ACPE poll: physician leaders distressed by specialist shortage; On call pay controversial

Physician Executive, May-June, 2005 by Bill Steiger

Specialists should quit whining and do their fair share like everyone else.

Partial pay

Only neurosurgery, orthopedics and specialties dealing with jaw fractures are being paid.

We limit it to anesthesia, though others have asked. Anesthesia has special needs in our market and it's clear they simply can't make enough money to provide a competitive package given the demands of their exclusive contract. So our precedent is to compensate for call if they can't make MGMA median.

Currently doing this for pediatric orthopedics and general orthopedics. It appears that we will need to consider it for ENT in the near future.

New generation

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It is a generational thing. The older generation feels that ED call is an obligation; the younger generation feels that it is an imposition.

Pay plans

We have had specialists push to get paid for ER call, then quit the staff when it didn't work in their favor.

When the outside trauma specialists wouldn't take call, the hospital hired their own team. This turned out to be very expensive for the hospital, but seemed to send the message to other groups that were considering asking for call money. I haven't heard of any disputes since.

We have worked with the specialists groups to provide locum tenens coverage on occasion to give some relief for vacations, illness, etc. On the other hand, we have demonstrated we will actively recruit for employed specialists to provide the services we need and actively compete with the current group of specialists if they fail to provide the needed services. So far, the carrot and threatened stick has worked.

All of our specialists are not employed and are not being paid to take ED call.

Rather than start down the road to pay for ER call, we are employing specialists. We get better coverage and ancillaries. We have hired neurosurgeons, general/vascular surgeons, pediatricians, neurologists. All the other groups have backed down and agreed not to ask for ER money, fearing we would hire specialists in their area and compete with them with our 50 primary care employed physicians. We have calculated this is cheaper and more productive in the long run than paying every specialist for every night, and still having no loyalty or ancillaries. Of course we are in South Florida, where malpractice is outrageous and costs of business and living are outrageous, so physicians are much more willing to go the salaried route.

Pandora's Box

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Our fear is opening Pandora's box and then having to pay ALL physicians to take ER call.

This is a very difficult and sometimes troubling issue for our organization. How do you determine which specialties get compensated for ER call? Our primary care and medical subspecialties provide ER call without compensation. Our surgical specialists say they will not provide anymore coverage unless they are compensated. What do we tell our internists, family physicians and others who are willing to do this without compensation? This is a box I wish had not been opened.