In April 2009, Sullivan, Cotter and Associates surveyed 142 organizations across the country for its fifth annual survey of physician on-call pay rates and practices. Here are some of the survey's key findings. Editor's note: Percentages offered throughout may total more than 100 percent due to multiple response categories.
1. More than half of physicians providing call coverage are paid. According to the survey, 54 percent of physicians providing on-call coverage received compensation. However, physicians providing on-call coverage at trauma centers are slightly less likely to receive pay than those at non-trauma centers.
2. On-call pay varies greatly by medical specialty. Trauma surgeons led the pack with 78 percent of hospitals providing stipends to trauma surgery first calls. Neurosurgery (76 percent) and orthopedic surgery (72 percent) followed closely behind. First-call OB/GYN physicians received compensation from 65 percent of hospitals, and cardiologists fell behind them with 45 percent of hospitals providing on-call compensation. Family practitioners didn't fair as well. Only 22 percent of hospitals reported paying these specialists for on-call coverage.
3. A majority of hospitals reported challenges in finding physicians to provide call coverage. Of the hospitals in the survey, 80 percent reported difficulties finding physicians for on-call coverage. This shortage has caused some facilities to reduce services. Specifically, the survey found 9 percent of hospitals having to shut down one or more services due to a lack of physicians available to provide on-call coverage. Plastic surgery was the most-commonly cut service line and neurosurgery came in second.
4. More than half of hospitals reported increased expenditures on physician on-call pay in the past 12 months. Fifty-five percent of survey participants said expenditures have increased. Breaking down those responses, as a percentage of all responses:
5. Nearly 60 percent of hospitals reported employing physicians specifically to provide on-call coverage. Even after hiring physicians, it is not uncommon for hospitals continue to provide compensation for on-call coverage. Specifically:
While nearly half of hospitals provide compensation for on-call coverage, most (72 percent) do not provide employed physicians additional compensation when they are actually called in. Of the 28 percent that do:
6. Independent physicians are more likely than employed physicians to be paid for call coverage. According to the survey, 82 percent of hospitals pay some independent physicians to provide call coverage. Additionally, independent physicians are more likely to receive compensation for actually being called in than employed physicians, and 70 percent of independent physicians always retain professional fees generated while on call.
Here is a breakdown of how hospitals compensate independent physicians for their services when called in:
Of hospitals that provide subsidies for unassigned or uninsured patients, 73 percent provide a percent of the Medicare fee schedule, and 27 percent provide a guaranteed level of payment. Of these who pay a percent of the Medicare fee schedule, 60 percent pay the full amount of the Medicare fee schedule, while the average is 115 percent of the fee schedule.
7. Most on-call pay is funded solely by the hospital. However, medical groups and the state sometimes contribute. Specifically:
8. Hospitals are most likely to determine on-call pay levels through negotiation, consensus building and examining local market rates. Specifically, here is how hospitals reported determining on-call rates:
When setting on-call rates, hospitals cited local market rates (80 percent), national market rates (70 percent), frequency of call (68 percent), likelihood of being called in when on-call (61 percent), acuity and intensity of care provided when on-call (51 percent), payor mix (32 percent), amount of inpatient follow-up care required (29 percent) and malpractice risk (16 percent) as considerations.
9. Not all physicians are required to provide on-call duties, paid or unpaid. Seventy-six percent of survey participants reported exempting some physicians from providing on-call coverage for the following reasons:
10. On-call pay is expected to grow. One-fifth of survey participants indicated they plan to start paying more physicians for on call services within the next six months. The reasons cited were:
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1. More than half of physicians providing call coverage are paid. According to the survey, 54 percent of physicians providing on-call coverage received compensation. However, physicians providing on-call coverage at trauma centers are slightly less likely to receive pay than those at non-trauma centers.
2. On-call pay varies greatly by medical specialty. Trauma surgeons led the pack with 78 percent of hospitals providing stipends to trauma surgery first calls. Neurosurgery (76 percent) and orthopedic surgery (72 percent) followed closely behind. First-call OB/GYN physicians received compensation from 65 percent of hospitals, and cardiologists fell behind them with 45 percent of hospitals providing on-call compensation. Family practitioners didn't fair as well. Only 22 percent of hospitals reported paying these specialists for on-call coverage.
3. A majority of hospitals reported challenges in finding physicians to provide call coverage. Of the hospitals in the survey, 80 percent reported difficulties finding physicians for on-call coverage. This shortage has caused some facilities to reduce services. Specifically, the survey found 9 percent of hospitals having to shut down one or more services due to a lack of physicians available to provide on-call coverage. Plastic surgery was the most-commonly cut service line and neurosurgery came in second.
4. More than half of hospitals reported increased expenditures on physician on-call pay in the past 12 months. Fifty-five percent of survey participants said expenditures have increased. Breaking down those responses, as a percentage of all responses:
- 25 percent said expenditures have increased by 1-10 percent.
- 26 percent said they have increased by 11-50 percent.
- 4 percent said they have increased by more than 50 percent.
5. Nearly 60 percent of hospitals reported employing physicians specifically to provide on-call coverage. Even after hiring physicians, it is not uncommon for hospitals continue to provide compensation for on-call coverage. Specifically:
- 46 percent pay employed physicians to provide call coverage.
- 39 percent provide no on-call pay to employed physicians.
- 15 percent provide no on-call pay but indicate that on-call duties are considered when determining total cash compensation levels.
While nearly half of hospitals provide compensation for on-call coverage, most (72 percent) do not provide employed physicians additional compensation when they are actually called in. Of the 28 percent that do:
- 14 percent provide an hourly rate.
- 11 percent pay them based on relative value units for physician work (wRVUs).
- 5 percent pay fee-for-service.
6. Independent physicians are more likely than employed physicians to be paid for call coverage. According to the survey, 82 percent of hospitals pay some independent physicians to provide call coverage. Additionally, independent physicians are more likely to receive compensation for actually being called in than employed physicians, and 70 percent of independent physicians always retain professional fees generated while on call.
Here is a breakdown of how hospitals compensate independent physicians for their services when called in:
- 25 percent provide a subsidy for unassigned or uninsured patients.
- 15 percent provide an hourly rate.
- 11 percent provide fee-for-service payment.
- 7 percent provide a subsidy for malpractice insurance.
- 7 percent provide payment based on wRVUs.
Of hospitals that provide subsidies for unassigned or uninsured patients, 73 percent provide a percent of the Medicare fee schedule, and 27 percent provide a guaranteed level of payment. Of these who pay a percent of the Medicare fee schedule, 60 percent pay the full amount of the Medicare fee schedule, while the average is 115 percent of the fee schedule.
7. Most on-call pay is funded solely by the hospital. However, medical groups and the state sometimes contribute. Specifically:
- 87 percent said on-call pay is funded solely by the hospital.
- 12 percent said both the hospital and medical groups contribute to funding.
- 2 percent said funding comes solely from the medical group.
- 1 percent said the state subsidizes on-call expenses.
8. Hospitals are most likely to determine on-call pay levels through negotiation, consensus building and examining local market rates. Specifically, here is how hospitals reported determining on-call rates:
- 48 percent negotiate on-call pay levels with each physician or practice.
- 46 percent develop on-call pay levels through a consensus process involving management and physician leadership.
- 12 percent determine on-call pay levels through a fair-market-value analysis.
- 2 percent determine on-call pay levels at the board level.
When setting on-call rates, hospitals cited local market rates (80 percent), national market rates (70 percent), frequency of call (68 percent), likelihood of being called in when on-call (61 percent), acuity and intensity of care provided when on-call (51 percent), payor mix (32 percent), amount of inpatient follow-up care required (29 percent) and malpractice risk (16 percent) as considerations.
9. Not all physicians are required to provide on-call duties, paid or unpaid. Seventy-six percent of survey participants reported exempting some physicians from providing on-call coverage for the following reasons:
- Age — 69 percent
- Courtesy or consulting medical staff privileges only — 58 percent
- Length of service at organization — 39 percent
- Administrative responsibilities —12 percent
- Individual basis — 5 percent
- Low number of physicians in the specialty — 2 percent
- Departmental basis — 2 percent
10. On-call pay is expected to grow. One-fifth of survey participants indicated they plan to start paying more physicians for on call services within the next six months. The reasons cited were:
- Shortages of physicians willing to provide on-call coverage in certain specialty areas, primarily surgical specialties and intensivists.
- Desire to increase the amount of coverage provided in certain specialty areas.
- Demands from medical staff.
- Physician expectations have increased as more specialties receive on-call pay.
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