Random dumb question. At university hospitals obviously the residents in each field take call. What about all those other hospitals not affiliated with med schools? Do they just have private practice physicians in the community take call or what?
Who takes call at hospitals not affiliated with med schools?
- Thread starter kwel
- Start date
- Joined
- Aug 4, 2003
- Messages
- 1,380
- Reaction score
- 34
Yes.
- Joined
- May 20, 2010
- Messages
- 5,700
- Reaction score
- 7,943
There are residents in community hospitals too...
- Joined
- May 10, 2011
- Messages
- 999
- Reaction score
- 56
Community hospitals that have residents are in the significant minority. At most hospitals, it is private physicians or employed hospitalists taking call.
- Joined
- May 20, 2010
- Messages
- 5,700
- Reaction score
- 7,943
Not at all, I was just curious as to how this system worked when there are no residents around. How do hospitals ensure there are docs to take call? For residents it's a requirement of their program, but what about in the community? Is it on volunteer basis?
- Joined
- Jan 9, 2006
- Messages
- 15,421
- Reaction score
- 7,797
The private practice group will make a call schedule. Just like in residency.
Also just like resident call is a requirement of the program, so is attending call a requirement of your contract.
- Joined
- Sep 11, 2011
- Messages
- 68
- Reaction score
- 0
Agreed. I think that most* community hospitals that lack residency programs are also much more likely to be smaller, serving a less demanding hospital, and more manageable for the local call-taking physicians. My school send us out for rotations/preceptorships/observerships to several local community hospitals that are only looking to develop residency programs, and they are significantly tamer than the teaching facilities...
IMO != Evidence-Based 🙂
IMO != Evidence-Based 🙂
- Joined
- Apr 9, 2000
- Messages
- 39,952
- Reaction score
- 18,721
In my community, for surgeons it works a little differently.
Some hospitals have employed surgeons and they take X amount of call as required by their contract. The vast majority of general surgeons who have privileges at the hospital do not have a contract and therefore, have no assigned or expected amount of call. They voluntarily put themselves into the call pool and the schedule is made by the hospital.
Recently one of our hospital systems found themselves in somewhat of a pickle when they decided they couldn't afford the surgeons they had hired and fired a few of them. Guess what? No one to cover the full month of call. They went to their surgeons on staff, some of whom refused to take more call because of the way they'd treated their friends (by firing them with 1 month notice) and others took it (in the words of one), "I wouldn't help those rat bastards if my life depended on it, but I'll take more call because it will get me more business."
Surgical specialists are another story. Most hospitals in large cities learned awhile ago that forcing call upon them meant no one stayed on staff. For example, some hospitals require Plastics, ENT, Ortho and Neuro to take call as part of having privileges at that hospital. Those specialists that didn't want to have to take call simply said, "its a big town, I'll go to Hospital Y down the street that doesn't require call". That's what I did when the hospital closest to my main office decided to require call for all general surgery trained practitioners, even if you had done a subspeciality fellowship. I packed up my bags and operate elsewhere just a few blocks away.
can't answer that last question as I'm an Emergency Physician, but I can tell you from my perspective, I work at a mid-sized community gig. Most specialties have at least 2 groups covering. The way it works is that, say for example, orthopedics has 3 groups in the area that are associated with my hospital. Those groups rotate, so say group A covers MWF, Group B covers TR, and Group C covers the weekend. Within each group, their members rotate call. So any particular member of any particular group only covers call at my hospital maybe a couple times a month.
Though I'm sure each group does cover a few hospitals in the area.
Now primary care docs is another story. Some use the hospitalists, some are in rotating groups, but some solo practitioners are technically on call 24/7. They don't have to come in in the middle of the night, but certain providers are apt to be woken up to be told about a patient of theirs at any given moment, except if they're on vacation and have another PCP covering them.
Though I'm sure each group does cover a few hospitals in the area.
Now primary care docs is another story. Some use the hospitalists, some are in rotating groups, but some solo practitioners are technically on call 24/7. They don't have to come in in the middle of the night, but certain providers are apt to be woken up to be told about a patient of theirs at any given moment, except if they're on vacation and have another PCP covering them.
Who mandates this? What if the group just refuses to be a part of the call rotation? Can the hospital just refuse to offer their services to that group?
- Joined
- Jun 22, 2008
- Messages
- 13,815
- Reaction score
- 130
That's how it works. The hospital makes taking call mandatory for getting OR privileges.
Medicine is business, it's a you scratch my back, i'll scratch yours world.
The hospital may refuse to credential you if you're not on call because they'll lose the benefit of being able to keep (as opposed to transfer to another hospital) patients. If you want the benefit of working for them, I'm sure they're going to want some sort of beneift in turn. If you provide other significant benefits to the hospital (aka good PR or bringing in an alternate form of revenue), then they may not care.
Refusing to be part of the call rotation means you also don't get patients referred to your practice from the ED. It's lost revenue. Most groups don't like losing business to the competition. If you don't mind the lost business, then it's not a big deal. Some groups I'm sure are inundated with patients sent from primary care groups.
Smurfette
Gargamel always had a thing for blondes.
Staff member
Administrator
Volunteer Staff
20+ Year Member
- Joined
- Jun 7, 2001
- Messages
- 5,059
- Reaction score
- 4,634
Some hospitals *may* pay physicians to take ER call, others don't. It also is specialty-specific, as some specialties rarely have an ER emergency that requires them to go in to evaluate the patient (thus not worth 'paying' a physician to take call), and others (surgical fields, cardiology, possibly OB/gyn) can get swamped on call, but it's in the hospital's best interest to make sure those fields are available at all hours due to emergencies.
My hospital does NOT give call pay, but I wouldn't be surprised if that changes in the future as hospitals in nearby communities are starting to do so.
My hospital does NOT give call pay, but I wouldn't be surprised if that changes in the future as hospitals in nearby communities are starting to do so.
group_theory
EX-TER-MIN-ATE!'
Staff member
Administrator
Volunteer Staff
Lifetime Donor
20+ Year Member
- Joined
- Oct 2, 2002
- Messages
- 4,865
- Reaction score
- 2,252
Yup. It's a business. And depending on the specialty, hospital, location, patient population (and payer mix), some hospitals will have no trouble getting call coverage, while others will have to resort to payment to get groups to take call (where revoking hospital privilege will just exacerbate the specialist shortage). Some group fight to have the ED refer their calls to them because it can be a lucrative referral base. However, some places will have trouble getting specialists to take call.
A hospital that has a large indigent population, and a large uninsure or medicaid population, with not a lot of local competing physician groups, may have trouble getting call coverage for certain specialties, such as neurosurgery, or ortho, ENT, plastics, etc. When on call, they are responsible for seeing anyone in the ED (that the ED docs call them upon). Although they can bill the patient for the visit, if they are uninsure then they will not be compensated. Plus now that they have establish a doctor-patient relationship, they can't just drop the patient. Plus if it requires emergent surgery, that non-paying patient will then bump the previously scheduled elective surgeries (on paying patient). So not only do you not get reimburse for seeing the patient, but you don't do procedures on patients that you were originally scheduled to see, and you are liable for any potential malpractice allegation (people without insurance don't tend to have good pre-injury care or even follow-up care, and would blame any complications, on the provider). Hospitals have tried to revoke admitting, surgical, or even hospital privileges, but then with the advent of Outpatient surgicenters (where there is no call, share in profits, predictable shiftwork, low-risk patients), taking the teeth out of that threat. Some hospitals have resorted to paying physician call groups to take call (or guaranteeing reimbursement, even if the patient is uninsure) . The OIG of HHS have issued a written advisory that on-call per-diem payments to physicians does not violate the anti-kickback laws
https://oig.hhs.gov/fraud/docs/advisoryopinions/2012/AdvOpn12-15.pdf
Here are some articles (some a few years old) that discuss this issue
http://www.washingtonpost.com/wp-dyn/content/article/2007/12/20/AR2007122002322.html
http://www.acep.org/content.aspx?id=26484
http://birminghammedicalnews.com/news.php?viewStory=1697
http://www.nejmcareercenter.org/art...-newest-entrants-in-the-hospitalist-movement/
- Joined
- Aug 4, 2003
- Messages
- 1,380
- Reaction score
- 34
Depends on the medical staff's bylaws. Some hospitals like Wing Scap alluded to require call while others do not to maintain privileges. Call is a way for doctors to pick up patients and procedures. When patients are insured, doctors are banging on the doors to take call. When patients are uninsured, nobody wants to take call. Old timers will say that it's your duty as a doctor to take call regardless of insurance status because its the privilege to take care of poor patients, but those guys lived in a time when they made buttload of money and could afford a few charity cases here and there. But in recent times with rising practice expenses and decreasing reimbursements, people will opt out of call if they're not fully dependent on the hospital (I.e. outpatient specialties, like primary care, but also ENT, Ophtho, Plastics, and Derm). So either the hospitals force call on them or they pay doctors to take call.
Many young surgeons will take call despite not being paid because they need to keep their surgical skills fresh while they are building their practices. Plus, call allows you to interact with other doctors in the hospital, network, and build a name for yourself for referrals and what not.
There's another component that hasn't been mentioned, which is outside influences. To use a local example, counties in California manage the EMS system, including licensing emergency rooms. Without a call schedule, the hospital won't have a licensed emergency room ("paramedic receiving center" is the local term), which will prevent EMS from transporting any patients to that facility outside of disaster/mass casualty incidents. Using the county I'm most familiar with, emergency hospitals have to keep a call schedule updated daily with the following specialties...
...and either call schedule or transfer agreements for patients requiring...
Section VI C. (PDF page 4 and 5)
Now there's two huge points with this. First, when it comes to either making one group mad or basically closing down a major entry portal for patients the choice is easy. Second, every hospital in the county has to play by the same rules. It's not like the hospital down the street isn't going to have a call schedule, and it's not like the other groups at the hospital are going to let one group get out of playing the call game.
- Internal Medicine / Family / General Practice
- Cardiologist
- General Surgeon
- Anesthesiologist
- Pediatrician
- Orthopedic Surgeon
- Obstetrician / Gynecologist (if no OB services, than just gyn)
...and either call schedule or transfer agreements for patients requiring...
- Surgeon with vascular surgery privileges
- Plastic Surgeon
- Otolaryngologist
- Cardiothoracic Surgeon
- Neurosurgeon
- Urologic Surgeon
- Psychiatrist
- Ophthalmologist
- Oral Surgeon
Section VI C. (PDF page 4 and 5)
Now there's two huge points with this. First, when it comes to either making one group mad or basically closing down a major entry portal for patients the choice is easy. Second, every hospital in the county has to play by the same rules. It's not like the hospital down the street isn't going to have a call schedule, and it's not like the other groups at the hospital are going to let one group get out of playing the call game.
