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  • Placing a Value on " On Call" responsibilities

    Our group practice is now facing our first transitionary phase of an older Doc requesting to move to a non call situation in the future. He will still work in the practice on a part time basis. For us this is precedent setting, and we are faced with trying to figure out a "value" to being on call. In our specialty, someone is always on call, and thus it is a critical part of working in this field. Not being on call is the Holy Grail of practicing medicine in my mind. Obviously, others have faced this issue before and have worked through it. Any care to chime in and offer some rough suggestions or explain how they handled the situation?

     

     

  • #2
    Difficult situation since even those that are effectively not on on in anything other than anesthesia/ER maybe a couple others are still always on call to a degree or another. So if he still works at all, he's basically asking for someone to take his call and a value needs to be arrived at. Interesting scenario.

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    • #3
      There is a crap-ton of call in anesthesia, unless maybe you work strictly in an ambulatory setting.

      Our call (academic institution) does have a monetary value, but was worked out a long, long time ago and I have no idea how they calculated it.  So I have no first-hand knowledge in working it out.

      But I would think you have a few options depending on your set-up.  If you're in an "eat what you kill" practice, I would think it would take care of itself.  You could also go free-market and have him (and the person covering it) determine how valuable it is independently.  A third option, if salaried, would be to try to estimate an hourly amount and assign the value that way.

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      • #4




        There is a crap-ton of call in anesthesia, unless maybe you work strictly in an ambulatory setting.

        Our call (academic institution) does have a monetary value, but was worked out a long, long time ago and I have no idea how they calculated it.  So I have no first-hand knowledge in working it out.

        But I would think you have a few options depending on your set-up.  If you’re in an “eat what you kill” practice, I would think it would take care of itself.  You could also go free-market and have him (and the person covering it) determine how valuable it is independently.  A third option, if salaried, would be to try to estimate an hourly amount and assign the value that way.
        Click to expand...


        You may take call in anesthesia, but you're not still typically on call for all your other patients every single day all the time is what I was trying to say. I dont take call at all, but my patients may call and need something at any time, so Im always "on call" to an extent. Not implying anesthesia doesnt take call, was not the intent. I was just assuming you dont have that same level outside scheduled call in anesthesia, and pay is usually worked out in those situations.

        In this one, where you're asking others to field your patients calls or take your shifts, thats a different ballgame. Agree eat what you kill takes care of itself.

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        • #5
          First things first: you have to talk with the others in the group and decide if you want to pick up the extra call. A face to face meeting probably needs to happen to discuss the DETAILS and not a simple, "Yeah, sure, we can pick it up." If only a few are willing, then those few can negotiate their price with him. If nobody wants to pick up the extra call regardless of price, then this is a non-starter.

          In our practice, those that transition to a part-time role still take call. They work fewer weeks and a proportional decrease in call. But that's easier to do in path, especially since we hardly ever get called when we're on call.

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          • #6


            First things first: you have to talk with the others in the group and decide if you want to pick up the extra call. A face to face meeting probably needs to happen t
            Click to expand...


            Thank you for your concern - but this has been discussed and agreed upon by all of the partners for several years. We are hiring a new doc to handle the volume as the older Doc slows down.  Unfortunately, none of us bothered to think through the monetary value of not being on call.

            We run a roughly 70/30 split on base salary and productivity, so we are not totally eat what you kill, and thus it won't really adjust fairly on the productivity side. Nor are we employed physicians. I do like the idea of trying to estimate a free market coverage, i.e.) if I had to hire a per diem for coverage what would that cost.

            Interesting scenario and new for us, I may follow the same pathway...although I may also just retire completely at his age...not sure I want to deal with the BS of medicine that long.

             

             

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            • #7
              This is an issue that comes up in a lot of different ways and a lot depends on your specialty and what call entails. Are you internists just taking phone calls on call? Are you invasive cardiologists taking STEMI call? Trauma surgeons taking in-house call? Etc.

              Whenever this comes up in my radiology practice (where there are two call pools), we try to establish the "free market" rate for the service by finding people in the group to cover the call. I can get a colleague to cover my IR weekend call for $2000 so that's the rate. Weekend general call (in house, all weekend) goes for $5-6000. These would be starting points to discuss the value of not taking call on an ongoing basis.

              If you value the call too low, there are no takers. Too high and everyone is clamoring to do it. Just right and there is an equilibrium of people buying and selling their call. This value might move over time with the changes in group composition and nature of the work.

              Once the late career doc starts the glide to retirement, I recommend that the path is relatively short (no more than 2-3 years) and well-defined, and the terms are in the best interests of the group, not the senior partner. (I say that as the soon-to-be part time gliding senior partner!)

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              • #8





                First things first: you have to talk with the others in the group and decide if you want to pick up the extra call. A face to face meeting probably needs to happen tClick to expand…

                We run a roughly 70/30 split on base salary and productivity, so we are not totally eat what you kill, and thus it won’t really adjust fairly on the productivity side. Nor are we employed physicians. I do like the idea of trying to estimate a free market coverage, i.e.) if I had to hire a per diem for coverage what would that cost.Click to expand...


                I like the per diem rate but like Vagabond MD, I'd set the rate based on what the price others in the group will do to take it, not a locums-type person.  A locums would be much more expensive and setting the rate from this would probably be unfair to the one who wants to ease back.  Additionally, if you have others in the group who want to "moonlight" (young docs or whatnot), this is a good opportunity for them to negotiate a price.  The 70/30 split adds a little wrinkle to negotiating so be sure to factor that in as well.

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                • #9




                  If you’re in an “eat what you kill” practice, I would think it would take care of itself.
                  Click to expand...


                  I would say this is not the case in most specialties, as the time commitement for call is huge, and the "kill" is relatively tiny compared to the production that occurs during daytime hours Monday through Friday.

                  If I were on an "eat what you kill" payment system (I'm in anesthesia), I'd opt to work 0600 to 1400 and let others take over once we're down to 1 or 2 rooms. I'd guess 80% of our production occurs during those 8 hours, with the other 20% in the remaining 16 hours of the day. That's why there needs to be a call premium paid to those who remain on duty during low yield hours.

                  I did like your other suggestions, though.

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                  • #10







                    If you’re in an “eat what you kill” practice, I would think it would take care of itself.
                    Click to expand…


                    I would say this is not the case in most specialties, as the time commitement for call is huge, and the “kill” is relatively tiny compared to the production that occurs during daytime hours Monday through Friday.

                    If I were on an “eat what you kill” payment system (I’m in anesthesia), I’d opt to work 0600 to 1400 and let others take over once we’re down to 1 or 2 rooms. I’d guess 80% of our production occurs during those 8 hours, with the other 20% in the remaining 16 hours of the day. That’s why there needs to be a call premium paid to those who remain on duty during low yield hours.

                    I did like your other suggestions, though.
                    Click to expand...


                    +1
                    Erstwhile Dance Theatre of Dayton performer cum bellhop. Carried (many) bags for a lovely and gracious 59 yo Cyd Charisse. (RIP) Hosted epic company parties after Friday night rehearsals.

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                    • #11
                      We have 3 part time urologists in our large group practice with no call responsibilities. We have a base + production model for part timers based upon RVUs and revenue. Works well for them, if they work harder, they can get a significant quarterly bonus. As a group we feel that their experience is an asset to the practice and reward them as such.

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                      • #12




                        Our group practice is now facing our first transitionary phase of an older Doc requesting to move to a non call situation in the future. He will still work in the practice on a part time basis. For us this is precedent setting, and we are faced with trying to figure out a “value” to being on call. In our specialty, someone is always on call, and thus it is a critical part of working in this field. Not being on call is the Holy Grail of practicing medicine in my mind. Obviously, others have faced this issue before and have worked through it. Any care to chime in and offer some rough suggestions or explain how they handled the situation?

                         

                         
                        Click to expand...


                        Let the market solve the problem. That's what we did with our night shifts. It turns out that in this market a night shift is worth about 50% more than a day shift. There's a value at which some members of the group will voluntarily take the older doc's call. That's what it should be priced at.
                        Helping those who wear the white coat get a fair shake on Wall Street since 2011

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                        • #13
                          It all depends on the culture of your practice and what feels is right. I recall about 16 years ago when the the senior partner offered that he would not take call anymore and offered to pay the other partners $ 6000  to take all his call for the year. This was a "partner's meeting" and I was facetious ( i has seniority over the other partners) and  I stated would out bid him for $ 25,000 and that was the beginning of the end. I actually thought I was funny at the time. It cost me me a fortune in litigation.

                          Our group blew up. I still took call up to 11 years later. I should not have if I had any sense.

                          If I could play it again, I would have said that the senior partner had a point and that since I was not the senior partner if anybody wanted to take me my call I would pay double.

                          Do not take call call unless the hospital makes it worth your while.

                           

                           

                           

                           

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                          • #14







                            If you’re in an “eat what you kill” practice, I would think it would take care of itself.
                            Click to expand…


                            I would say this is not the case in most specialties, as the time commitement for call is huge, and the “kill” is relatively tiny compared to the production that occurs during daytime hours Monday through Friday.

                            If I were on an “eat what you kill” payment system (I’m in anesthesia), I’d opt to work 0600 to 1400 and let others take over once we’re down to 1 or 2 rooms. I’d guess 80% of our production occurs during those 8 hours, with the other 20% in the remaining 16 hours of the day. That’s why there needs to be a call premium paid to those who remain on duty during low yield hours.

                            I did like your other suggestions, though.
                            Click to expand...


                            It's a fair point.  I was going to argue that if you're in a practice with lots of young grads with lots of debt, it might not matter how large the "kill" is, only that there is one.  But in a way that is still market forces at work (scarcity of opportunities makes even light call desirable).  So I agree, a pure EWYK is probably unreasonable unless the reimbursement/time ratio is good.

                            I'm in anesthesia, also, and have been a part of various setups.  As an attending, the shifts are assigned a value, and they seem to be fairly (or slightly over-) valued, as free ones are pretty quickly gobbled up.  As a resident, we had "voluntary" moonlighting that would frequently end up assigned as it was onerous and way underpaid.  People would actually pay other residents on top of what the shift was worth in order to get rid of it.

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                            • #15




                              . A face to face meeting probably needs to happen to discuss the DETAILS and not a simple, “Yeah, sure, we can pick it up.” If only a few are willing, then those few can negotiate their price with him. If nobody wants to pick up the extra call regardless of price, then this is a non-starter.
                              Click to expand...



                              The White Coat Investor wrote:






                              Our group practice is now facing our first transitionary phase of an older Doc requesting to move to a non call situation in the future. He will still work in the practice on a part time basis. For us this is precedent setting, and we are faced with trying to figure out a “value” to being on call. In our specialty, someone is always on call, and thus it is a critical part of working in this field. Not being on call is the Holy Grail of practicing medicine in my mind. Obviously, others have faced this issue before and have worked through it. Any care to chime in and offer some rough suggestions or explain how they handled the situation?

                               

                               
                              Click to expand…


                              Let the market solve the problem. That’s what we did with our night shifts. It turns out that in this market a night shift is worth about 50% more than a day shift. There’s a value at which some members of the group will voluntarily take the older doc’s call. That’s what it should be priced at.
                              Click to expand...


                              Agreed. The 70/30 split isn't key here - the market is.

                              I often begin such discussions by discussing some specific examples. Is $100/shift enough? How about $1000? How about $5000?  Go through this in a face to face meeting, and show how many shifts each person will have to cover over the next 6-12 months. Who is going to cover his/her shift on 7/4? How about 12/24?

                              Setting a mutual time to re-negotiate is okay too.

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