessarily have to work each and every shift that needed to get filled, but you were responsible for getting it filled. This pretty much blew, except that we got paid $70/hr when we did have to work extra, and that certainly softened the blow.
As an attending we have no back-up system. When I asked what would happen if someone forgot to show up, or got into a car accident on he way in, or got the flu, or a helicopter fell on someone...etc and I was met with silence. We have no real contingency plan. I think it's obvious that an ED needs one.
I think that a good solution is possible with 3 requirements:
1) Your group has at least 25-30 docs.
2) Calling in sick (or whatever) is sufficiently painful that people are strongly motivated not to abuse the system.
3) Getting called in is sufficiently compensated for your grumbling to be offset by the perks.
With >27 docs, no one doc will have to take call (which is a 24 hour call) more often than once every 4 weeks. You don't get bugged at home for BS. It's only if you need to come in, and once the overnight shift has arrived you can go to bed pretty much certain that you wont get called in.
If you work in a group where you are salaried, and you just have a certain # of shifts to work, then calling in could = paying 2 shifts back to whoever you called in (see #3). If you work in more of a "eat what you kill" set up, then when one gets called in he/she would get paid an extra hourly pay on top of productivity (see #3) and that comes out of the paycheck of whoever called in(see #2).
I think that this would be a fair system, which would provide for contingencies, and would minimize abuse.