Readers Write: No Easy Answers For Scheduling Physician On-Call Coverage

No Easy Answers For Scheduling Physician On-Call Coverage
By Suvas Vajracharya, PhD

Recent criticism of on-call scheduling practices in the retail sector means that it may be time for healthcare operations leaders to review on-call scheduling practices for their physician teams.

In recent weeks, the retail sector has experienced close scrutiny for on-call arrangements with their staff. According to Reuters, New York Attorney General Eric Schneiderman and “his counterparts in seven states, including California and Illinois, have sent letters to a number of companies in the last year requesting information about their scheduling practices.” In response, employers like Aeropostale and Walt Disney have begun discontinuing the practice of keeping hourly workers on call for last-minute shift changes to avoid further legal disputes.

In healthcare, on-call coverage is regulated under the Emergency Medical Treatment and Active Labor Act (EMTALA). Most medical institutions choose to pay on-call physicians to ensure appropriate coverage under these rules. According to a 2012 SullivanCotter report, nearly two-thirds of healthcare organizations provided call pay to at least some physicians, up from 54 percent in 2010. However, the EMTALA regulations are excessively vague and “in a manner that best meets the needs for the hospital’s patients” can be interpreted in ways that leave physicians feeling like they’re receiving an unfair deal.

“In the MGMA’s 2013 Medical Directorship and On-Call Compensation Survey, primary care physicians reported a median on-call rate of $100 to $150 per day,” according to an article in Medical Economics.

From the physician perspective, these rates may not fairly balance the sacrifices they are making to provide on-call coverage during their days off — if they are receiving compensation at all. For retail employees, state officials concluded workers can be harmed by “unpredictable” schedules that can increase stress, strain family life, and make it harder to arrange child care or pursue an education. Fundamentally, to be on call as either a retail employee or a physician requires foregoing activities and flexibility with free time.

With physician burnout on the rise, heavy variation in the frequency of calls and a wide range in the number of physicians participating in call rotation, health leaders should invest proactively in finding fair on-call strategies to ensure the hospital’s access to physicians and to prevent turnover. How do we fairly compensate a physician for remaining in close proximity to the hospital and being physically and mentally capable of providing direct patient care at a moment’s notice? How do we weigh the difficulty of taking calls on holidays or weekends or being on primary call versus backup call?

Providing adequate on-call coverage remains a constant challenge for most healthcare institutions. Making it a program that is seen as fair and respectful of physician staff can be a crucial first step. Using scheduling technology instead of a manual process not only removes the sense that personal bias may be influencing how on-call hours are assigned, but also provides transparency across teams and flexibility for swaps. Scheduling technology with advanced algorithms based on artificial intelligence can also ensure that on-call schedule enforces work patterns in harmony with circadian rhythm of physicians who need to work at any hour.

Healthcare operations leaders should want to follow the lead of companies like Gap, who proactively change their policies to stay ahead of on-call criticism. Small policy changes can dramatically reduce risk for healthcare operations and improve physicians’ professional satisfaction.

Suvas Vajracharya, PhD is founder and CEO of Lightning Bolt Solutions of South San Francisco, CA.