Healthcare is always changing, and the pandemic accelerated change in many ways. Healthcare leaders and physicians might be wondering how recent changes will impact call pay. Let’s take a look at the origin of conflict over call pay, factors that are perpetuating it, and why we believe call pay will continue to be a pain point requiring creative and sustainable solutions.

Origins of a conflict

Physicians began to ask for on-call compensation after EMTALA was passed in 1986, requiring them to provide care regardless of their patients’ ability to pay. Shortly after, reimbursement rates decreased. This exacerbated providers’ frustrations, which comes as no surprise given that they were being asked to work more for less money. The demand for call pay increased over the years, and by the 2000’s, the expense was rising at a rate that was unsustainable, threatening the financial viability of many healthcare organizations.

The rise in physician employment

The recent rise in physician employment has made on-call compensation a common component of physicians’ salaries. As a result, administrators expected agitation around call pay to become a thing of the past. But that didn’t exactly happen. Decades ago, the call pay crisis began with a perceived lack of fairness, and many doctors still don’t believe call pay is handled fairly. This has perpetuated contention over call pay and contributed to a culture of distrust at many hospitals.

The mixed medical staff

While call pay is included in employed physicians’ contracts, private practicing physicians are typically paid a per diem. There’s often a lack of understanding between these groups concerning how and why each side gets paid. Right or wrong, unequal treatment is typically seen as unfair, resulting in demands for more pay. These demands place administrators, who are already searching for ways to contain costs, in a difficult position, and it places a strain on their relationships with their doctors.

The impact of telemedicine

The pandemic brought about the widespread and rapid adoption of telemedicine. Telemedicine helped the industry navigate the increased demand for care, particularly in emergency departments. But it also further complicated working relationships between administrators and physicians. If one speciality is receiving support in the form of telemedicine, other specialties might interpret this as a decrease in the specialty’s call burden, leading them to ask for additional on-call compensation. A similar phenomenon occurred in conjunction with the rise in hospitalist programs.

Like the rise in physician employment, the rise in telemedicine was an unprecedented event, but the underlying issue surrounding call pay has remained the same for many years. No matter how the industry evolves, physicians care most about fairness. 

What’s next for call pay?

Successful call pay programs that will be able to endure the volatility of the industry are the ones based on the fairness physicians seek. In order to maintain the fairness of a program, you’ll need to prioritize flexibility of plan design and commit to the ongoing governance of your program. When a program is updated frequently to reflect changes in an emergency department’s needs, changes in the burden experienced by different specialties, and changes in employment models, it’s more likely to continue to serve the organization in the way it was intended to.