Hate Having to Take Call? Make It Less Painful

Gail Garfinkel Weiss, MSW


March 06, 2013

In This Article


Hate being on call? Join the club. While it's a necessary and inescapable part of being a physician, call remains among the least favored aspects of doctors' work lives. Robert Blum, MD, a pediatrician in Bingham Farms, Michigan, refers to call as "the worst part of practice," a sentiment that a large number of doctors undoubtedly share.

But even though taking call is a traditional part of medical practice, some doctors, already bleary-eyed from putting in hectic days at the office, have said "Enough!" to seeing patients after regular hours as well. As a result, more and more practices are taking steps to make call less of a burden by reducing or eliminating it altogether, or using automation to help. Are these strategies working? Let's take a look.

Easing the Onus by Striving for Fairness

It's common for long-time physicians to back away from call on the theory that they have done their share. However, it's also common for younger doctors to feel that their call requirements are more demanding than necessary. This can create dissension in a practice and jeopardize the esprit de corps necessary for teamwork and office efficiency. Disgruntled doctors aren't that great for patient relations, either.

"Call division is a bit like alchemy -- part art and part science," says Kenneth T. Hertz, a practice management consultant with the Medical Group Management Association (MGMA) Health Care Consulting Group. "Many practices have a policy driven by age. There are also issues about counting the number of regular call days, holiday call days, and weekend call days to make sure that you don't have fewer call days than I do."

Flexibility and even-handedness are key factors in acceptable call schedules. For example, among the 7 pediatricians in Blum's practice, only the most senior associate takes no call, but otherwise call is equally divided. It helps, too, if part-timers do their share, as happens at INTEGRIS Family Care Central, a primary care clinic in Oklahoma City. Internist Mary Ann Bauman, MD, says that by taking call, the part-timers gain acceptance as full members of the practice.

Paying Doctors for Doing Extra Work

Paying physicians who take call extra gives them added impetus to work additional hours -- and eases resentment in groups where some doctors duck call responsibility. Sumana Reddy, MD, a family physician in Salinas, California, says that the employed doctors in her practice get a stipend of about 7% of income for working outside of regular office hours. That and the fact that the physician who sets up and manages the call schedule is, in Reddy's words, "scrupulously fair," makes call more tolerable for all concerned.

Other practices use a relative value unit (RVU) system to divide call-related payouts. For example, weekday call might be worth 1 RVU; weekend days might be worth 2 RVUs. The agony of call is blunted by a larger paycheck.