The 2010 Sullivan, Cotter and Associates annual report on physician on-call pay found that physician on-call pay expenditures have generally increased over the past 12 months. Kim Mobley, managing principal with SullivanCotter, discusses five factors that impact on-call pay.
1. Amount of call coverage provided. Ms. Mobley says the level of on-call pay provided to a physician is closely related to the amount of call coverage the physician is expected to provide. The amount is also tied to the likelihood that the on-call physician will be called in to provide services when he or she is on-call. "If you think of a trauma surgeon, when they're on call, there's a pretty good likelihood they'll be called in to provide services relative to perhaps a gastroenterologist or a urologist," she says. For this reason, the level of on-call pay does not necessarily correlate to the average annual compensation of a particular specialty. "Some of it can be almost counter-intuitive," Ms. Mobley says. "In some instances you can have specialties that are fairly highly-paid, such as ophthalmology, that have relatively low on-call pay rates."
2. Payor mix. The on-call pay stipend may also be affected by the organization's payor mix and the amount the physician gets paid when called in. If a physician is providing call to an urban trauma center with an underserved population, he or she may expect a higher on-call pay stipend because reimbursement for the population is lower. Hospitals have to keep on-call pay stipends high enough (though obviously still at fair market value) to attract physicians to take call.
3. Number of available physicians in the community. If a physician is the only neurosurgeon in a small, rural community, Ms. Mobley says he or she will likely receive higher on-call compensation than a neurosurgeon in a large, urban area. The physician can command market share in the region; if he or she isn't available to provide coverage, the hospital is out of luck. On the other hand, large academic medical centers may provide lower on-call pay rates because they are staffed with residents who can help provide coverage. Ms. Mobley says the Sullivan, Cotter and Associates survey found that call pay rates are especially high at critical access hospitals because of the limited amount of physicians in their communities.
4. Organization policy on on-call pay. Physicians started receiving payment for call around 10 years ago, prior to which they were expected to provide services voluntarily as part of their affiliation with the hospital. Ms. Mobley says Sullivan, Cotter and Associates has recently seen some hospitals starting to provide call pay for excess call only. "That's a really important trend," she says. "For example, [the hospital] would expect a physician to provide so many shifts per month of call coverage, and beyond that, you get the pay." She says that extra pay would be granted to physicians who carry an extraordinary burden of call — for example, surgeons in smaller communities who are tasked with providing most of the coverage for their specialty.
5. Number of scheduled cases versus emergency cases. Call pay will also depend on whether the specialty receives more scheduled cases or more unexpected cases. For example, though cardiovascular surgeons are highly compensated physicians, their cases are generally scheduled in advance rather than at the last minute. "They're not as likely to be on-call pay [because] they're not being called in to perform emergency cardiovascular surgery," Ms. Mobley says. "OB/GYN tends to be higher because they're on call quite often and very likely to be called in [for an emergency birth]."
Learn more about Sullivan, Cotter and Associates.
Read more about compensation:
-Six Cincinnati Healthcare Execs Earned More Than $1M in 2009
-Blue Cross Board Members Pay Suspension Will Not Fix Rising Healthcare Costs
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1. Amount of call coverage provided. Ms. Mobley says the level of on-call pay provided to a physician is closely related to the amount of call coverage the physician is expected to provide. The amount is also tied to the likelihood that the on-call physician will be called in to provide services when he or she is on-call. "If you think of a trauma surgeon, when they're on call, there's a pretty good likelihood they'll be called in to provide services relative to perhaps a gastroenterologist or a urologist," she says. For this reason, the level of on-call pay does not necessarily correlate to the average annual compensation of a particular specialty. "Some of it can be almost counter-intuitive," Ms. Mobley says. "In some instances you can have specialties that are fairly highly-paid, such as ophthalmology, that have relatively low on-call pay rates."
2. Payor mix. The on-call pay stipend may also be affected by the organization's payor mix and the amount the physician gets paid when called in. If a physician is providing call to an urban trauma center with an underserved population, he or she may expect a higher on-call pay stipend because reimbursement for the population is lower. Hospitals have to keep on-call pay stipends high enough (though obviously still at fair market value) to attract physicians to take call.
3. Number of available physicians in the community. If a physician is the only neurosurgeon in a small, rural community, Ms. Mobley says he or she will likely receive higher on-call compensation than a neurosurgeon in a large, urban area. The physician can command market share in the region; if he or she isn't available to provide coverage, the hospital is out of luck. On the other hand, large academic medical centers may provide lower on-call pay rates because they are staffed with residents who can help provide coverage. Ms. Mobley says the Sullivan, Cotter and Associates survey found that call pay rates are especially high at critical access hospitals because of the limited amount of physicians in their communities.
4. Organization policy on on-call pay. Physicians started receiving payment for call around 10 years ago, prior to which they were expected to provide services voluntarily as part of their affiliation with the hospital. Ms. Mobley says Sullivan, Cotter and Associates has recently seen some hospitals starting to provide call pay for excess call only. "That's a really important trend," she says. "For example, [the hospital] would expect a physician to provide so many shifts per month of call coverage, and beyond that, you get the pay." She says that extra pay would be granted to physicians who carry an extraordinary burden of call — for example, surgeons in smaller communities who are tasked with providing most of the coverage for their specialty.
5. Number of scheduled cases versus emergency cases. Call pay will also depend on whether the specialty receives more scheduled cases or more unexpected cases. For example, though cardiovascular surgeons are highly compensated physicians, their cases are generally scheduled in advance rather than at the last minute. "They're not as likely to be on-call pay [because] they're not being called in to perform emergency cardiovascular surgery," Ms. Mobley says. "OB/GYN tends to be higher because they're on call quite often and very likely to be called in [for an emergency birth]."
Learn more about Sullivan, Cotter and Associates.
Read more about compensation:
-Six Cincinnati Healthcare Execs Earned More Than $1M in 2009
-Blue Cross Board Members Pay Suspension Will Not Fix Rising Healthcare Costs
-17 Statistics on Hospitalist Workload, Pay and Benefits