Why Employed Physicians May Skimp on ER Call

As hospital-employed doctors seek out gigs that promote better work-life balance, facilities face bigger gaps in their ED call schedule. 

This article is excerpted from a story originally published on the Credentialing Resource Center, July 31, 2017.

Physicians once used ED coverage as a way to build their patient base. They would treat an unassigned patient in the ED, and that patient would then become a patient of the treating physician, helping build up the physician’s private practice. Now, fewer physicians own a practice; many are choosing employment arrangements with their organization. Some hospitals assume that employing physicians will solve the call coverage issue because they can include specific call arrangements in the employed physician’s contract.

“Good luck with that one,” says Rick Sheff, MD, chief medical officer for The Greeley Company in Danvers, Massachusetts. “Maybe you can contract with them for an employment in which they have to take call, but in an era of increasing physician shortage, they are getting better offers. You want them to take call one in four [days] and they get an offer from a different hospital to take call one in six.”

This mindset can be chalked up to physicians increasingly making choices based on their lifestyle and health, whereas in the past, work usually dictated physicians’ personal choices, says Robert J. Marder, MD, president of Robert J. Marder Consulting. One of these options is to work fewer hours, which includes not taking call.

The other problem with putting a specific number of call days in a physician’s contract, says Marder, is the physician will stand by that number even if things change at your organization. What if down the road there is a need for that physician to take call more frequently?

“Let’s say you put in the contract that they have to cover call three nights a week; you can’t make them cover four nights a week” if you need the extra coverage, says Marder. Still, he advises that organizations try to negotiate with physicians and build language into their contract about call coverage.

Another option is to employ or contract a specialist group for the sole purpose of taking call or hiring the group for regular service but adding call requirements to their contract.

“That may ruffle the feathers of existing groups because they don’t want to take call, but they don’t want someone coming in to take existing patients. But that might be part of the discussion. If you don’t take call, we are going to have to hire somebody,” says Marder.

Another option is for the hospital to help the group struggling with ED coverage by hiring an additional physician to fill the gap. The hospital could offer to subsidize the cost of the extra physician for the first few years, explains Marder, with the understanding that the physician will take call a certain number of nights.