Thursday, November 14, 2013

The Scientific and Objective Call Schedule

call schedulingExcessive Call continues to be a top reason that doctors seek other employment. It’s simply one of the biggest bones of contention in group practices of every size.

The arguments revolve around a call schedule’s fairness and the resulting volume for each physician. Even a plan perceived as “fair” by all participants won’t suppress physician turnover rates if the group’s size forces everyone to take call more often than desired for their individual lifestyle expectations.

Your call schedule must be as “scientific” and objective as possible, clearly communicated to all concerned, and managed by someone with authority supported by all participants.

It should not come as a surprise that controversy regarding call schedules strains group relations about as much as worries about income distribution. After all, physicians trained to be independent thinkers compromise their autonomy to join group practices for top reasons like reduced call and shared costs. Therefore, they’ll pay close attention to any perceived inequities in those areas.

Group size, medical specialty, geographic characteristics, number of hospitals served, physician seniority, and physician compensation methods all play significant roles in forming a call schedule you can live with. No single plan seems to work well in different practice settings.

That said, there are several principles and steps everyone can use to flesh out the mechanics of a workable call schedule:
  • Keep the mission to “provide quality care” in sight at all times.
  • Recognize that the practice provides care 24/7, 365 days a year.
  • Accept that physicians see taking call as their most demanding responsibility.
  • Never deviate from the physician-established rules and guidelines.
  • Remain unbiased—always.
Follow certain steps in creating and managing the schedule, too:
  • Determine the length of time the schedule will cover.
  • Distribute time-off request packets to physicians with deadlines for submission. The packets include records of previous vacations, remaining vacation allowance, and important dates and conferences coming up.
  • Work out conflicts individually or in meetings as required.
  • Build the schedule with consistent flow from previous schedules, allowing for variables (like time-off requests) to create a logical plan. 
Finally, the call schedule must include in its framework components such as:
  • Holidays;
  • Weekends;
  • Weeknights;
  • Hospital rotations;
  • Office rotations;
  • Back-up call for certain functions; and
  • Specialty considerations.
Most groups assign call schedule management to a senior physician or medical director and their administrators breathe a sigh of relief. If a nonphysician has this responsibility, the group must clearly outline the rules, stick to them, and protect the administrative person from typical assaults from disgruntled doctors or those seeking special favoritism. All in all, the job is probably best left up to the physicians to work out doctor-to-doctor.



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photo credit: Amarand Agasi via photopin cc