ED Call Pay - Is it just about the money?
During the thousands of interviews that we have had with physicians over the past several years, we have encountered a wide spectrum of attitudes toward the profession. It is interesting how openly physicians share with us their perspectives on a variety of subjects. As compensation consultants perhaps we cannot relate fully with the issues facing the healthcare industry and physicians in particular, but we have certainly had a unique vantage point from which to learn by simply listening to physicians as they express their feelings about their work and their relationships within the healthcare system.
This week during an engagement with a community hospital in New England we were somewhat surprised by a conversation with a young physician who described his work as a “privilege”. He was amazed at the struggle many of his colleagues were having about being compensated for covering the unassigned patients in the ER. He shared with us that his brother pursued law and was driven exclusively by financial gain but over the years his brother had never seemed to be happy. He chose to pursue medicine, driven by his belief that practicing medicine is a privilege regardless of the financial rewards. This conversation wasn’t typical of the many discussions that we have with physicians regarding the changes in healthcare and being paid for ED call coverage.
Atul Gawande would be considered an authority on the subject of the issues facing physicians. He delivered this year’s commencement address at Harvard Medical School and his speech was posted in The New Yorker on May 26, 2011 under the title, Cowboys and Pit Crews. Dr. Gawande is a MacArthur Fellow, a general and endocrine surgeon at the Brigham and Women’s Hospital in Boston, a staff writer for The New Yorker, and an associate professor at Harvard Medical School. He wrote the recent New York Times best seller, The Checklist Manifesto.
We found Dr. Gawande’s commencement speech to be consistent with what physicians and executives are telling us anecdotally. After years of working closely with hospital executives and physicians addressing the vexing issues of the narrow but complex matters of emergency department call pay, we have had a “pit-row pass” to view many of the topics that Dr. Gawande addresses in his description of the delivery of healthcare today.
In the speech Dr. Gawande states, “We are at a cusp point in medical generations. The doctors of former generations lament what medicine has become. If they could start over, the surveys tell us, they wouldn’t choose the profession today. They recall a simpler past without insurance company hassles, government regulations, malpractice litigation, not to mention nurses and doctors bearing tattoos and talking of wanting “balance” in their lives. These are not the cause of their unease, however. They are symptoms of a deeper condition—which is the reality that medicine’s complexity has exceeded our individual capabilities as doctors.”
In our experience, we believe that “call pay” is not the cause of physicians’ unease but a symptom of a deeper condition. From a variety of perspectives there really is not enough money to resolve the issues surrounding emergency department call coverage. Dr. Gawande observes, “…the places that get the best results are not the most expensive places. Indeed, many are among the least expensive…the pattern seems to be that the places that function most like a system are most successful.” The way that we interpret this is that much of the demand for pay is an outward manifestation or mask for other issues related to efficiency and productivity.
We have seen remarkable transformations by the use of a structured physicians’ committee assembled to address the issue of “call pay”. Physicians representing those specialties that have the most significant “burden” imposed on their practice and lifestyle gather to collaborate on defining and quantifying the relative burden for their medical staff. The discussions reveal that most specialties do not fully understand their cohorts’ ED coverage stress points and how non-compensation related solutions exist.
Dr. Gawande observes, “You must have …the ability to implement at scale, the ability to get colleagues along the entire chain of care functioning like pit crews for patients. There is resistance, sometimes vehement resistance, to the efforts that make it possible.” Furthermore, he adds, “These values are the opposite of autonomy, independency, self-sufficiency.”
We predict that we will not see the end of the demands for being paid for ED call coverage by private practicing physicians serving on today’s medical staffs in hospitals across the country. We believe that the pressure on hospital executives to pay for call, to increase the current amount of pay, and to add to the number of specialties that are being paid will accelerate. However, we believe that a better understanding of the real issues and by addressing those issues through a well-guided physician’s panel will result in a call pay program that is more effective, efficient, and satisfying for all stakeholders.
We asked the young physician in New England if he would encourage his two young sons to follow his career path and become a physician and he said that it would be a dream-come-true if his sons became doctors.
Maybe it really isn’t just about the money.
Read Dr. Gawande’s commencement address at here.