Next-Gen Doctors Opting-Out

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

Of course, it’s getting more expensive these days to take hospital call as physicians are electing not to take this responsibility because of decreased reimbursement rates. Others opt-out because of a desire to spend more time with family, and/or scheduling conflicts. And, let’s not forget the liability concerns.

Historical Review

But, back in the old days, I recall eagerly signing up for call to make a few extra bucks [it was a very competitive proposition back then], as I started my fledgling practice.  About a decade later, I didn’t make much on-call money any more, but continued my rotation and chalked it all up to societal “pro-bona care”. And, the increased service visibility still garnered me a few lucrative patient referrals. Then, it became a financial and out of office-time loss, and ultimately a great liability headache. Fortunately, I could afford not to do it any more; and quit. Let the younger guys and gals “pay their dues”, I reasoned.

Legal Issues

Now today, there is a growing revolt of specialists against hospital on-call duties that threatens to violate Federal law and lose status as trauma centers. Specialties most likely to refuse include plastic surgery, ENT, psychiatry, neuro-surgery, ophthalmology and orthopedics. And, refusing to respond to assigned call is a violation of Federal law and carries fines as much as $50,000 per case.

Opting –Out

In contrast, refusing to sign up for call does not violate the law, and more physicians are taking this option. The problem opting-out problem is especially acute in California where hospitals are combating the issues with compensation, reporting the miscreant docs to the authorities, or threatening to remove them from staff completely.

Assessment

In turn, doctors are fighting back with lawsuits.

Other Supporting Opinions

Essayist Jeff Goldsmith,President of Health Futures Inc, and Associate Professor of Public Health Sciences at the University of Virginia*recentlyopined that:

“We can expect intensified conflict with private physicians over the hospital’s 24-hour mission and service obligation, specifically providing physician coverage after hours and on weekends. Younger physicians have shown decreased willingness to trade their personal time to cover hospital call in exchange for hospital admitting privileges as their elders did. Those admitting privileges are either less essential or completely unnecessary in an increasingly ambulatory practice environment. The present solution is for hospitals to pay stipends to independent practitioners for call coverage or to contract with single specialty groups large enough to rotate call internally.” 

NOTE: * Goldsmith, Jeff: The Long Baby Boom, by Johns Hopkins University Press, May 2008.

Conclusion

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