On-call

Call sucks. I have been doing it for too many years and still hate it. No matter how you slice it, there is nothing fun about doing call. The cherry on top has always been that we don’t get paid for anything by phone and yet it is our highest liability in our job. When we do have to go into the ER at 3:00 AM, the pay is minimal. Obviously, I am not the only doctor who hates this aspect of our profession. A Boston Globe article recently pointed out how some Massachusetts hospitals are paying surgeons and other medical specialists $1000 a night to be on-call. This has brought on the debate between some of the older docs who think being on-call is a physician’s responsibility and some of the younger ones who don’t. The latter consider themselves “contractors in a competitive market dominated by insurance companies seeking to control healthcare costs”. Amen.

Federal law requires emergency rooms to provide specialists on-call to handle all types of, well, emergencies. The problem is that the hospitals don’t really want to pay much for this requirement. Many specialists who have had the option to bail from call have done so and this has created somewhat of a crisis in our country. There are different opinions about whether docs are ethically, morally and professionally obligated to do call but I say that is crap. The article makes a good point by explaining that in the good old days when doctors made a fair reimbursement from insurance companies and the government they would feel this obligation for call. No longer. Some of the doctors now feel like it is indentured servitude. And I agree.

There are a lot of interesting points to this phenomenon. One is that if physicians band together we can make the healthcare system bend in our favor. This “pay for call” issue proves it. It turns out that hospitals have some extra cash laying around and will pay a fair wage if you pressure them. Second, the older generation of physicians may feel an obligation to do what they did 50 years ago but they have to realize that times have changed. Right now a little thing called managed care rules the land. All bets are off and all rules can been broken. The second point is more personal. No where in the article is the issue of primary care doctors being paid mentioned? You have got to be kidding me! We come into the ER more often than the specialists! We get paid less than the specialists! It seems, according the Boston Globe article, we still are the steerage class of medicine.