With three general steps, groups can benefit from call-sharing just like bigger practices.
Physicians are feeling the squeeze these days: decreasing numbers of available on-call physicians, increasing mergers, on-call compensation issues, and the need to provide 24/7 on-call coverage is taking its toll on physician morale no matter the size of the group. The increasing use of hospitalists and technology such as EHR has great potential to alleviate stress for physicians in medium and large groups, but what steps can “smaller” practices take? Here are some ideas I have learned while training smaller on-call scheduling groups.
1. Form an On-Call Sharing Group
- Five seems to be the magic minimum number of physicians needed; enough to cover nightly rotation Monday-Thursday, with a separate rotation for weekends
- All call partners should have privileges at the same hospitals
- All call partners should belong to the same specialty, if possible
2. Determine Scheduling Rules, Rotation, & Process
- Keep rules simple! Groups create problems for themselves with too many complicated, intricate rules, especially if a small group considers all individual physician preferences. The more rules/preferences needed, the more time it will take to create/maintain the schedule, and the more money you will spend when buying software to help you.
- Have one
schedule“manager” or Call-calendar Czar. Often a practice manager may not have enough clout to gain cooperation, so a physician is designated the Primary Scheduler, and a manager is a Secondary Scheduler who helps maintain the calendar once it is created. Softwarecan often assist with creation, distribution, and everyday changes to the calendar.
- Determine the scheduling period so everyone knows what it is. Will weekends be scheduled out further than weekdays? What are the expected fair tallies?
- Determine who will cover major holidays, keep them fair, and documented. Track holiday duty accurately!
- Ask providers for dates off well in advance of the calendar release date. The
more slackyou allow, the later you will get the information, sometimes right up to the release date of the calendar.
- Pass the Draft Calendar around for approval. This is an important “buy-in” step for call-sharing groups. Commitment and comments in the presence of all participants seem to be helpful.
- Determine how swaps will be handled and approved or denied. If you have a process in place, you will keep your administrator sane longer with fewer he-said/she-said issues and last minute changes. Be sure and keep a “time-stamped” record of all requests and how they are handled!
3. Publish and Maintain the Schedule
A schedule will only be trusted if it is accurate; it will only be used if it is easily found.
- How will you keep the schedule up-to-date and in the hands of the on-call partners as well as after-hours answering services and the hospital ER?
- Will you fax or email it, or will the schedule be available online?
- How will you control access to the schedule?
Should You Consider Software to Help You? Why Spend the Money?
Some physicians in on-call partnerships do not feel the need for software to create a simple schedule for a small group, especially if the Primary Scheduler is an unpaid volunteer. However, looking beyond creation, there are benefits to be considered that software can offer to all providers within the on-call partnership.
- Tallies and history, transparent and available at any time may help with fairness issues.
- An online central location will help with communication and availability of the current schedule.
- Templates and/or rules can keep the process accurate and repeatable.
- Provider ability to make swap requests themselves and automatic tracking of results will improve accountability.
- SmartPhone access and personal calendar import are becoming important to Providers.
The real goal of any scheduling calendar is communication, so the right provider is being called in the middle of the night. This holds true for both large and small call groups. So, why not form an on-call partnership group of your own and gain some of the benefits and peace of mind larger groups enjoy?