Nearly two-thirds of physicians receive additional pay for providing emergency department on-call services in the hospital, according to a survey from the Medical Group Management Association.
Neurological surgeons had the highest median daily rate for providing on-call coverage, about $2,000 a day. Near the top of the pay scale were neurologists ($1,500), cardiovascular surgeons ($1,600), internists ($1,050), and anesthesiologists ($800).
Among the specialties earning lower median daily rates for on-call compensation were: psychiatry ($500), general surgery ($500) gastroenterology ($500), ophthalmology ($300), and family medicine without obstetrics ($300), according to the data.
The survey of more than 2,500 physicians in group and solo practices and other health care providers found that 38% of respondents did not receive additional compensation for on-call coverage, while 62% received some type of added payment. Of those who received additional payment, the most common method of payment was a daily stipend.
But the survey's findings prompted a skeptical response from some emergency medicine experts.
This is the first year that the Medical Group Management Association (MGMA) has surveyed physicians and other health care providers about on-call compensation levels.
“Historically, on-call duties have been sporadically compensated by hospitals. However, we're seeing more hospitals compensating physicians, and we're seeing hospitals paying more,” Jeffrey Milburn, a consultant with the MGMA Health Care Consulting Group, said in a statement. “Hospitals are realizing they must compensate group-practice physicians for on-call duties.” For those who get paid for on-call coverage, more than two-thirds were paid only by the hospital. About 16% received added pay from their medical group only, and another 16% received some type of added pay from both the hospital and the medical group.
The survey also found that for most specialties, physicians working in multispecialty group practices received higher on-call compensation than did those in single-specialty practices.
Regional pay variations also were seen. For example, orthopedic specialists received higher compensation in the East, while general surgeons were paid at a higher rate in the Midwest than in other areas of the country.
Some of the regional variation is likely related to the medical malpractice climate in the state, said Crystal Taylor, MGMA assistant director of survey operations, adding that physicians also were likely to be paid more if they provided on-call duties in a trauma center.
Dr. Michael Carius, a past president of the American College of Emergency Physicians, questioned the MGMA survey findings. While ACEP has not commissioned a survey of its own on the on-call payment issue, anecdotal evidence indicates that the number of physicians receiving compensation to provide on-call coverage is much lower than is indicated by the survey, he said in an interview.
Hospitals increasingly are willing to consider creative arrangements, such as sharing on-call physician panels between hospitals, Dr. Carius said. However, in this tough economic environment, most hospitals are likely to be reluctant to pay for on-call coverage, he said.
“It really is a hospital-by-hospital and region-by-region problem,” Dr. Carius said.
ACEP and the emergency medicine community as a whole have been concerned about on-call coverage for a number of years. The ACEP On-Call Task Force, chaired by Dr. Carius, issued policy recommendations on the topic last year.
The task force recommended that policymakers provide liability protections to emergency and on-call specialty physicians to try to remove barriers to taking call. For example, one strategy proposed would be to change the threshold for a civil malpractice suit so that the plaintiff would have to show “recklessness” by the on-call specialist rather than “simple negligence.”
The task force also recommended the adoption of a compensation model for physicians who provide on-call coverage in the emergency department. A system that pays physicians a per-patient fee rather than a flat stipend would make the most sense, Dr. Carius said.
The task force also supported various ways that hospitals in the same region could work together to provide on-call coverage.