Weekend Call Schedules

[NJWxMan]

I am exploring ways to replace an unpredictable weekend call system within a major medical center. My current responsibilities: ED commitments (2 or less normally) consults (varies) and inpatient (24 beds max). What are your weekend responsibilities? How many psychiatrists work on weekend?

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[Mass Effect]

Is this mandatory call that everyone must do or are they getting paid generously for doing it? I also need a little more on the consult front. There's a huge difference in workload between a call in which you may get 2 or 3 or 0 consults versus one where you get, on average, 10 - 20 consults.

 

[TexasPhysician]

What is call?

 

[nexus73]

At our hospital this would be 3 doctors as part of their regular 7 on 7 off schedule. In total we cover about 30-36 total patients a day so 10-12 patients each.

if this was covered by weekend moonlighters two doctors is adequate but I’d expect them to be getting paid a significant premium over the employed doctors.

 

[wolfvgang22]

Quit doing call by having social workers or NPs/PAs do the consults. Pay them for each consult so they like doing them. Train and supervise them and have them call you for advice on anything not straight forward. Anything not straightforward gets admitted and seen by a psychiatrist.

 

[NJWxMan]

Is this mandatory call that everyone must do or are they getting paid generously for doing it? I also need a little more on the consult front. There's a huge difference in workload between a call in which you may get 2 or 3 or 0 consults versus one where you get, on average, 10 - 20 consults.

Staff psychiatrist responsible for one weekend per quarter. Avg workload for 1 psychiatrist: 1-2 ED commitments, 14-20 inpt followups, 1-3 admission Evans, 1-4 hospital consults. Significant unpredictability and variability.

 

[Armadillos]

Staff psychiatrist responsible for one weekend per quarter. Avg workload for 1 psychiatrist: 1-2 ED commitments, 14-20 inpt followups, 1-3 admission Evans, 1-4 hospital consults. Significant unpredictability and variability.

Maybe outpatient has made me lazy in that I spend most my day with patients I already know, but potentially doing 6+ new consult/admissions on top of 20 followups of inpts Im seeing for the first time sounds like a really tiring Saturday.

 

[Mass Effect]

Staff psychiatrist responsible for one weekend per quarter. Avg workload for 1 psychiatrist: 1-2 ED commitments, 14-20 inpt followups, 1-3 admission Evans, 1-4 hospital consults. Significant unpredictability and variability.

That's a lot. Have you considered teaming up with a locums company and hiring a locums to do this?

 

[NJWxMan]

Maybe outpatient has made me lazy in that I spend most my day with patients I already know, but potentially doing 6+ new consult/admissions on top of 20 followups of inpts Im seeing for the first time sounds like a really tiring Saturday.

I'm an early career psychiatrist and have been at my job for over 5 years. I work hard and believe in providing excellent care. Our current system has made me loathe coming in for that quarterly weekend. We've had per diems quitting due to the excessive workload.

 

[NJWxMan]

That's a lot. Have you considered teaming up with a locums company and hiring a locums to do this?

We have 3-4 per diems that cover, buttoned recently quit. Admin thought it was a pay issue and simply increased hourly rate to $130. Ready for it? Didn't help one bit.

 

[psychapp121]

We have 3-4 per diems that cover, buttoned recently quit. Admin thought it was a pay issue and simply increased hourly rate to $130. Ready for it? Didn't help one bit.

130/hr? Isn’t that like very low? Lol..

 

[psychapp121]

Quit doing call by having social workers or NPs/PAs do the consults. Pay them for each consult so they like doing them. Train and supervise them and have them call you for advice on anything not straight forward. Anything not straightforward gets admitted and seen by a psychiatrist.

NPs don’t work weekend or take call dude..they complain if you give them an extra patient during the day let alone working nights or weekends

 

[Mass Effect]

We have 3-4 per diems that cover, buttoned recently quit. Admin thought it was a pay issue and simply increased hourly rate to $130. Ready for it? Didn't help one bit.

Are you kidding? That kind of weekend work is not going to attract anyone for less than $175 - 200/hr. Even PGY 3s will demand higher pay for that much moonlighting work. Much sweeter gigs out there for much more pay.

NPs don’t work weekend or take call dude..they complain if you give them an extra patient during the day let alone working nights or weekends

Tell that to the NP covering my hospital.

 

[calvnandhobbs68]

We have 3-4 per diems that cover, buttoned recently quit. Admin thought it was a pay issue and simply increased hourly rate to $130. Ready for it? Didn't help one bit.

Yeah 130 hahaha a resident probably wouldn’t even moonlight for that workload. Tell em to up it to 200 and see who bites.

 

[wolfvgang22]

NPs don’t work weekend or take call dude..they complain if you give them an extra patient during the day let alone working nights or weekends

So do I.

I'm done being overworked and underpaid. It took me five years as an attending to wake up to the fact that pleas to continue to "provide excellent care" was how hospitals played on my ego and compassion for patients to keep working me like a dog. I've done enough long nights with no sleep and weekends to last a lifetime. The world will keep turning when I'm gone, and it seems there is enough demand to avoid bad conditions. I don't give a s*** if some iron man doctor somewhere thinks I'm lazy, weak, or whatever. I'm confident I have helped a lot of people and continue to do my share for a fair price right now. Young doctors need to know this is the way.

 

[psychapp121]

So do I.

I'm done being overworked and underpaid. It took me five years as an attending to wake up to the fact that pleas to continue to "provide excellent care" was how hospitals played on my ego and compassion for patients to keep working me like a dog. I've done enough long nights with no sleep and weekends to last a lifetime. The world will keep turning when I'm gone, and it seems there is enough demand to avoid bad conditions. I don't give a s*** if some iron man doctor somewhere thinks I'm lazy, weak, or whatever. I'm confident I have helped a lot of people and continue to do my share for a fair price right now. Young doctors need to know this is the way.

I agree..the answer is not NPs..it is increasing pay to 200+/hr

 

[calvnandhobbs68]

Staff psychiatrist responsible for one weekend per quarter. Avg workload for 1 psychiatrist: 1-2 ED commitments, 14-20 inpt followups, 1-3 admission Evans, 1-4 hospital consults. Significant unpredictability and variability.

Forgot to add that if they give a bunch of **** for 200 an hour they’re absolutely making way more than that JUST off the inpatients (unless like half of them are uninsured). Even if someone bills for a 12 hour day, the hospital is making more than that off the facility fee alone. Not to mention the ED consults and hospital new consults.

 

[NJWxMan]

Thank you all for the feedback. The concern that I have is that many times, there's not enough time in a day to get all of the work done. Throwing more money at psychiatrists does only that: more money made but crappy care. 2 ED commitments, 14-20 inpt follow ups, 1-3 inpt evals, and 2-4 consults (and sometimes 1-3 consult follow ups). I'm recommending splitting pay between 2 psychiatrists: one does only inpt and the other does ED/consults. I'm also considering a float system in which a second psychiatrist comes in later in the day and completes only consults.

 

[psychapp121]

Thank you all for the feedback. The concern that I have is that many times, there's not enough time in a day to get all of the work done. Throwing more money at psychiatrists does only that: more money made but crappy care. 2 ED commitments, 14-20 inpt follow ups, 1-3 inpt evals, and 2-4 consults (and sometimes 1-3 consult follow ups). I'm recommending splitting pay between 2 psychiatrists: one does only inpt and the other does ED/consults. I'm also considering a float system in which a second psychiatrist comes in later in the day and completes only consults.

I mean for that amount of work if it was on the weekend including call at night it should be around 6k I would imagine for the weekend or more...are you paying 130/hr for 48 hours? Or 130/hr until they finish their work so that would be like a 10 hour day so 1300 bucks per weekend day? If it’s 1300 that’s horrible lol

 

[NJWxMan]

I mean for that amount of work if it was on the weekend including call at night it should be around 6k I would imagine for the weekend or more...are you paying 130/hr for 48 hours? Or 130/hr until they finish their work so that would be like a 10 hour day so 1300 bucks per weekend day? If it’s 1300 that’s horrible lol

10 hr day. Walk away with $1300 for the day for per diems. As a staff psychiatrist, I cover 48 hours of light phone call, but no pay since it's part of our contractual work.

 

[psychapp121]

10 hr day. Walk away with $1300 for the day for per diems. As a staff psychiatrist, I cover 48 hours of light phone call, but no pay since it's part of our contractual work.

1300 sucks though especially as a 1099..I’m surprised anyone would do that..it’s actually so bad..even 2k is not good..there are some places where they work you hard but at least you can make 3k a day or more

 

[Jules A]

10 hr day. Walk away with $1300 for the day for per diems. As a staff psychiatrist, I cover 48 hours of light phone call, but no pay since it's part of our contractual work.

That pay is awful especially for a challenging patient load. The better hospitals in my area have done away with making the attendings work weekends which has also resulted in them being able to attract and retain decent, young psychiatrists. Some use locums which is expensive and generally not ideal, others have set moonlighters who make between $3,500-$5,000 weekend which is usually the better system.

 

[NJWxMan]

Thank you all for your responses. Very helpful.

 

[Sushirolls]

I'm done being overworked and underpaid. It took me five years as an attending to wake up to the fact that pleas to continue to "provide excellent care" was how hospitals played on my ego and compassion for patients to keep working me like a dog. I've done enough long nights with no sleep and weekends to last a lifetime. The world will keep turning when I'm gone, and it seems there is enough demand to avoid bad conditions. I don't give a s*** if some iron man doctor somewhere thinks I'm lazy, weak, or whatever. I'm confident I have helped a lot of people and continue to do my share for a fair price right now. Young doctors need to know this is the way.

Truth. I'll rubber stamp this, too.

 

[FlowRate]

Someone else mentioned this in the forum recently: If it's a staffing issue then that's what needs to be made clear to the administration. This sounds like staffing AND pay. But is administration ready to shell out 4x for each weekend?

 

[Ironspy]

They need to hire TWO moonlighters to split the work AND pay EACH of them $200/hour to be well-staffed long term

Thank you all for the feedback. The concern that I have is that many times, there's not enough time in a day to get all of the work done. Throwing more money at psychiatrists does only that: more money made but crappy care. 2 ED commitments, 14-20 inpt follow ups, 1-3 inpt evals, and 2-4 consults (and sometimes 1-3 consult follow ups). I'm recommending splitting pay between 2 psychiatrists: one does only inpt and the other does ED/consults. I'm also considering a float system in which a second psychiatrist comes in later in the day and completes only consults.

Yeah 130 hahaha a resident probably wouldn’t even moonlight for that workload. Tell em to up it to 200 and see who bites.

Are you kidding? That kind of weekend work is not going to attract anyone for less than $175 - 200/hr. Even PGY 3s will demand higher pay for that much moonlighting work. Much sweeter gigs out there for much more pay.



Tell that to the NP covering my hospital.

 

[NJWxMan]

They need to hire TWO moonlighters to split the work AND pay EACH of them $200/hour to be well-staffed long term

Eek. That was my suspicion. Admin wondering by locums have been needed. BTW, this is a top 5 hospital in the state.

 

[Sushirolls]

Eek. That was my suspicion. Admin wondering by locums have been needed. BTW, this is a top 5 hospital in the state.

Admin will continue to wonder, drag their heals, and will not make any real change until they have burned you and the other core docs out and every one leaves. Even then if there are still a few hold out docs who stay for whatever reason, they'll continue to keep it short staffed. Seen and heard this time and time again. Advocate for yourself and make the changes you can, and if not, make the changes in your life/career to improve your situation. To quote some one else on SDN "The hospital won't love you back."

 

[Ironspy]

Admin will continue to wonder, drag their heals, and will not make any real change until they have burned you and the other core docs out and every one leaves. Even then if there are still a few hold out docs who stay for whatever reason, they'll continue to keep it short staffed. Seen and heard this time and time again. Advocate for yourself and make the changes you can, and if not, make the changes in your life/career to improve your situation. To quote some one else on SDN "The hospital won't love you back."

Admin will continue to get bonu$e$ for their indispensable role in patient care while wondering why they “can’t get a psychiatrist to stay” at their illustrious hospital

 

[Marasmus1]

10 hr day. Walk away with $1300 for the day for per diems. As a staff psychiatrist, I cover 48 hours of light phone call, but no pay since it's part of our contractual work.

Wow that pay is horrible. My hair stylist works around 10 hours on Saturday and probably pulling more than 1300$.

 

[hamstergang]

Wow that pay is horrible. My hair stylist works around 10 hours on Saturday and probably pulling more than 1300$.

Of the few hospitals I know of in NJ, I don't know any paying more than $130/hr for weekend work.

 

[Marasmus1]

Of the few hospitals I know of in NJ, I don't know any paying more than $130/hr for weekend work.

Maybe. But in my opinion, and I am not trying to undervalue anybody, whoever accepts that kind of pay for that amount of work has probably many disciplinary actions following them wherever they go say they are not competitive enough for lucrative gigs.

In NY State average Locum pays around 150$ fresh out of residency for similar jobs.

 

[NJWxMan]

Of the few hospitals I know of in NJ, I don't know any paying more than $130/hr for weekend work.

Ding ding ding. That's what I'm learning. Apparently, 100-130 is customary.

Also, locum does not mean per diem. Our per diems have been working at this hospital for years.

 

[Mass Effect]

Thank you all for the feedback. The concern that I have is that many times, there's not enough time in a day to get all of the work done. Throwing more money at psychiatrists does only that: more money made but crappy care. 2 ED commitments, 14-20 inpt follow ups, 1-3 inpt evals, and 2-4 consults (and sometimes 1-3 consult follow ups). I'm recommending splitting pay between 2 psychiatrists: one does only inpt and the other does ED/consults. I'm also considering a float system in which a second psychiatrist comes in later in the day and completes only consults.

Wait, what? You want them to split the pay so each psychiatrist would only be paid $65/hr for coming in on a weekend and (for one of them) seeing 14 - 20 inpatients and 1 -3 inpatient evaluations??

No one will ever do that and if you require them to do that, they will likely quit, yesterday.

 

[Mass Effect]

Ding ding ding. That's what I'm learning. Apparently, 100-130 is customary.

No, it isn't customary in my experience. I don't know which hospital you're at (though top 5 in the state isn't a huge thing, imo), but I can tell you that with locums jobs paying at least $150 (and many much more)/hr, I don't of moonlighters who would take your assignment. I certainly wouldn't. I don't even think my residents would take it. With a workload like that (even cut in half), they should be making at least $3-5K for the weekend.

 

[psychapp121]

Of the few hospitals I know of in NJ, I don't know any paying more than $130/hr for weekend work.

then move..130/hr is an absolute joke for weekend work..or any work. Start your own PP if the rates around you are that low..you’ll make much more

 

[NickNaylor]

Our inpatient unit is an 18-bet unit. On the weekends, we have an attending, a resident, and a moonlighting midlevel who is responsible for seeing 4-5 follow-up patients that are selected by the primary team as "moonlighter appropriate" (i.e., very stable with few expected changes in medication regimen over the weekend). Only faculty that work on the inpatient unit are responsible for covering call. Call is essentially on a "volunteer" basis in the sense that, while there needs to be coverage each weekend, we do not have any difficulties getting the faculty group to cover weekend call. The call schedule is created in several-month blocks in advance. Each service is responsible for covering its own service - i.e., the inpatient group is not responsible for covering consults (ED or otherwise) and vice versa.

Pay is $1000/day, more if there is no moonlighter and you are responsible for seeing those patients. While some days can be busy - especially if there are multiple admissions overnight and a full unit - generally people work from 8am to 4-5pm and sometimes finish significantly earlier depending on the volume and ratio of follow-ups to new admissions. All and all, not a bad weekend. For the consult service - which also covers the ED - one of the faculty works on a Friday-Monday schedule, so that is simply that person's normal work schedule.

 

[Mad Jack]

I am exploring ways to replace an unpredictable weekend call system within a major medical center. My current responsibilities: ED commitments (2 or less normally) consults (varies) and inpatient (24 beds max). What are your weekend responsibilities? How many psychiatrists work on weekend?

We cover about that much work with two residents each weekend, maybe 8-10 ED patients, 21 unit beds (it's a 24 bed unit but usually a few can't have roommates), and 5 consults per day that are split between the two of us with no onsite attending after 10ish (attending does zero notes). I'd imagine it's a two person job, but a miserable one.

 

[Mad Jack]

Ding ding ding. That's what I'm learning. Apparently, 100-130 is customary.

Also, locum does not mean per diem. Our per diems have been working at this hospital for years.

Jesus, moonlighting rates are higher for residents in many places. That's an insult

 

[psychapp121]

Our inpatient unit is an 18-bet unit. On the weekends, we have an attending, a resident, and a moonlighting midlevel who is responsible for seeing 4-5 follow-up patients that are selected by the primary team as "moonlighter appropriate" (i.e., very stable with few expected changes in medication regimen over the weekend). Only faculty that work on the inpatient unit are responsible for covering call. Call is essentially on a "volunteer" basis in the sense that, while there needs to be coverage each weekend, we do not have any difficulties getting the faculty group to cover weekend call. The call schedule is created in several-month blocks in advance. Each service is responsible for covering its own service - i.e., the inpatient group is not responsible for covering consults (ED or otherwise) and vice versa.

Pay is $1000/day, more if there is no moonlighter and you are responsible for seeing those patients. While some days can be busy - especially if there are multiple admissions overnight and a full unit - generally people work from 8am to 4-5pm and sometimes finish significantly earlier depending on the volume and ratio of follow-ups to new admissions. All and all, not a bad weekend. For the consult service - which also covers the ED - one of the faculty works on a Friday-Monday schedule, so that is simply that person's normal work schedule.

not worth it..time is very precious, when you’re already working 5 days a week, 1k for a 9 hour day is not even close to worth it..but to each his own I guess

 

[NickNaylor]

not worth it..time is very precious, when you’re already working 5 days a week, 1k for a 9 hour day is not even close to worth it..but to each his own I guess

Agreed, but you roll the dice. Some days you're done by 1pm. Additionally, you have a resident, so they do the bulk of the documentation and are first-line for all nursing and other issues.

If all you're worried about is money, I agree, I can make more working a 9+ hour day in the ED across the street. But for most of us, money is not the primary motivator.

 

[Ironspy]

Maybe. But in my opinion, and I am not trying to undervalue anybody, whoever accepts that kind of pay for that amount of work has probably many disciplinary actions following them wherever they go say they are not competitive enough for lucrative gigs.

In NY State average Locum pays around 150$ fresh out of residency for similar jobs.

I'm in NY and get locums offers a lot for both city and upstate. Most are $160-220/hour. I am also just out of residency.

 

[Mass Effect]

Agreed, but you roll the dice. Some days you're done by 1pm. Additionally, you have a resident, so they do the bulk of the documentation and are first-line for all nursing and other issues.

If all you're worried about is money, I agree, I can make more working a 9+ hour day in the ED across the street. But for most of us, money is not the primary motivator.

Just curious, what is the primary motivator for weekend call?

 

[Jules A]

Admin will continue to get bonu$e$ for their indispensable role in patient care while wondering why they “can’t get a psychiatrist to stay” at their illustrious hospital

Indeed and why does it seem the bigger the name the smaller the pay?

Of the few hospitals I know of in NJ, I don't know any paying more than $130/hr for weekend work.

In Jersey with their enormous property taxes and HCOL? It is surprising and disappointing that they are willing to work for that. Would hate to see their weekday rates.

Just curious, what is the primary motivator for weekend call?

Speaking only for myself that would be the $.

OP I'd either try to sell it to admin as two providers or one who gets paid per encounter and is willing to grind for ~$5,000. For weekends in my opinion Its not so much about needing a super Doc as someone reliable, who ensures the patients all remain alive and doesn't attempt to reinvent the wheel.

 

[BiscoDisco]

Are there weekend jobs which are in-hospital, full weekend coverage, and pay for the full 48 hours? I was under the impression you could find these 48 hour weekend shifts and pull in 7-8k a weekend.

 

[NickNaylor]

Just curious, what is the primary motivator for weekend call?

Given a choice, I would rather not do it at all, but that's not really an option. But if I have a choice of either working on the unit that I primarily work on for the weekend or moonlighting in the ED on those same days for more money, I would rather work in the former. I find working in the ED and dealing primarily with substance use and malingering soul-killing, exhausting, and not particularly meaningful or fulfilling. At least on the inpatient unit the patients have actual illness that we can do something about and, generally, are seeking treatment. In the ED, having most encounters feel adversarial or outright hostile with patients that, generally, are not particularly interested in actually improving their condition is tiring.

I will happily take less money if I feel like I'm actually doing something meaningful with patients with the time.

 

[NickNaylor]

Are there weekend jobs which are in-hospital, full weekend coverage, and pay for the full 48 hours? I was under the impression you could find these 48 hour weekend shifts and pull in 7-8k a weekend.

One of our state hospitals has this exact setup - weekend coverage is provided by folks who work the full 48 hours of the weekend and do nothing but see new admissions that come in over the weekend and provide cross-coverage duties.

 

[Mass Effect]

Are there weekend jobs which are in-hospital, full weekend coverage, and pay for the full 48 hours? I was under the impression you could find these 48 hour weekend shifts and pull in 7-8k a weekend.

Yes, and in some cases, it's 10K for the weekend.

 

[hamstergang]

then move..130/hr is an absolute joke for weekend work..or any work. Start your own PP if the rates around you are that low..you’ll make much more

There's a price to pay for contuining to live in the best of the 50 states... Also for me personally, the goal isn't to make the most money possibly out of any job. There are other factors which matter to me and in my life.

Wait, what? You want them to split the pay so each psychiatrist would only be paid $65/hr for coming in on a weekend and (for one of them) seeing 14 - 20 inpatients and 1 -3 inpatient evaluations??

I didn't interpret splitting the pay it that way. The hospital shouldn't care whether it's one or two psychiatrist coming in since presumably the same number of patients are seen in the same number of man-hours, so both psychiatrists get $130/hr but for fewer expected hours.

Jesus, moonlighting rates are higher for residents in many places. That's an insult

Insurance pays the same whether the licensed doctor is still in residency or not, so why would you expect the rates to be different?

 

[Mass Effect]

There's a price to pay for contuining to live in the best of the 50 states...

I have a feeling your definition of the best of the 50 states is different from mine.

I didn't interpret splitting the pay it that way. The hospital shouldn't care whether it's one or two psychiatrist coming in since presumably the same number of patients are seen in the same number of man-hours, so both psychiatrists get $130/hr but for fewer expected hours.

But that's still pretty ridiculous. If I'm expected to see 14 - 20 inpatients, it's still going to take me some time to do it, not to mention I'm coming in on the weekend. If the hospital is expecting to pay the same amount of money, but it's divided among two psychiatrists, I still think that's a lousy deal.