On-call physician compensation survey released

Sullivan, Cotter and Associates, Inc. has published its sixth annual survey of physician on-call pay rates and practices, the 2010 Physician On-call Pay Survey Report. The survey report, with data from 148 health care organizations nationwide, outlines physician on-call pay practices and rates paid for 40 physician specialty areas along with data reported for trauma centers and non-trauma centers.

Over half (55%) of the survey participants report that their physician on-call pay expenditures have increased within the past 12 months.  From 2007 to 2010, the median on-call expenditures reported by trauma centers more than doubled: the median trauma center on-call pay expenditure in 2007 was $1.2 million compared to 2010 expenditures of $2.4 million.   For non-trauma centers, the expenditure in 2007 was $433,849 compared to $798,000 in 2010.

The majority (95%) of the survey participants report providing on-call pay to at least some of their non-employed physicians with admitting privileges.  Nearly two-thirds (65%) report providing on-call pay to at least some of their employed physicians; however, over one-quarter (27%) indicated that the call pay was factored into the employed physician’s salary, therefore, no additional pay was provided.  About one-half (51%) of the survey participants reported that their physicians provide concurrent call coverage for more than one hospital within their health system.  In such instances, the majority (79%) provide additional compensation for this coverage.

The practices vary with regard to how a physician is compensated when called in to provide services. According to Kim Mobley, the survey director and managing principal of SullivanCotter, “In order to secure the required call coverage, organizations may supplement traditional professional fees with subsidies for unassigned/under insured patients, fee-for-service payments, flat hourly rates and malpractice subsidies.”  These subsidies may also apply to the follow-up care to an unassigned patient.

The key variables impacting physician on-call pay rates, according to the survey, are the rates of local and national market benchmarks, frequency of the call coverage provided, and the likelihood of being called in for service.  The payor mix and the compensation received when called in are also important variables for determining call pay rates.  Many of these variables were also included in the Office of the Inspector General’s Advisory Opinions pertaining to on-call pay. 

An emerging practice that is gaining traction is the use of compensation for excess call only.  According to the survey, this is used by about one-quarter (27% of participants). Compensation for excess call is a practice in which the physician provides a specified number of call coverage shifts per month or per year without compensation.  Once a specified number of shifts are exceeded, compensation is provided. Compensation for telephonic coverage only is also an emerging pay practice, with 15% or organizations providing this to physicians who are required to respond to the call telephonically, but are not required to present at the hospital.  In such instances, about 20% of the organizations reported that they only pay a portion of the normal unrestricted on-call rate, which is typically 55% of the rate.

The rates paid for call coverage vary by significantly by physician specialty.  In addition, some specialties are far more likely to receive on-call pay than are others.  “These data represent national market norms. Local market rates paid to physicians providing call coverage can vary,” said Mobley, who notes that on-call pay for surgical specialties providing trauma coverage typically represents the highest on-call pay rates. For example, the median hourly on-call pay rate paid to a Stroke Neurologist is $20.83 for unrestricted call coverage while the median rate paid to an Ophthalmologist, a higher paid specialty area, is $12.50 per hour. Mobley adds, “Some highly compensated specialties receive relatively low on-call rates of pay, as the market rates take into consideration the amount of call coverage required and the likelihood of being called in.”