Career and Life Planning Guidebook for Medical Residents

Callcoverage– Physiciancall coverage is almost a core expectation for many clinical specialties and practices. In the past, hospitals might have relied on physicians to provide coverage of emergency departments and other specialty departments without providing compensation to the physicians. Generally speaking, in today’s terms, physicians are unwilling to take on the additional risk and effort associated with call coverage without additional compensation. Although some hospital bylaws may still require some minimum number of uncompensated on-call days, especially for employed specialist physicians, this practice is less common than it was in the past. Call coverage may be limited to your clinical practice (i.e.,yourpatients),butmorethanlikelywillincludesome form of hospital coverage. An extension of traditional call coverage is the emergence of telemedicinewhich is being seen with increasing application in behavioral health, neurology, and cardiology. Call coverage compensation may take many forms such as a daily stipend, an hourly rate, professional fees generated for actual professional services rendered, credit toward productivity compensation, an activation rate, or a subsidy for uninsured or unassignedpatients. Compensation for call coverage is fundamentally a function of the burden associated with the call coverage. Examples of call burden include the size of the physician panel participating in the call rotation (e.g., 1:5), the restricted nature of the coverage, the scope, size, and trauma designation of the facility or facilities being covered, the acuity of patient care associated with the coverage, projected volumes of telephonic consultation and/or activations to present to the hospital, the applicable payer mix and associated risk for reimbursement, and other unique factors relevant to the coverage. Hospital options for call coverage include employed physicians, independent physicians, APPs, or locum tenens. In cases where there is a shortage of physicians to provide sufficient and often-required levels of 24/7/365 coverage, you may be asked to provide “excess” shift coverage above and beyond a reasonable and customary full-time obligation. Concurrent coverage of more than one hospital and/or more than one specialty panel will also influence the value of call coverage. There may also be shift differentials for evening, weekend, or holiday coverage. Be careful about comparing call coverage compensation “to your friend down the street who works at XYZ hospital,” as physician call coverage is fact specific and your burden is not the same as someone else’s, even in the same clinical specialty, across different facilities and in different markets. Also, be aware call coverage value may be included in a base salary structure and not necessarily paid out per shift. In instances where call coverage is paid on a per-shift basis, there are national surveys such as Sullivan Cotter & Associates and Integrated Healthcare Strategies that report physician specialty call pay data. Quality initiatives – No doubt you have heard about healthcare’s shift from volume-based care to value-based care. It’s a long journey, but one that is no less taking form with increasing quality metric-driven incentives designed to improve the quality of care delivered to patients and also result in lower healthcare costs. Implementation of quality incentives in a physician compensation model require trust, transparency, and data validation. There is no magic number for how much compensation might be put at-risk for such quality incentives, but you might expect anywhere from 5% - 20%. The specific types of metrics will vary among clinical practices and departments. Common metrics might include patient satisfaction, charting, clinical quality scores (e.g., percentage of patients receiving preventative services), or rates of surgical complications or hospital-acquired infections. The Centers for Medicare and Medicaid has long supported this transition to value-based payment SECTION II: T MINUS TWO YEARS CAREER AND LIFE PLANNING GUIDEBOOK FOR MEDICAL RESIDENTS 228