We know "equal" is always fair, until it's not... such as when sharing On Call with another Group or scheduling part-time Physicians. We also know spread needs to be pretty even through out the scheduling time period.
However, if the spread is great, and the tallies for the Providers are even and correct for the percent load given, how can the tallies STILL be unfair?
The tally date-range used to evaluate the schedule is crucial. Remember, it’s not just rules and spread, its tallies over an agreed upon time-frame. The Group as a whole must be using the same date-range to evaluate the schedule, otherwise you will each have a different result.
Three things to look out for regarding on-call tallies:
1) Be aware of the date-range selected for evaluating the Tally Report. The Group may not be using the best tally date-range while evaluating the tally results. The number of Providers being scheduled needs to be considered when determining such a date-range. If all Providers are fully available (no vacations) and all are to get the same number of weekends, then it is simple to show how the evaluation date-range being used makes a difference.
- Example1: If you have 29 providers in the group and schedule each provider for one weekend each, the tally for the year will not be even. There are only 26 weekends in a year, so there will be 3 providers with NO weekends. The actual date-range for an accurate evaluation of a "year" should be 29 weeks.
- Example2: Similarly, if you have 10 providers, the date-range for 6 months would not give even tallies since that covers 13 weekends, so several providers would be scheduled for two weekends during that time-frame. A better evaluation date-range would be 20 weeks (allowing everyone to even-up for covering vacations) or possibly 10 weeks if all 10 providers are full time with no vacations.
In practice, Providers really are unavailable for various reasons and take differing loads of call, so the date-range used for “fairness” evaluation matters even more. As a rule of thumb, I have found using a date-range long enough for the lowest-percent load provider to get assigned at least 1 weekend is usually long enough, since the tallies will reflect this as a full-event (no 1/2 person being scheduled). Another rule of thumb is to use a long enough evaluation date-range for all the full-time Providers to serve at least 2 weekends. This allows enough time to for Providers to “catch up” after vacation time off.
2) Providers with specialized skills might end up over-scheduled when looking at cross-job situations.
Schedulers will often say "All the providers share equally for on call, except those who do interventional backup".
Why? Because the back-up job is extra duty. If the interventionalists do the same amount of Primary Call as the others (100% load) AND also do the interventional backup call, their load would 100% plus the percent from the backup assignments! In many cases this is too much duty-time, so the Providers with the interventional skill are assigned less Primary Call than the others who do not do backup. How much less depends on the number of providers in the group available to be assigned to each of those jobs.
Good On Call Scheduling software has a feature where you can set and adjust the load factors for each individual provider/job so you can account for the needs of any particular Group. When done correctly, the total cross-job tally for the interventionalists doing Primary+Backup, will be close to the tally for Primary-only for those providers who do not do interventional back up. Everyone ends up with close to the same Total cross-job tally over the date-range examined.
Again, the date-range being used to evaluate the schedule is crucial. If individuals in the Group use different date-ranges, they will get different tallies and false sense that the schedule is unfair!
3) Cross-DayType tallies may also be considered for fairness, especially in regard to weekends.
The default expectation seems to be that all Providers serve the same number of Fridays, the same number of Saturdays, and the same number of Sundays during the evaluation date-range. If the Group’s rule is "If a provider is assigned On Call on Friday, then he also does Saturday/Sunday", the scheduling engine automatically populates the weekends evenly.
But there are groups who do not chain their weekends like this and still expect each Provider to serve the same number of each of the individual daytypes regarding weekends. This can make counting the tallies especially taxing if done manually with an excel sheet.
You could toss your excel sheet/ abacus thing and spring for automated call scheduling software to make the whole schedule creation and “counting tallies” thing so much easier. The Group could then discuss “fair” in a meaningful, transparent, repeatable manner.
Key takeaway: To make the math work and generate fair tallies, the tally date-range used to evaluate the schedule is crucial. Automated software makes the reporting and counting easy.