How Much Should Clinicians Be Paid for Being On Call?

Carolyn Buppert, MSN, JD


February 26, 2018

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A reader asks, "How much are physicians and nurse practitioners (NPs) typically paid to take after-hours calls?"

Response from Carolyn Buppert, MSN, JD
Healthcare attorney

Pay for "taking call," as it is referred to in the medical profession, varies tremendously, from nothing extra over and above one's salary to $4500 per 24 hours, for neurosurgeons who are "on call" for a trauma center. One company that surveys hospitals places the average per-hour payment for on-call services at $12.50 for primary care, $30.73 for most specialties, and $83.33 for neurosurgeons on call for a Level I trauma center.[1]

Compensation for taking call is negotiable. The questions to answer, in the negotiating process, are:

  • What is the specialty?

  • What hours and days need coverage?

  • Does pay cover all hours a clinician could be called, or only the time spent when actually called?

  • What is the history, in the past 1-2 years, of volume of calls?

  • Is the clinician required to be ready to come to the office or facility? Is there extra compensation if the clinician has to visit a patient?

  • What is the population of patients involved? (Are they the clinicians' own patients? Are they patients of the clinician's practice? Are they patients enrolled at another practice?)

  • Will the on-call provider have access, remotely, to the health records for any patient who calls?

  • Are there policies and procedures that the clinician must follow when taking call?

  • What is the fair market value of the on-call service? To determine fair market value, the organization will need a consultant, and/or will need to refer to composite data available in such publications as the resource guide.[1]

Some employers expect their employed clinicians to take call, and the compensation for taking call is built into the salary and benefits package. The expectations and compensation usually are covered in an employment agreement. Let's say a NP's employment offer from a primary care practice includes a salary of $110,000 per year, which compensates the NP for 35 hours of patient visits weekly; 5 hours of administrative services weekly; and on-call coverage for the practice's patients 1 week every month, covering 5 PM to 8 AM on weekdays and 24 hours a day on the weekend days.

If $110,000 seems adequate compensation for the 40 hours per week, but not enough when on-call service is required, the NP might negotiate for an additional $17,000. The additional compensation of $17,000 in this example was calculated by multiplying the number of annual on-call hours by $12.

The employer might argue that $90,000 is adequate for the patient visits and administrative time, and the offer of $110,000 includes compensation for the on-call services. From there, the parties will negotiate the numbers reach a compromise, or walk away. Note that terms of employment other than monetary compensation may compensate for taking call. For example, the clinician might negotiate for extra vacation time as compensation for taking call. Or, the clinician may negotiate for a day off during the week that the clinician is on call.

When the on-call service is stand-alone (that is, the clinician is not employed for services other than taking call), an hourly rate or flat fee is very important, obviously. Again, the numbers are negotiable. The parties will want to answer the questions listed above and come to an agreement, in writing, about expectations and compensation.


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