Although CMS does not require small groups of physicians to be on-call for a service every day if it is overly burdensome due to the size of the practice, but the hospital may feel differently. It is tough for a hospital to only be “open” for a service on certain days when they have physician on-call coverage. How is EMS or the public supposed to know if you are open to receive patients without calling in each time. This can cause potential patients and other hospitals from bringing in business to the ED. For this and many other reasons some small practice groups have elected to share the on-call duties with other practices to lessen the burden on the physicians while maintaining service levels for the local hospital. A true win/win, when done correctly.
Two groups decide to share call and one group takes this week, the other group takes the next week. Sounds easy enough right? It might be that simple if you were talking about anyone but physicians. Shared call when done incorrectly can make things worse for the physicians. How so? By getting called incorrectly over and over when they are not on assignment. After getting 2 or 3 calls in an evening and having to tell an operator that it is not you or your practice, it’s the other group. Then they argue with you telling you that it’s not what the schedule says, you may as well just take the damn call, you have already been interrupted so many times that it may not even matter anymore.
As you can imagine there is a right way and a wrong way to share call. Here are a few basic, but important things to think about.
- Be in the same or surrounding community. Many Medical Staff Offices have policies regarding the maximum time you can take to respond to an on-call request.
- Have privileges at the same hospitals. if you can’t admit another doctor’s patient to the facility that your colleague ordinarily uses, but instead must admit to your hospital, nobody’s bound to be happy. And if the patient can’t receive the services he needs at your hospital, you create an opening for a malpractice suit.
- Have the same skill set. If you have some choice this makes the most sends for the sake of patient care and risk management. In rural areas this isn’t always possible.
- Be careful of who you partner with. Never cover with someone who writes meds without seeing the patient, or writes too many narcotic prescriptions.
How many call partners do you need? According to an October 1, 2009 article from Physicians Practice titled Call Sharing for Small-Group Docs, “Five is the golden number for doctors who want a nightly rotation Monday through Friday, with a separate rotation for weekends. Going higher than five means even fewer hours tethered to your phone, but there’s a price to pay. Because you’re entrusted with a larger volume of patients, you could be eaten alive with the medical problems of total strangers.”
Once you have the right people its time to figure out the schedule. There are two options, the first according to the 2009 article, “In the six-member call group of gastroenterologist Gregory Smith in Athens, Ga., doctors meet every three or four months over dinner to map out their schedule. Even so, doctors invariably need administrative help; not only for creating the calendar but also distributing it to call partners, the answering service, and hospitals — not just once, but every time it changes.” Many doctors function as call-calendar czar, sometimes rotating the responsibility annually. Back in 2009 this was the norm, dinner and manual scheduling by one person who clearly drew the short straw. In 2018 modern practices use on-call scheduling software to create an evenly and fairly distributed on-call schedule where both practices can submit vacation requests and the schedule is created around the doctors time off. Physician Scheduling Software also makes swaps and communicating the schedule to the hospital a breeze. Everything is live and on-line, making it one source of on-call truth. For detailed information on how to create shared call schedule between two small groups check out Amy's latest blog post.
When everything is said and done it also makes sense to memorialize the terms with a shared call agreement that is revisited each year. Consult with your favorite attorney to have something simple but solid drafted. Remember an EMTALA citation regarding on-call happens to not only the hospital but also the physician who was on-duty. The fines can be $50,000 each. It is very important to get this right.
Sharing Call with the right people can make sense and help reduce physician burnout, especially in a smaller community. They key is to make sure that all the aspects are thought through and covered in an agreement.
Photo courtesy of Stuart Miles