December 1999 Bulletin

Managing call is tricky business

BONES survey finds practices use a variety of policies and methods

You have three orthopaedic surgeons who want to stop taking call in two or three years; what do you do if you have no policy to follow?

Pat McAnally, administrator, Ozark Orthopaedic and Sports Medicine Clinic, Fayetteville, Ark., sent a fax message asking for advice from members of the BONES Society, a national organization of orthopaedic administrators.

There's a tangle of issues and many solutions, as is apparent in the replies to McAnally's request for advice.

Meeting the demands for having enough physicians to take call can be a tricky business. Young physicians like and/or need to be on call to build a practice and become known for future referrals. As their practice grows and demands from their profession and their family increase, taking calls becomes less attractive.

Complex issues arise, including setting limits on how many physicians can go off call, establishing criteria for who qualifies to go off call, reducing salaries of physicians who are not taking call and requiring those physicians to retire within a few years. The practice can hire younger physicians who will take call, but how long should the older physician continue to do surgery? There's no problem, if everyone in the practice is overworked, but if not, the younger physician who is taking call may believe he/she is in competition with the older physician who has given up call.

Knoxville Orthopaedic Clinic, Knoxville, Tenn., has a policy related to senority and compensation, said Glenn D. Sumner, CEO. If the physician has been in the practice for 20 years and there are enough physicians to meet the call coverage, a physician can elect to go off call. The physicians' compensation is based on 70 percent productivity and 30 percent salary. Going off call results in a 10 percent reduction in the salary portion of the compensation.

The practice has 27 physicians plus five who are off call and one, a pediatric orthopaedic surgeon, who gave up call at a general hospital and only covers calls involving children.

Allan Fentner, practice administrator, Orthopaedic Associates in Cleveland, Ohio said, "we only allow physicians to go off call, based on staffing needs. That is specified in language in their contracts." Fentner suggested McAnally consider a job-sharing arrangement that allows adequate coverage for the practice and allows a reduced call schedule for the three physicians.

Tallahassee Orthopedic Clinic, Tallahassee, Fla., has two founding members who do not take call. The guideline for giving up call is that the physician has to be older than 55 years of age and has more than 20 years of service, said Deborah A. Whooley, administrator. "The group looks at going off call as an earned right," she said. The practice has recently hired two physicians who are taking up the slack.

Call is mandatory until age 55 at Orthopaedic Associates, Baltimore, Md., said Jim Linz, CEO. "I consider call in ER as an asset of the practice," he said. "It keeps the physician and the group in front of the primary care doctors," he explained.

Linz suggested that McAnally "take a percentage of the bottom line after expenses and set it aside to pay the doctors." If the doctors want to stop taking call, it is a financial decision, he said. "If they decide to take call, it is a major benefit when the spouse knows that the doctor is getting paid when he/she gets up in the middle of the night to take call," Linz said. "You will no longer hear the doc complaining because the spouse won't be."

Linda Tiefel observed that increased compensation is not very important for the senior physicians. "The young guys might do it, but soon burn out," she said. "Money can't buy family time."

Tiefel, CEO at Lakewood Orthopedic Clinic, Lakewood, Colo., suggested that the senior physicians should be allowed to go off call first and then the next in line and so on as the call schedule permits and new physicians are available to cover the needs. But, she stressed that it is important to establish a minimum number of physicians who take call. Tiefel said that should be predetermined by the practice's board of directors.

Her practice uses a point system that combines the physician's age and number of years in the practice. When the two numbers total 60 points, the physician can go off weekend call. When the numbers add up to 80 points, the physician can go off all call.

What did McAnally's practice decide to do? The physicians held a retreat and discussed the issue, but did not come to a conclusion. Many issues surfaced from reducing compensation for physicians who stop taking call to setting a mandatory limit on how long the physician should work after he/she stops taking call. The practice has a few more years to find a solution.

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