What does call look like as a private practice hem/onc attending?

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TexasMed22

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Specifically, I'm curious about how frequently overnight call is usually taken, how often you get called, and what you end up having to do when called (in a standard private practice environment).

Thank you!

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Specifically, I'm curious about how frequently overnight call is usually taken, how often you get called, and what you end up having to do when called (in a standard private practice environment).

Thank you!
I don't think there is going to be a "standard". It's going to depend on the size of the group, the number of hospitals covered, the type of practice (if you manage BMT and leukemia patients for instance), the culture of the hospitals, etc. But I can give you examples of community practice that I'm familiar with.

My old group (hospital employed community) had ~14 docs covering 5 hospitals. No acute leuks or transplant, minimal inpatient chemo, almost all patients with hospitalists as primary. Call was evenly split among the group which meant ~2 weeknights a month and ~4 weekends (Fri 5p - Mo 7a) a year. Calls were obviously variable but a busy night was half a dozen calls (mostly bunched in the 5-7p and 5-7a times) and a busy weekend would have you seeing 10-12 patients (total, not daily) over the course of the weekend. We had an NP to take outpatient calls during the day. I had plenty of weeknights and even a couple of weekends that were complete no-hitters over the course of 11 years at that job. I can count on one finger the number of times I ever went back to the hospital after hours to manage a patient, and that was at 7pm on a Thursday, not 3am on a Sunday or anything ridiculous.

Another group I know well (large physician owned MSG) covers 2 hospitals with 4 (now 5, soon to be 6) docs. Call is again evenly split but they choose to do a full week at a time and cut back their clinical time by 20% during their call weeks. They too would field a few calls a night and see 5 or 6 patients a weekend. They have a triage RN on weekends who fields outpatient calls and only calls them for critical things, the rest goes in the EMR.

A group I'm somewhat familiar with (true PP) has ~20 docs, again covering 7 or 8 hospitals but divided into 2 groups for the purposes of taking call. Similar volumes to the others except this group does manage acute leuks and auto BMT so gets more inpatient calls. Call frequency is like my old group (weeknights and weekends are separate and are "Q-Doc". They pay a nurse to take outpatient calls 24/7 and only take direct hospital calls and urgent patient stuff from the triage RN.

My current job has 2 docs. We take no call. Zip...zero...nada. Hospital employed rural community-based practice covering one rural CAH. Calls are routed to the local mothership (65 miles away) and the ED and hospitalists basically understand that if they need our help managing something in the middle of the night, the patients need to be shipped out to a higher level of care anyway and they just do it.
 
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I don't think there is going to be a "standard". It's going to depend on the size of the group, the number of hospitals covered, the type of practice (if you manage BMT and leukemia patients for instance), the culture of the hospitals, etc. But I can give you examples of community practice that I'm familiar with.

My old group (hospital employed community) had ~14 docs covering 5 hospitals. No acute leuks or transplant, minimal inpatient chemo, almost all patients with hospitalists as primary. Call was evenly split among the group which meant ~2 weeknights a month and ~4 weekends (Fri 5p - Mo 7a) a year. Calls were obviously variable but a busy night was half a dozen calls (mostly bunched in the 5-7p and 5-7a times) and a busy weekend would have you seeing 10-12 patients (total, not daily) over the course of the weekend. We had an NP to take outpatient calls during the day. I had plenty of weeknights and even a couple of weekends that were complete no-hitters over the course of 11 years at that job. I can count on one finger the number of times I ever went back to the hospital after hours to manage a patient, and that was at 7pm on a Thursday, not 3am on a Sunday or anything ridiculous.

Another group I know well (large physician owned MSG) covers 2 hospitals with 4 (now 5, soon to be 6) docs. Call is again evenly split but they choose to do a full week at a time and cut back their clinical time by 20% during their call weeks. They too would field a few calls a night and see 5 or 6 patients a weekend. They have a triage RN on weekends who fields outpatient calls and only calls them for critical things, the rest goes in the EMR.

A group I'm somewhat familiar with (true PP) has ~20 docs, again covering 7 or 8 hospitals but divided into 2 groups for the purposes of taking call. Similar volumes to the others except this group does manage acute leuks and auto BMT so gets more inpatient calls. Call frequency is like my old group (weeknights and weekends are separate and are "Q-Doc". They pay a nurse to take outpatient calls 24/7 and only take direct hospital calls and urgent patient stuff from the triage RN.

My current job has 2 docs. We take no call. Zip...zero...nada. Hospital employed rural community-based practice covering one rural CAH. Calls are routed to the local mothership (65 miles away) and the ED and hospitalists basically understand that if they need our help managing something in the middle of the night, the patients need to be shipped out to a higher level of care anyway and they just do it.
In group #3 and #4, how often would docs have to be physically rounding in the hospital on the weekend? Is that similar to the overnight call frequency, meaning its roughly Q6? I was under the impression that PP hem onc didn't do much actually rounding in the hospital since the hospitalists/NP can usually handle their patients.
 
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In group #3 and #4, how often would docs have to be physically rounding in the hospital on the weekend? Is that similar to the overnight call frequency, meaning its roughly Q6? I was under the impression that PP hem onc didn't do much actually rounding in the hospital since the hospitalists/NP can usually handle their patients.
You'd be surprised how quickly hospitalists and surgeons forget how to manage simple medicine/surgery stuff once "cancer" is on the problem list. I used to get called for "this patient has Stage I breast cancer and just had a STEMI, can you come see them and tell us if she should get a CABG?" or "your partner sees this patient for CLL and they're admitted with DKA, we need you to see them and make sure the diabetes isn't from their CLL". Those are both actual "consults" I've gotten. At least since COVID, a lot more people are comfortable with me just making recommendations and dropping a note in the chart with them outlined. You can at least bill for this now (interprofessional consult) so it's not a complete waste of time anymore.

There are also a surprising number of patients with cancer out there who won't let another physician do anything for them in the hospital until they see their oncologist and clear it with them.
 
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You'd be surprised how quickly hospitalists and surgeons forget how to manage simple medicine/surgery stuff once "cancer" is on the problem list. I used to get called for "this patient has Stage I breast cancer and just had a STEMI, can you come see them and tell us if she should get a CABG?"
Omg this happened to me like 3 times in a week one time, I thought I was taking crazy pills.

"Can you comment on prognosis in this Stage I / II Breast Cancer patient to determine whether we should treat this STEMI/NSTEMI?"

:bang:
 
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