On-Call Pay: Raise for PCPs, Cut for Surgical Subspecialists

May 30, 2013

The percentage of primary care physicians paid for their hospital call coverage bolted past the 50% mark in 2012, although their compensation pales in comparison with that for surgical specialists and subspecialists, the Medical Group Management Association (MGMA) reports.

In 2011, 43% of family physicians, internists, pediatricians, and obstetrician-gynecologists received compensation for their hospital call coverage, whether that meant being on duty at the facility or carrying a pager around town for general emergency department (ED) or trauma calls. In 2012, 58.4% of primary care physicians taking hospital call were paid for this work, according to the MGMA publication Medical Directorship and On-Call Compensation Survey: 2013 Report Based on 2012 Data. The survey was released last month.

The percentage of all physicians paid for their hospital call coverage also increased, going from 60.7% to 70% from 2011 to 2012.

Decades ago, such work used to be an uncompensated duty that came with medical staff privileges, but hospitals must now put dollars on the table to persuade physicians to carry a pager. Physicians no longer view ED coverage as an important source of new patients. Instead, they are prone to view the ED as a malpractice suit waiting to happen. In addition, younger physicians are inclined to limit their work hours for lifestyle reasons, said MGMA healthcare consultant Jeffrey Milburn.

"As one medical director once said, older doctors live to work, and younger doctors work to live," Milburn told Medscape Medical News.

The shortage in primary care clinicians may help explain the big increase in the percentage of primary care physicians who are compensated for hospital call coverage, said Milburn. These clinicians bargain from a position of strength.

"The pressure is on the hospitals," he said.

The physicians most in demand for call coverage are surgical specialists such as general and orthopedic surgeons and surgical subspecialists such as neurosurgeons. The percentage of surgical specialists and subspecialists who are paid for their call coverage climbed to almost 81.1% and 87.6%, respectively, in 2012.

In another indicator of market demand, the amount that surgical specialists and subspecialists received far exceeded that for their primary care colleagues. Surgical subspecialists pulled down a median daily stipend of $900 for call coverage in 2012 compared with $250 for primary care physicians. However, the rate for surgical subspecialists decreased 10% in 2012, whereas primary care physicians received a 7% raise.

Anesthesiologists commanded the highest daily stipend last year, at $2400.

The MGMA survey results are based on the responses of almost 4000 clinicians in 295 group practices. The report can be purchased for $540 ($275 for MGMA members) on the association's Web site.

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