How does the "On-Call" system for surgeons work?

Question

Let's say you are an Orthopedic surgeon who work's in a hospital, do you have to be on call or is it optional? I know you get paid more but that isn't my questions. Also, when you ARE on call, do you stay overnight? Where? I have heard that with resident's in some of these fields like Neurosurgery and Ortho you have to stay at the hospital like three day's in a row or something, that's brutal. How does this all work?

Answer 1

The on-call system for people who are fully-qualified doctors generally doesn't mean that they have to be actually in the hospital.  They may come in for a few hours to get to know the cases on their census, but usually they don't have to come in unless they're actually being called upon to operate, in the case of surgeons.

You usually don't get paid extra for taking call unless you are taking extra call for someone else.  There's usually a schedule and everyone takes call in turns, and mostly this is just to cover nights and weekends.  If you're in certain specialties or you're a big enough shot, you may not have to take call at all.  ;-)

Residents are a different proposition.  Residents do get paid, but everyone (basically) gets paid the same amount.  Everyone has to take call.  It is no longer permitted for residents to be on call for more than 24 hours in a row (with certain exceptions for transfer of care and for being allowed to stay on a case if you got enough sleep the night before).  Calls are usually every third day or every fourth day--they can't be more often than that without putting the program in violation of the rules, and they're pretty serious about that these days.

It still is pretty brutal, though.  

Answer 2

Hang in there, Marie... you should be seeing the light at the end of the tunnel any time now. ;)

Being "on call" takes on a variety of different possible meanings to doctors once they are out of residency training.  To some extent, it's dictated by the hospital or hospitals that one chooses to work in.  

Hospitals that have residency training programs almost always have some doctors in the building 24 hours a day.  Hospitals which are trauma centers will have lots of work going on all night long.  The new rules regarding resident work hours limit us to scheduling no more than 80 work hours per resident per week, and no more than 24 continuous hours of work in which new patients might be taken in, and after that, a maximum of 6 hours with no new-patient duties, in which to tidy up before going home.  The regulations also specify that on average, there needs to be 1 or more days off in every seven (averaged over 4 weeks) and 10 hours off before returning after a 24 hour block of time on call.  These rules were instituted in 2004, just as I finished training.

These rules do not apply to doctors who are not in training in accredited programs governed by the ACGME (Accreditation Council for Graduate Medical Education).

It is also specified that sleep rooms be available for all residents who are on call in the hospital.  This used to include bunk beds crammed into little rooms that looked like army barracks.  Now, privacy is considered a resident's right.  Call rooms are typically very small rooms with a bed and a phone, and maybe a desk and chair.  They're often sequestered away somewhere that doesn't take up too much room.  Space in large hospitals is usually at a premium.  Residents don't typically sleep while on call, so the rooms don't really matter that much.  There is a constant flow of things that need to be done.

In the modern system, it's common to have a night team that works completely independently from the day team.  Care is transferred back and forth between teams of residents so that they have to stay for 24 hours only on specific days in which the night team is taking a "day off".  This has been very useful in controlling the count of work hours per resident per week.

Once out of residency, being "on call" tends to have different meaning.  Typically, being on call means that the doctor in question is the one who will be called by the emergency department or by doctors or nurses in the hospital who need help with patients urgently.  

Doctors who admit patients to the hospital need to be available for those patients 24 hours a day.  If that doctor is unavailable, then they need to have made arrangements for someone else to be available on their behalf.  This is a form of being "on call".  In a multiple surgeon group, for example, every night is given to one of the group to take phone calls and possibly go in to the hospital if needed.  If there are 3 surgeons in the group, and they share the burden equally, then each of them would be on call once every 3 nights in a rotation.

At busy hospitals with busy emergency departments, even if they're not designated as trauma centers, they may try to make sure that they have "surgical coverage" every night of the week.  This means that they will have someone designated to call for surgical issues every single night.  This can actually be difficult to achieve because there is a shortage of surgeons right now, and the shortage is actually growing.  Many times, there are no surgeons on call and if a patient arrives in the emergency department that needs surgical evaluation, they get transferred to another hospital with surgeons available.

To be on ER call, then, is to be at home, but to be ready to come into the hospital if needed for emergency cases.  

At some nice private hospitals where doctors actually compete with each other to work there, it can be a requirement for all doctors on staff to participate in an ER call rotation.  At other hospitals, there may be incentive pay to get doctors to agree to be on call.  At some hospitals, the coverage may be so problematic that a doctor is hired with full salary, specifically to be on call.  Many hospitals are unable to have surgeons on call all the time and end up transferring patients when they need surgeons or specialists.

Part of the reason that it's difficult to get doctors to agree to be on call is that it can be a money losing effort.  There are important laws about keeping patients safe, and they include that there cannot be a financial decision made to turn away a patient.  Care must be delivered in an appropriate fashion in an emergency.  If the patient cannot pay, then the bill goes unpaid.  

The patient cannot be turned away and the care cannot be altered from best-practice based on the status of their ability to pay.  Being on call, therefore, often means doing work for free, and oddly enough there are just as many lawsuits (in some cases MORE) generated by non-payi