Transparency in call pay: Can it cure medical staff division?


When call pay is creating division in a medical staff, it’s often because of the way contracts are negotiated. The most common approach is to negotiate with one specialty at a time behind closed doors. The lack of transparency in this approach has negative effects on hospital culture. For one, it fuels rumors that do not accurately reflect arrangements. It also pits specialties against one another in a fight for the same call pay dollars, and many believe that only those with political sway will be heard and adequately compensated. In other words, it is not believed to be a fair process. As a result, the hospital suffers from an environment of distrust and division, not only between medical staff and administration, but also between specialty groups.


That’s why we designed our Physicians’ Call Committee to be a platform for transparency. Our process was developed in 2005 with the help of physician leaders at Winchester Medical Center in Virginia, who were facing a call pay crisis. They believed that physician leaders should drive decisions on inclusion because they understood burden better than anyone. Former medical staff president at Winchester, Dr. Tom Oliver, said, “[We] felt strongly that while funding of the program would be the hospital’s responsibility, decisions on specialties to be included/excluded…should be decided by [the call committee] based upon available funding each year. It was felt such an arrangement would improve objectivity of the process.”


The committee, which is made up of 5 to 7 voting members, including an emergency room physician and a member of administration, works to develop a relative value for the burden of call for each specialty, not just those demanding to be paid. This is achieved using a fairness standard that goes beyond fair market value. After the burden of call is established for each specialty, the specialties are placed in tier groups and the call pay budget is allocated appropriately. The committee’s recommendations are shared with the medical staff before they are presented to the administration to ensure that call pay is no longer shrouded in secrecy.


This process transforms call pay from a point of contention to a source of good will. The simple fact that a process has been put in place to ensure the fairness of call pay arrangements goes a long way in the alignment of medical staffs with administrations. It also eases tensions between specialty groups. Even if there are specialties not being paid, they understand why, and they understand that the decision came out of a fair and transparent process.


Our clients have found that the Physicians’ Call Committee has led to a higher level of satisfaction surrounding call pay. Dr. Tom Oliver said: “Complaints about call have largely disappeared from the medical staff executive agenda. That’s the biggest thing that’s happened, is we just don’t hear people complain about it as much, so I think what it’s meant to the staff is a lower level of grief in general. Nobody likes taking call, but when you know you’re being recognized for it in some way then you’re just a little bit less unhappy about taking it. It hasn’t made us all happy physicians every time we’re taking call. We’re just less unhappy if I can put that in a positive way. I think that’s the biggest thing.”



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