While not a typical measure of productivity, call time is a very real part of practicing medicine.  In the past, call coverage was considered a professional responsibility or expectation of being a physician, particularly in a traditional, independent-physician-owned practice.

However, today more physicians employed by groups or hospitals are looking to escape the burdens of owning and running a practice. For some physicians, it's a quality-of-life issue, and they're looking to reduce or eliminate call time to have more free time or spend more time with family. For these reasons, it's becoming more common to compensate physicians for taking call time.

According to the Medical Group Management Association's (MGMA) 2010 Medical Directorship and On-Call Compensation Survey, 59 percent of respondents reported receiving additional on-call compensation. Of those receiving additional compensation, various methods were reported:  hourly, daily, weekly, monthly, and annual stipends. The majority (56 percent) of those respondents received a daily rate. Median daily rates vary among specialties and may also be adjusted for weekends and holidays.

Case Study

In a physician-owned OB/GYN practice, call coverage was divided evenly among five physicians.  Then, one physician requested to be relieved of call obligations to spend more time with family.  Of course, this placed an additional burden on the other four physicians who picked up more hours. The practice was faced with the dilemma of how to equitably compensate the physicians now that there would be a difference in work schedules. 

The practice developed a new compensation methodology divided into three components:  

  • Base salary
  • Productivity bonus based on work relative value units (wRVUs)
  • On-call compensation based on a daily rate

To determine on-call compensation, the practice researched and assigned values for call time.  A daily rate of $500 was established. Weekend days and holidays were assigned additional values over and above the daily rate at $150 and $250 respectively. The call pool, which was valued at $200,100, is illustrated below.


 
Annual Call Pool
Days Rate Pool $ $
Daily 365 $500 $182,500
Weekend 104 $150 $15,600
Holiday 8 $250 $2,000
Total Call Pool Value:   $200,100  
 

Prior to one partner's request to drop call, compensation was distributed equally among the physicians. Based on last year's model of no productivity or call, each physician would receive $267,000 out of a total distribution pool of $1,335,000.

The following chart shows how compensation was affected by the new methodology, taking into consideration productivity and on-call pay. Notice how Dr. E's compensation was reduced due to elimination of call duties and slightly lower productivity (specifics of the productivity calculation have been omitted to focus on the call issue).   
 

 

  Base Salary Productivity Call Total
Compensation
Dr. A $165,000 $63,966 $49,400 $278,366
Dr. B $165,000   $68,367 $54,250 $287,617
Dr. C $165,000   $59,719 $45,100 $269,819
Dr. D $165,000   $61,317 $51,350 $277,667
Dr. E (no call) $165,000   $56,531 $0 $221,531
Totals: $825,000 $309,900 $200,100 $1,335,000

 

 
The previous example is just one way call can be handled. Of course, the traditional expectation is that call is part of the job and is not separately compensated.

Some physicians may receive compensation only if they are actually called in and may be paid an hourly rate, fee-for-service payment, or a rate per work RVU for the work actually performed. In some practices, physicians may be required to take a minimum level of call, or they may be exempted for reasons such as age, length of service, or in exchange for performing other administrative duties.

The key is to know what is expected and how it might affect productivity, work/life balance, and ultimately your paycheck.

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