This creates a dilemma for the pediatricians still taking call. We ran into that in our group in 2013. A local multi-specialty group that included 2 pediatricians and 6 family practice doctors quit taking call – except for one of the family practice physicians that continued taking call, but only for his own patients. This took about half of the local primary care providers out of the call rotations.
At the time, we already had hospitalists that would only take call for adult patients as they were all internists by training. That left the nursery, labor and delivery, the ER and pediatric admissions uncovered. This is a major EMTALA compliance problem (Emergency Medical Treatment and Labor Act).
Our group “stepped up” to cover, believing that we would gain patients for our practice. But we found that, on average, 30 to 40 percent went to other practices, some of whom were exactly those who dumped this mess on us in the first place. The lesson? Don’t think you will get patients for your practice out of such an arrangement.
It became a burnout job for multiple reasons. To start with, we were covering night and day, yet our competition would show up rested every day after their patients had received top quality hospital care from us.
In addition, as anyone that pays attention to reimbursement knows, hospital pediatrics tends to be very inefficient if you are running back and forth from home. In other words, working in clinic pays much better than running back and forth on call.
Our local hospital administration made numerous promises to fix the situation by either getting them back in the call schedule or bringing in help. Nothing materialized.After a few months, our group unilaterally decided to not come to the ER for any patients that were not from our clinic. We told the hospital that if they needed admission, they should load them in an ambulance and ship them somewhere else.
This resulted in a mix of threats from administration and ER staff, to report us for EMTALA violations for not taking the fictitious “EMTALA call” (a phrase they made up). Sometimes ER staff just lied about who the patient’s primary care provider was.
Overall, it helped, but left us covering labor and delivery with a secondary level nursery. After several rounds of negotiations and promises that did not materialize stretched out over 2 years, we hired a consultant to calculate the value of taking call. Many hospitals in other areas of the country pay for call, so there was no shortage of comparisons.
We told administration that we were done taking call for any patient that wasn’t ours. This is what surgeons have done for years, and have been receiving payments to be available for trauma call.Hospital administration finally came to the bargaining table, and we now receive payment for taking unassigned call for labor and delivery. The call payments are not enough to make anyone rich, but they are enough to add to salaries and get recruits to give us a serious look compared to practices that sign everything out to hospitalists.
Administration would not pay additional fees for admissions from the ER so those are currently being shipped elsewhere.
If you need to locate a consultant to give a valuation for call at your local hospital or details of what we negotiated, contact me at firstname.lastname@example.org.
Progress in Pediatrics Fall 2019 is October 10 and 11