During our recent update to our Call Schedules and Compensation Database for physicians, we noticed some trends that we thought would be both interesting and helpful for physicians to be aware of. The purpose of our group compensation data is to help physicians know their worth by increasing transparency when it comes to pay and compensation for physicians. We hope to help tackle issues such as physician burnout from poorly negotiated contracts. Below, we’ve compiled the overall trends we found for on call schedules and compensation to physicians when on call. It likely goes without saying that call amounts, responsibilities, and reimbursement will vary a lot from specialty to specialty, so make sure you check the data for your specific specialty for true apples to apples comparisons.
Learn more about our salary and compensation data for doctors, including how to access our databases and contribute. Data is unidentifiable and anonymous when contributing and free to access. Please note that to access the data as well as contribute to it, you will need to be a member of our Physicians Side Gigs Facebook group, which is only open to physicians.
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Is call mandatory or can doctors opt in or out?
Over 75% of our physician members reported that call is mandatory at their current position.
Less than 15% said that call is optional.
The remainder reported situations such as:
Some call is required while other call is optional
They have a choice between what type of call they want to be on
Call requirements are determined by part-time or full-time status
The number of different scenarios presented by members highlights the importance of discussing such topics during your contract negotiations. Whatever your potential employer tells you, and whatever you agree to, make sure it is in writing. Verbal promises or explanations aren’t binding if they aren’t in your physician employment agreement.
Additionally, make sure that your contract specifies a maximum for how often you can be on call. We’ve seen several situations in the communities where physicians ended up taking double or more call than they were expecting to because other physicians retired, left, or were fired and either not replaced or were replaced with non-physician practitioners who negotiated no call as part of their agreement. It’s very important that your contract doesn’t have vague wording such as ‘call will be distributed evenly’ - in this situation if you are the only physician, you could be asked to take call every day without additional compensation!Â
Learn more on our physician contracts and contract negotiations page.
How is call coverage determined for doctors?
Most of our physician members say that call coverage is split evenly. This can be a potential benefit of joining a larger organization or practice, as you have more individuals in the pool for call requirements. In larger groups, this can mean that some physicians take call only a handful of times per month.Â
Some members reported that call coverage was determined based on clinical FTE. Some physicians noted unique scenarios such as call only being distributed amongst the partners in the group, whereas employed physicians were exempt. Another unique scenario amongst many groups was the ability to buy or sell call, so that doctors within the group could choose to take more or less call based on their desire to make more income or their willingness to give up income, respectively.
Who is included in the call coverage pool can depend on the practice environment and size, as well as individually negotiated contracts, overlap between specialty services that can handle similar issues, and who decides to opt in.Â
Interestingly, 35% of our members who included their call information for the database noted that even on days when they aren’t on call, they still cover their own patients.
A call rotation is often determined ahead of time and scheduled, adding some predictability and allowing doctors to make plans outside of their call rotation. The amount of time in advance that the call schedule was prepared varied, but not surprisingly, tends to be greater for groups for larger groups.
Holidays seem to rotate, and most institutions and practices try to divide them up as evenly as possible.
Where call is optional, it appears some of our members prefer to pick up the call coverage as often as possible. Picking up extra shifts as a side gig is probably one of the most lucrative and flexible side gigs many physicians can have, as side gigs utilizing your medical expertise tend to pay better. Therefore, it’s often mentioned when physicians on our communities are asking about side hustles, and often included on our unique side gigs for physicians section of our side gigs page.
Learn more on our side gigs for physicians page.
What is the on call compensation for doctors?
Over 65% of the physicians who contributed to our call and call compensation database mentioned they are not paid for being on call. Given the amount of inconvenience and distribution this can cause in physicians’ lives while they are away from work trying to decompress, this finding is something we hope transparency can help improve. Being unable to shut off work can be one of the factors that contributes heavily to physician burnout.
Not convinced? We asked our members specifically if call was a major contributor to burnout. 60% of respondents said yes.
Generally, private practices are more likely to pay for call or be paid by the hospital systems that they take call at, while doctors employed by a hospital system reported they aren’t. In the past, it was often customary for private groups that provide essential services to a hospital system to take call at that system for free. This was a mutually beneficial relationship in many ways since you also had admitting privileges at the hospital and it may have been part of the hospital bylaws. Increasingly though, it seems private groups are asking for compensation for these services, and considering taking their admitting privileges to hospitals where call responsibilities aren’t mandatory if the hospital system insists on free call coverage.Â
Note that many hospital systems require having certain specialties on call to maintain their trauma level status, so if you are a specialty that they need in the call pool to maintain their trauma designation, know that you have more leverage.
If you are in the midst of contract negotiations at an employed position where call is mandatory and uncompensated, consider asking for a clause that any call responsibility > ‘x’ number of nights requires compensation at a rate of ‘y.’ This can be a good way to ensure you’ll only be put on call if truly necessary, that systems are incentivized to find replacements for those that drop out of the call pool, and that you won’t be asked to backup non-physician practitioners who aren’t required to take call for free.
Can doctors do their on-call rotation from home or do they have to go in?
Over 75% of our doctors reported they are able to perform call responsibilities from their home. Only about 17% are required to do call in house. You all can probably guess which specialties are required to be in house (or can assume they’ll be in house).
Given that 65% of the same respondents aren’t paid for having to be on call, we’re at least glad to see that it appears there’s some overlap with those two data points.
For physicians who take home call, we also asked what percentage of the call they end up having to go into the hospital. The median response was 10%, while the average was a little under 25%. Again, this was heavily dependent on specialty and we urge you to look at the data for your own specialty to find apples to apples datapoints.
Do doctors get paid for the patients they see on call?
We asked our members if they got paid for the production via RVUs, collections, etc. for the patients they saw while on call. It was about a 50/50 response.
Of the physicians that were paid, some reported as little as $2,000 a year. The average, however, ended up closer to $45,000. That’s a significant amount of potential money left on the table for the 50% of our physicians who reported not being paid for their call work, making it an important topic to bring up during your employment negotiations.
Learn more about contract negotiations for physicians.
How many days a year are doctors on call?
Given the different practice environments and how call is usually evenly distributed among the physicians in the group, the numbers here range greatly.
The median number of days a year our doctors reported being on call is 65. The average, however, is significantly higher at 82.
When looking at the distribution, we noticed that doctors who reported less call coverage throughout the year tended to work in an academic setting or were employed by a hospital system, which instinctively makes sense as they are likely part of larger groups where call is distributed amongst more people.
Ironically, members who worked in these settings also reported some of the highest rates of being on call, which suggests that call requirements though less frequent may either be more onerous, complex, or be related to not being paid for those responsibilities. In private practice, while very few people likely enjoy being called in, you will likely be compensated for your time, whether it be via billing for the encounter or via your call stipend. Remember, If you’re feeling burned out and considering a shift out of medicine, it might be less the systemic conditions than issues at your specific job, so consider shifting to a different practice environment before hanging up the stethoscope altogether.
Conclusion
We hope the stats above help highlight areas where we think physicians are prime for better negotiations when putting together employment contracts.Â
We believe strongly that fair compensation for call coverage is necessary, as so many physicians feel their altruism is taken advantage of in these situations. This is particularly true when other members of the healthcare team are not required to take call but represent an increasing percentage of the hospital employed workforce.Â
Additionally, flexibility in the call schedule such as options to be compensated based on the number of call shifts that are taken can allow physicians who are seeking more compensation to take more call while allowing those for whom time off is a greater priority to be able to take some time off is critical with today’s physician demographics. As the makeup of our healthcare workforce gets more heterogeneous, shifting away from hard and fast call arrangements will keep more physicians in medicine as it will allow them to practice on their own terms.Â
In general, these factors together can help lessen physician burnout, and should be viewed as a solution to clinician burnout that actually moves the needle. With more and more physicians leaving medicine in today’s modern healthcare industry, these opportunities to make call responsibilities more palatable should be considered seriously by employers.
To dig into the data yourself, including looking for comparable data for doctors with a similar specialty, in your city, or with your specific practice environment, visit our compensation data for physicians to use in contract negotiations page.
If you are exhausted from the situation at your current position, we have a job board to help you find a better fitting position to meet your needs and to help balance your professional and personal goals. Before you sign an employment agreement for your next position, make sure to have a physician contract attorney review it to provide invaluable professional insights. Our physician contract negotiations page can also help you be on the lookout for contract red flags and know what parts of your contract (such as call!) to negotiate.