Taking call

[BoardingDoc]

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Do you guys take call for your patients? At my program, we have a system where patients can page the on call fellow if they have "urgent after hours issues." 9 times out of 10 this is some utterly inane question or an issue which could clearly wait until normal business hours.

Once in a blue moon it's a real problem (generally with someone who has a pump) and so I see the value in having someone on call, but the 90%+ nonsense rate makes it obviously unpalatable.

Just wondering what people out in practice are doing.

 

[geauxg8rs]

Do you guys take call for your patients? At my program, we have a system where patients can page the on call fellow if they have "urgent after hours issues." 9 times out of 10 this is some utterly inane question or an issue which could clearly wait until normal business hours.

Once in a blue moon it's a real problem (generally with someone who has a pump) and so I see the value in having someone on call, but the 90%+ nonsense rate makes it obviously unpalatable.

Just wondering what people out in practice are doing.

Just say no
To pumps

 

[callmeanesthesia]

Not doing pumps and not doing med management I’m sure helps cut down on the BS. We have an answering service after hours. If my patient calls, the answering service calls me. I get called maybe twice a month? Usually post-injection flare of pain. Still certainly some BS calls. Patient last seen 6 months ago who calls at 2 am because their pain is so bad they can’t sleep. “Go to the ER for evaluation to make sure it’s not an emergency. I can’t promise they’ll fix it or give you narcotics but they can make sure you don’t need emergency surgery. Call my office during normal business hours and make a follow up.”

 

[SSdoc33]

No call

 

[BoardingDoc]

Just say no
To pumps

Oh, to be clear, I am never touching another damn pump again starting July 1st.

 

[paindoc007]

No call. Doesn’t make sense for our speciality.

 

[Laryngospasm]

As bob marley said no pumps and med management no cry.. (and minimal calls )

 

[giddyup]

4 interventional pain plus 2 general PM&R at my practice which is large private neurosurg group. we take call for interventional pain patients. 3 calls a month supposedly. just joined 6 mos ago and my first call month is june so we will see

 

[OM1027]

Do you guys take call for your patients? At my program, we have a system where patients can page the on call fellow if they have "urgent after hours issues." 9 times out of 10 this is some utterly inane question or an issue which could clearly wait until normal business hours.

Once in a blue moon it's a real problem (generally with someone who has a pump) and so I see the value in having someone on call, but the 90%+ nonsense rate makes it obviously unpalatable.

Just wondering what people out in practice are doing.

When I first started my practice, I had the same question, as I do not use a call service. I reached out to my malpractice carrier, and their risk management consultant sent me the following email:


"Thank you for calling the risk management helpline today for guidance related to on-call requirements of physician offices. There is no federal law requiring physician offices to provide on-call services. The Emergency Medical Treatment and Labor Act (EMTALA) applies to hospitals only which often have on-call requirements for physicians with privileges at a facility. If you do have privileges at a hospital, your on-call responsibility should be in the by-laws.

In review of the the medical practice acts for any state requirements, it too says that there is no requirement for physician offices to provide on-call services and that doctors can choose whether or not to offer after-hours call coverage for their office.

If your practice will not have on-call coverage, it’s important to clearly communicate that to all patients. Best practice is to ensure you have messages on your website, answering service, and within any patient agreements or consents, where to go for care after office hours. Many practices will simply state, “If you are having an after-hours emergency, hang up and call 911”, or a similar message.

Please let me know if you have any further questions or concerns."

 

[Laryngospasm]

I personally communicate any potential complications and symptoms that are rare and catastrophic and tell patients how to handle them. Because believe it or not something as simple and easily explained as an epidural hematoma can be missed by non pain people.

 

[kstarm]

We have a group of 5 interventionalist. We take about 10-12 weeks of call per year. The call is strictly for interventional procedure complications which though I don't like, it does seem reasonable that we would cover issues related to our procedures. I maybe get 1-2 calls per year. It is about the easiest call anyone could ask for and I still hate it. If you are able to get set up without call that is by far the best in my opinion.

 

[DODOCSS]

I'm a fellow as well and thankfully we don't have too many pumps. I'd say I average when on call, I get about 1 call every 3 days, and call my attending almost never. 98% are pain exacerbations (post-procedural or otherwise). I make sure to warn every patient prior to procedure that 'the numbing can wear off before the steroids kick in so can get worse before it gets better." But a newly placed pump in an admitted end-stage cancer patient will inevitably lead to middle of the night pages.

One thing I've found when going to industry sponsored cadaver labs, talks, etc is that there are variable definitions of 'on call.' For example, had a couple really successful private practice guys tell us that they have great jobs with no call, nights, or weekends. But later when asked about what happens if there's a procedural complication or patient issue, "well, the ER knows how to get a hold of me if they need to..." or some variation on that. So basically they're always on call and don't realize it.

Personally, I would love to never be on call. Professionally, I see the value of being on call particularly as proceduralists, even if we can't fix the problems we cause. But I remember as an ER doc seeing a patient with a cellulitis around their year-old SCS leads (never having seen any SCS patients in residency since it wasn't done in our area) and being super frustrated unable to reach the pain doc to ask if I can leave it in and prescribe abx, pull the leads, or if have to transfer to tertiary care (who was refusing since it wasn't their patient).

ok sprite

 

[bear2020]

I'm a fellow as well and thankfully we don't have too many pumps. I'd say I average when on call, I get about 1 call every 3 days, and call my attending almost never. 98% are pain exacerbations (post-procedural or otherwise). I make sure to warn every patient prior to procedure that 'the numbing can wear off before the steroids kick in so can get worse before it gets better." But a newly placed pump in an admitted end-stage cancer patient will inevitably lead to middle of the night pages.

One thing I've found when going to industry sponsored cadaver labs, talks, etc is that there are variable definitions of 'on call.' For example, had a couple really successful private practice guys tell us that they have great jobs with no call, nights, or weekends. But later when asked about what happens if there's a procedural complication or patient issue, "well, the ER knows how to get a hold of me if they need to..." or some variation on that. So basically they're always on call and don't realize it.

Personally, I would love to never be on call. Professionally, I see the value of being on call particularly as proceduralists, even if we can't fix the problems we cause. But I remember as an ER doc seeing a patient with a cellulitis around their year-old SCS leads (never having seen any SCS patients in residency since it wasn't done in our area) and he since it wasn't their patient).

If you do implants then call may make sense. If not then no. This is a neurosurgery consult at our hospital not a pain doc consult.

 

[paindoc007]

But later when asked about what happens if there's a procedural complication or patient issue, "well, the ER knows how to get a hold of me if they need to..." or some variation on that. So basically they're always on call and don't realize it.

Uhh, no..
That’s technically the situation for me. If there’s some emergent issue on a patient of mine an ED doc can reach out to me if necessary.
That’s happened one time since I started in 2017. That is NOT call.

 

[Ronin1]

Call to me is having to go in to the hospital. Like many pain docs I’m always on call via an answering service but rarely called and never go in. I get my partner to cover my calls if I’m out of the country otherwise I deal with it. I took a call yesterday on a post intercept patient for instance from 1000 miles away. Maybe 1 call a month

 

[TIVAndy]

the ones that make you angry are the ones that forgot to follow up and need a med refill. on a weekend. my mid levels take those.