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On Call in EM?

Discussion in 'Emergency Medicine' started by docB, Nov 30, 2008.

  1. docB

    docB Chronically painful
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    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?
     
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  2. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner
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    I know Apollyon's group takes call.
    Unless all the groups in the area had it, it would be a rather largish negative for me.
     
  3. Jarabacoa

    Jarabacoa non carborundum ilegitemi
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    I'm on call from 3-4 days a month. I get paid 20 dollars an hour to be on call. It is only from the hours of 12 noon to 8 PM. So, last month, I I got paid 20 bucks an hour to sit at home and be available. I got called in for 1.5 hours one day. We are a small group, with single coverage, and the call system is to provide a buffer for those occasional moments when the poop hits the fan. The one time I've activated the on-call system, was when I was standing at the head of the bed, about to intubate a bacterial meningitis/status epilepticus patient, had a colles fracture to sedate and reduce in the next room, was in the middle of working up 5 other patients, and had 5 in the waiting room. This doesn't sound like much, but our administration and our director have a goal of keeping the wait time to see the doctor (after triage and nursing assesment) to around 30 minutes. Yes, our patients don't know how good they have it.

    Call days are Tuesday through Friday only, as we have mid-level coverage from 12-8 (0r 10) on Saturday through Sunday.
     
  4. dchristismi

    dchristismi Gin and Tonic
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    My group does not have a call system. My best girlfriend from residency joined a group that does.
     
  5. WilcoWorld

    WilcoWorld Senior Member
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    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.
     
  6. Apollyon

    Apollyon Screw the GST
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    Our group has ~50 docs, covers 4 hospitals, and we take 1 call a month (the FPs that do fast track are not in the call pool). It's not paid unless you get called in. It's for sick call from 7a-7a the next day, and overload from 11a-2400. I haven't been called in in months, and, for sick call, no one has ever been called in, in the morning, for "I can't come in today". For people with an emergent problem, there's always been a volunteer to work the balance of the shift, without having to resort to the call person. This is likewise true for when a schedule hole opens, and we need to poll for people who can work.
     
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  7. beriberi

    beriberi Senior Member
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    I am in a 10-15 doc group (with another 5-10 docs that are privledged but do not work regularly at our hospital) and no call. I honestly would be happier with some kind of system --as it is, the secretary starts calling when somebody can't come it. It is rare, but happens. A few times we have had to go from 9 hour shifts with 1 hour overlap to 10 hour, no overlap (which are really like 11-12hour shifts). It screws things up a lot more than you think.

    Call sucks, but you need to have a system of some kind in place. And once/month sick call is nothing compared to being in a different specialty and being "on call".
     
  8. Hallm_7

    Hallm_7 Senior Member
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    It sounds like all groups have "call." Some have "call" and have an organized, systematic way of distributing it. Other groups deny they have "call" and either have unsuspecting and unscheduled guys come in or have current staffing pull a few extra hours. I'd choose the group that has the organization and system in place to guarentee fair and equitable distribution of these shifts.
     
  9. Koko

    Koko Koko
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    Currently job searching after completing multiple interviews. My two top choices both have a call system, and I am fine with that. As others have stated, it seems like a better alternative than scrambling when someone can't do their shift.

    One place has PAs doing swing shifts to cover the bulk of the days of the year, so the rest of the group of MDs just have 4 days/year to be on call for a 12 hour period.
     
    #9 Koko, Dec 3, 2008
    Last edited: Dec 3, 2008
  10. OP
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    docB

    docB Chronically painful
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    This is a pretty interesting thread in that one of the reasons many people cite for going into EM is "no call." Seems like that may be a myth. I do acknowledge that there's a difference between being on call to cover sick outs or overflow as opposed to answering patient calls all night long.

    I'd also echo Hallm_7's point that everyone has to have some form of call whether it's formal or informal because there will always be some sick calls and emergencies. Before we had our present call system we had to scramble and it was usually the directors who had to cover which was a pain.
     
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  11. spyderdoc

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    We have 14 docs in our group. We don't have call per se, but if someone is sick, they will go down the roster. The one that goes in gets a $500 stipend for good measure. If the director has to cover the shift, he gets $1000....Luckily, only rarely has anyone had to use the call system....
     
  12. The White Coat Investor

    The White Coat Investor Practicing Doc and Blogger
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    We have "Back-up" shifts in case a doc goes down. You cover all 5 shifts that start in that 24 hour period if one of those docs can't work. That doc then owes you a shift to be paid back at an unspecified later date. I've been called once or twice in 2 years and I used it once (wife in labor.) It's not that bad if the call-ins are infrequent. Sounds like you get called in more. Any reason you decided to pay each other to be on call instead of just dividing it up evenly?
     
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  13. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner
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    The more I think about it, the more a set standard system makes sense. The guy who writes fingers and tubes in every orifice once made a point about how his holiday season sucked because he would be called the the director because someone would "have a flight cancelled". Because he would be in town, and "dependable", he would get called in. And yes, being the dependable one sucks, just ask everyone in residency.
    So I would rather have set days that suck than an entire vacation. I would rather have someone else cover the call though. Aren't there residents out there moonlighting that could cover them?
     
  14. roja

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    I definitely went in because of no 'call'. Of course, when I thought call, I flashed to what that meant for all those other unlucky services: taking calls all night on patients, admissions, etc. I didn't equate it with 'sick call' or 'back up'.

    I don't mind a sick call/back up policy. people get sick, things happen. The ED goes on. Somehow we have to keep the ED staffed. In nyc, we had randomly assigned sick call days. about 4-5 a year. You just had to be available if someone came in. (no payback, payed per diem rate if you were called in). It was rarely abused.

    Where I am now, we have someone who is the 'call' person, for a month. If someone calls in, that person just gets on the horn adn starts calling people. Apparently its not difficult to get people to cover it. You get double shift credit payed back. So, I got called in for an extra 4 hours and was credited 8 hours.
     
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  15. WilcoWorld

    WilcoWorld Senior Member
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    I agree with your sentiments on the difference between "real" call & sick call. I also agree (obviously, from my earlier post) that a sick call is needed.

    However, I would prefer not to do it the way your current group does call. That's how we did it at my residency, and as McNinja pointed out - when there is some volunteerism involved, the responsible / considerate end up bearing a disproportionate amount of the weight. Plus, that whole month of call suuuuuuuucks.
     
  16. roja

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    Yeah, I think it is wierd as well. But apparantly it has been like that for a long time. And because of the fact that you get 'double credit', basically the shift paid back plus an extra shift credit, it doesn't take long to get one covered. As the 'call' person, you don't come in. You just get on the phone and find someone to cover it.
     
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  17. Midwest Medic

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    Our group covers 2 hospitals and has 15 physicians in it. Right now we do not have a call system, but are contemplating how to set one up. Our first model would be a call person who would get $100 a day for being on call, and be called in between 10a-10p when the waiting room gets to X number of people or X time. As for sick call, when one can not get to work, we just start calling down the roster. Most of the people in our group are amazing, and we cover for each other very well. Guess I got lucky in that sense.
     
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