Burnout, Age, Two Factors Affecting ED Call

Although not a new issue, with changes in lifestyle and practice, increased burnout, and staying in practice at later ages, physicians no longer want to spend one in three nights in the hospital. 

This article was excerpted from an article originally published on the Credentialing Resource Center, July 31, 2017.

If your organization is struggling to get physicians to take ED call, you are not alone.

“In the last 3 years, Greeley has worked with 700-plus hospitals and healthcare systems all around the country, all sizes and complexities. The most challenging, difficult project we ever work on is ED call,” says Rick Sheff, MD, chief medical officer for The Greeley Company in Danvers, Massachusetts. “It really speaks to how deep and thorny the challenges are.”

With increasing nonclinical obligations, pressure to see more patients in a day, and uncertainty about how they will be paid, physician burnout is becoming a common issue, with call being just one more obligation to add to physicians’ workload. The problem is that physicians are staying in practice longer, so older physicians are still taking call.

“It is a burnout experience in many specialties; we do recover from sleep deprivation less well as we get older,” says Sheff.

This can factor into the economic issue of taking call. For surgeons, taking call can affect the rest of their schedule. “If surgeons take call, they may be wiped out the next day and can’t operate. They might not want to schedule an OR day the day after call,” explains Robert J. Marder, MD, president of Robert J. Marder Consulting.

Burnout is not just an issue among aging physicians. Studies show that younger physicians are becoming burned out with fewer years of experience under their belts. According to a Medscape survey, 44% of physicians age 35 or younger reported high levels of burnout. One way young/new physicians are fighting burnout is by opting for a more balanced work-life ratio. According to Marder, physicians are now making choices based on their lifestyle and health, whereas in the past, work usually dictated physicians’ personal choices. One of these options is to work fewer hours, which includes not taking call.

If possible, hospitals should work with the medical staff to create language in its bylaws that allows physicians to request to opt out of taking call after a certain age or number of years of service.

“That is a nice thing to be able to offer, but it is not an automatic ‘gimme.’ What if you don’t have enough physicians in that specialty to cover call?” asks Sheff, adding that all ED call coverage/privileging decisions
need to be determined by the medical executive committee (MEC). 

By having something in the bylaws, organizations can plan for fluctuations in call coverage, says Marder. If the bylaws say physicians can request to opt out of call coverage after 20 years of service on the medical staff, the organization can track which physicians are approaching that mark and who might soon ask to be relieved of call duties.

An alternative for call opt-out is physician age rather than years of service. This approach addresses the issue from a patient safety perspective of age of fitness for duty, like airline pilots, rather than as a reward for service, and it allows older physicians joining a new medical staff to not have the burden of call.

Before making changes to your bylaws, Marder recommends that medical staffs think through what works best for their medical staff, community, and hospital. A combination of both options is a possibility to consider, particularly if there is a large component of the medical staff that have faithfully served over the years. Organizations can also grandfather older staff under one policy and start new staff under a more updated approach.