On call

[what2do]

I was wondering if someone could be kind enough to explain how being on call works in family practice....who takes the calls when the patients are far away or when you're in clinic etc. I guess I don't understand the basis of why there is call in family practice. Also, is this the difficulty in being able to start your own practice or is it the low HMO payment that you need to join a group?

thanx

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[PACtoDOC]

Let me give you a clear answer that might help you to understand why you need call in FM. First of all, insurace companies require nowadays when you sign contracts with them that their patients will have access to you 24/7, even if that means by phone. So to get around this requirment, most physicians are forced to hire an answering service that takes and screens the after hours calls. Now I know you would think that there are not a lot of after hours calls, but there are. People put their trust in their FP more so probably than any other doctor. They want to ask them anything and everything that they may think cannot wait until the next office day. I have shared call in my previous family practice rarely before coming to medical school (I am a PA). It is truly a miserable experience. We had a total of 6 providers, 3 docs and 3 PA's. The PA's would occassionally take a call day for the doc to be kind and give them a break. This is perfectly legal as well. I can recall sitting on the tee on the golf course and having my cell phone repeatedly ringing from the service. People mostly call with illness that can't wait until tomorrow, or they don't think is quite serious enough to go to the ER. Then they call for refills that they just realized they are out of. You would be amazed the things you get called for. I think in my future practice I have decided to produce a small paperback brochure/book that stipulates all the major office policies. If you train your patients wll in the beginning, you can avoid the nightmare of the after hour call. Otherwise, you will be abused and NEVER get a full night sleep when you are on call. Also, in our practice, whatever doc was the on call doc was the one who saw all hospital patients in the evening and on weekends. So, it is a significant burden that you cannot avoid. Your best bet is to find another FP or IM doc in the area to share call with you. That works very well.

 

[what2do]

"whatever doc was the on call doc was the one who saw all hospital patients in the evening and on weekends. "

can you explain this in more detail plz? is this what a hospitalist would do?

Also, are you getting paid anything extra besides the office visits for being on call?? So I'm guessing this is why FP doctors cannot have their own practice like in the old days...


are specialists required to be reachable 24/7 as well?

 

[JustD0it]

bump

 

[PACtoDOC]

From what I saw, you generally make about 50% more per visit in the hospital setting than in the outpatient setting, so you are not working for free when you see these patients. Hospitalists are only used if you want to turf your patients to someone else for inpatient needs. Many FP's no longer do inpatient stuff and just send their patients to the ER after hours. If they get admitted then they are followed by a hospitalist. Some HMO's require patients to be seen by their contracted hospitalist and in those cases you don't have to take care of the patient's needs when they get admitted. But in an average sized city or town, many FP docs still choose to admit and care for their patients which means it is more feasible to share call to avoid being potentially woken up every night for something. That way you are guaranteed more nights of sleep than nights of call if you spread the burded around. Hope that helps.

Matt