Best ways to deal with call coverage

Key Points

It's a perfect recipe for conflict: As the AAFP is encouraging primary care doctors to provide round-the-clock call coverage-a key ingredient of its ideal practice model-more and more doctors are looking to cut down on their own after-hours work.

Young doctors, both male and female, are increasingly reluctant to sacrifice time with family and friends to take call. Some expect more pay for doing so. Others expect and ask for different perks-such as fewer regular office hours-in exchange for sharing equally in call. And young physicians aren't the only ones who want out; some older doctors do, too.

While the growing number of hospitalists has meant fewer 3 a.m. hospital visits for office-based doctors, that respite could prove temporary. The shrinking supply of primary care physicians, coupled with the aging baby-boom population's need for medical care, may lead to a surge in after-hours call.

"Call coverage is really a big issue these days," echoes Kenneth Hertz, a consultant with the Medical Group Management Association in Alexandria, LA. "One practice I met with was trying to recruit a pediatrician. The practice is in a small rural community, and the doctor it was negotiating with wanted to work only from 9 to 5-no weekends, and no call. He also wanted a lot of time off.

"The practice couldn't offer that, so the doctor took a job in another small community that apparently was able to meet his terms. With the shortage of doctors in specific specialties and the difficulty in recruiting to small rural areas, we're seeing all sorts of things that we didn't see years ago."

If conflicts over call coverage are stirring up trouble in your practice, restoring peace and finding a solution that everyone considers equitable will take some effort. Here are some options to consider.

Focus on the root of the problem

If you're having trouble covering call, try to identify precisely the issue that's creating the difficulty. Too few doctors? Too much swapping of hours? Physicians stonewalling against taking call?

While adding more doctors to the practice may seem like the best way to spread the burden, that's not necessarily so, says practice management consultant Judy Bee, with Practice Performance Group in La Jolla, CA. "Sharing call duty isn't a good enough reason to hold a group together," she notes. "If all the doctors feel overworked, hiring another provider may make sense. But if you don't need more doctors otherwise, you're better off trying to negotiate a call arrangement with doctors in other practices."

You may find it hard to organize a call group if you're working solo and reaching out to group practices for help. "Once a group has about five doctors, it can handle call internally and doesn't need the solo doctor," says Bee. You've got to offer something special as an enticement. "For example, one doctor who was negotiating call is Jewish, and his trump card was to take call on Christmas every year."

You may be reluctant to have doctors from another group cover call for you for fear of losing patients to them. Talk candidly about this up front, says Bee. "You need to determine how you'll all handle certain situations. For instance, if the on-call doctor from another practice sees a child during the night, all the doctors could agree that the original practice will handle any follow-up visits."