Keep the doctors' needs in mind, too
Understanding the physician's perspective may help risk managers improve call coverage, says Joshua Kugler, MD, FAAEM, FACEP, chief medical officer and senior vice president at South Nassau Communities Hospital in Oceanside, NY, who used to be the ED director. While there certainly are times when doctors just shirk their duties, it is important to remember that they may have justification for not wanting to take ED calls.
Most physicians respect the need to serve the community, but they also desire more uninterrupted time with family as they get older, he says. Plus, older and more successful physicians sometimes resent not being paid for their time spent on-call. In addition, late-night calls could impede a physician's ability to carry on with the following day's scheduled surgeries or other care.
When Kugler's facility was seeking to improve call coverage and keep physicians satisfied, the hospital brought together a number of physicians and asked them what would make the process better.
"We tried to have an open dialogue about this. Trying to do it unilaterally is a great mistake, because it just alienates your medical staff," he says. "We tried to get their buy-in."
The hospital came up with a solution that includes a system for paying some physicians for responding to ED calls. For most physicians, the threshold is three calls per month without pay, and then the hospital pays for each ED call after that. The idea was to compensate those physicians who felt they were shouldering too much of the burden for call coverage.
"A mile away from us, another hospital pays the physician for every ED call, so we have to battle that," Kugler says. "That's fine if it works for them, but we felt we reached a good compromise considering our surgeons' needs and our economic reality."
Source
For more information on improving call coverage, contact:
- Joshua Kugler, MD, FAAEM, FACEP, Chief Medical Officer and Senior Vice President, South Nassau Communities Hospital, Oceanside, NY. Telephone: (877) 768-8462.
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