The vast majority of providers still require physicians to provide on-call coverage, but nearly half pay physicians to do it, whether the physicians are employees or volunteers, according to a recent survey.
Financial pressures on physicians from declining reimbursement rates and the growing ranks of the uninsured were among the most frequently cited reasons physicians are demanding to be compensated for what they once provided as a public service, according to the survey by human resources consulting firm Sullivan, Cotter and Associates.
"When they're called in, they may not get reimbursed for their professional fees, so they want to get paid for it," says Kim Mobley, a Detroit-based principal with the Sullivan Cotter.
Other drivers of the pay-for-call movement are compliance requirements under the Emergency Medical Treatment and Active Labor Act that have increased staffing obligations for surgical specialists and the growing difficulty of recruiting or retaining physicians without an on-call payment mechanism in place.
"Five years ago, I'd get one on-call physician payment issue a year," according to Mobley, who says she has worked in the physician compensation field for 16 years. "Now, it's about one a week. It really started taking off two years ago."
Survey respondents represented 167 healthcare organizations, of which 85% were either hospitals or integrated delivery systems, 19% were medical group practices and the remaining 6% were other healthcare organizations.
Eighty-six percent of survey participants indicated that they require physicians to provide on-call coverage. Of these, 46% indicated they paid affiliated physicians who worked on-call voluntarily, and 43% paid for on-call coverage to their employed physicians.
Fifty-nine percent of participating organizations surveyed has residents on staff, and of those organizations, 72% indicated their residents provide on-call coverage.
To facilitate comparisons between the different pay arrangements, which included daily, weekly and annual stipends, the study converted them all to an hourly rate and listed data separately for physicians who were required to remain on site throughout the on-call period and those who weren't.
Of the physicians not employed by the facility, the list of median hourly pay for on-call service by physicians required to remain on site was topped by general surgeons ($33.33); followed by neurosurgeons ($32.29); orthopedic surgeons ($26.04); internists ($16) and OB/GYNs ($14.84).
"Your trauma surgeons, your orthos, your neuros, your OB/GYNs -- those are the ones who are most likely to get the on-call pay (now)," Mobley says. "But it seems to be increasing. We're seeing it expand into radiology, into some of the primary-care specialties. A couple of years ago, that would have been unheard of."