“Can’t come in; I am sick”

[Dr Mantis Toboggan]

I guess most of my experience with these systems was during residency where some clearly abused them. There were some residents I knew of, mostly in other programs, who activated it every month or two with regularity.

What we do if one of us can’t work or has an emergency is email or text the group. Someone always picks it up.

I guess re-reading my comment I come off as some sort of harsh badass which I can assure everyone I am not.

I guess my constitution is pretty good though as knock on wood I’m rarely sick.

(You are exposed to influenza A. Make a save versus Con or you suffer the “diseased” condition, +5 modifier if you received the flu shot, -2 if your mom is an anti-vaxxer).

Call outs for being a human being?
Made of flesh and blood?
That has emotions?

Your statement just reinforces a culture of toxicity.

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[DeadCactus]

My experience has been that "abusing the system" frequently translates into actually using the system while another cohort tries to stick to outdated practices and never actually uses the system as intended. Then they're mad because for a few extra days a month they can't drink or leave town but never actually call in when they would benefit from the system. I would argue that true abuse is exceedingly rare and even where it exists should be treated at the individual level. Nevermind that "abuse" it a strong word for calling someone in who knew it might happen that day and then taking one of their shifts in the future. And again, the existence of a system doesn't mean you need to abandon a culture of people generally trying to trade for coverage, it just makes sure there is a safety net.

People who come to the emergency department deserve to be cared for by physicians who are bringing their A game and not by someone distracted by illness or personal concerns.

 

[Brigade4Radiant]

Call is fine but should be paid since you are using their time and they can’t work for other places. Also being an independent contractor being on call is kind of tricky.

Call gets abused in residency because you don’t get paid for the shift

 

[dadaddadaBATMAN]

My experience has been that "abusing the system" frequently translates into actually using the system while another cohort tries to stick to outdated practices and never actually uses the system as intended. Then they're mad because for a few extra days a month they can't drink or leave town but never actually call in when they would benefit from the system. I would argue that true abuse is exceedingly rare and even where it exists should be treated at the individual level. Nevermind that "abuse" it a strong word for calling someone in who knew it might happen that day and then taking one of their shifts in the future. And again, the existence of a system doesn't mean you need to abandon a culture of people generally trying to trade for coverage, it just makes sure there is a safety net.

People who come to the emergency department deserve to be cared for by physicians who are bringing their A game and not by someone distracted by illness or personal concerns.

My guess is that mantis is referring to off service people who regard an em month as a vacation month and call out for 5 days because they’re “sick.” This does happen at some programs, and it’s kind of thorny to prevent because the primary program often doesn’t give a flying fu*k what the residents do in the ed.

That doesn’t mean that in the real world working with colleagues who have a work ethic that there shouldn’t be a call system.

 

[p1acebo]

My experience has been that "abusing the system" frequently translates into actually using the system while another cohort tries to stick to outdated practices and never actually uses the system as intended. Then they're mad because for a few extra days a month they can't drink or leave town but never actually call in when they would benefit from the system. I would argue that true abuse is exceedingly rare and even where it exists should be treated at the individual level. Nevermind that "abuse" it a strong word for calling someone in who knew it might happen that day and then taking one of their shifts in the future. And again, the existence of a system doesn't mean you need to abandon a culture of people generally trying to trade for coverage, it just makes sure there is a safety net.

People who come to the emergency department deserve to be cared for by physicians who are bringing their A game and not by someone distracted by illness or personal concerns.

That’s the thing though, who wouldn’t be upset by losing “a few extra days” per month of time off. Time is a commodity, and if my free time isn’t actually mine I expected to be compensated for it. A call system where you are paid for your time works fine, but you’re damn right I would be upset if I am expected to be on call without compensation.

Both places I work at we don’t have a call system. Admin on call sends an email out, people get paid time and a half, and we haven’t had any issues with coverage. If there ever was an issue then it’s the admin on call responsibility to figure out coverage/cover the shift themselves, since they are the ones receiving a stipend and have protected time.


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[emergentmd]

I have never seen a call in system or an on call system. On call keeps docs who are not working on a string the whole day which sucks.

If you are sick, send a group text out. If that doesn't work or an emergency, text the director. If not one truely can work, extend everyone;s ours by 2 and its covered.

never in all my years did an on call system benefit more than hurt.

 

[thegenius]

I have never seen a call in system or an on call system. On call keeps docs who are not working on a string the whole day which sucks.

If you are sick, send a group text out. If that doesn't work or an emergency, text the director. If not one truely can work, extend everyone;s ours by 2 and its covered.

never in all my years did an on call system benefit more than hurt.

?? At a prior job we had it, got paid $300 per 12 hrs you were on call. Twice/month. I didn't mind. It's not like it interrupted my mountain climbing experiences.

You basically can't drink or leave the area for those 12 hours. Otherwise you have almost unlimited freedom.

To each is own I guess.

 

[Groove]

I'm totally against call systems. Forcing someone to sit at home on their day off in case the ED needs to be decompressed and paying them pennies when they could have spent that day working a normal shift and making much more money is totally unfair. Most of the time it's not the physician that's the issue, it's lack of ancillary staff such as techs/nurses.

Plus, I can't enjoy a nice evening dram of scotch....on my DAY OFF? Seriously? LAME.

 

[DeadCactus]

That’s the thing though, who wouldn’t be upset by losing “a few extra days” per month of time off. Time is a commodity, and if my free time isn’t actually mine I expected to be compensated for it. A call system where you are paid for your time works fine, but you’re damn right I would be upset if I am expected to be on call without compensation.

Both places I work at we don’t have a call system. Admin on call sends an email out, people get paid time and a half, and we haven’t had any issues with coverage. If there ever was an issue then it’s the admin on call responsibility to figure out coverage/cover the shift themselves, since they are the ones receiving a stipend and have protected time.

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Sounds like you have a call system. Admin is on call. You pay them to take your share of the call. Now you have less money and a psychological incentive to not actually use the call system you're paying into. Bad for physicians, bad for patients.

Want to be paid for call? Fine. Take away from your normal shift pay and distribute it as a call-pay. You can play whatever shell games you want. At the end of the day, the group brings in a certain amount of income. That income is divided up. The group needs to staff the ED 24/7. Those shifts are divided up. Now if coverage falls through at the last minute, someone is going to need to step-up. Pay your admin, pay an incentive, pay a PRN physician, pay in lost income and maybe a lost contract, pay in lawsuits attributable to being distracted on the job, whatever.

Some of this is arguing semantics and different practice set-ups will have different optimal call logistics. But whatever mental gymnastics people want to play doesn't change that creating barriers to people calling out when they need to and running a critical function with no firm back-up plan is archaic.

 

[TooMuchResearch]

You know what's awesome about a call system?

Sometimes for a weekend I'm "on," I actually only take 24 hours of call (Friday-Sunday weekend, not sure if that's the norm). I'll happily get most of an extra weekend off and take some cash for the day I was on call.

I'm totally against call systems. Forcing someone to sit at home on their day off in case the ED needs to be decompressed and paying them pennies when they could have spent that day working a normal shift and making much more money is totally unfair. Most of the time it's not the physician that's the issue, it's lack of ancillary staff such as techs/nurses.

Plus, I can't enjoy a nice evening dram of scotch....on my DAY OFF? Seriously? LAME.

 

[OneTwoThreeFour]

I'm totally against call systems. Forcing someone to sit at home on their day off in case the ED needs to be decompressed and paying them pennies when they could have spent that day working a normal shift and making much more money is totally unfair. Most of the time it's not the physician that's the issue, it's lack of ancillary staff such as techs/nurses.

Plus, I can't enjoy a nice evening dram of scotch....on my DAY OFF? Seriously? LAME.

Literally the things you can't do are drink/do drugs or leave town. You don't need to sit at home. Go to the movies, clean your house, go shopping, spend time with your kids. Again, anything that isn't get intoxicated or be out of town. How do you usually spend a random Tuesday off?

 

[Groove]

Literally the things you can't do are drink/do drugs or leave town. You don't need to sit at home. Go to the movies, clean your house, go shopping, spend time with your kids. Again, anything that isn't get intoxicated or be out of town. How do you usually spend a random Tuesday off?

I haven't carried a pager since I was a resident and don't intend to start anytime soon. I thought that was the greatest thing about EM when I started and I still do today. The ability to leave work behind, turn off my phone and not worry about being called back to the hospital. It's glorious. If I felt like working, I would have worked an entire shift and earned 6-10x what they are probably paying you guys to be on call. I can't believe any of you doing routine call are ok with it. How many days a month are they requiring you to take call? Craziness.

 

[Brigade4Radiant]

Literally the things you can't do are drink/do drugs or leave town. You don't need to sit at home. Go to the movies, clean your house, go shopping, spend time with your kids. Again, anything that isn't get intoxicated or be out of town. How do you usually spend a random Tuesday off?

No you can’t work and how can you watch your kids if you get called in you have to get a back up babysitter. Also it is it is not a day off if you’re on call. You don’t need to justify what you do on off days same as justifying when you call off.

It’s not a random Tuesday being on call means calls for nights weekends and holidays so that means you can’t visit your folks for Christmas as well.

In academics who do call they also get vacation time as well. If you are doing call your hourly rate should be higher. It is the staffing company's responsibility to staff the ER let them do it why else then do they get all this money?

 

[p1acebo]

Sounds like you have a call system. Admin is on call. You pay them to take your share of the call. Now you have less money and a psychological incentive to not actually use the call system you're paying into. Bad for physicians, bad for patients.

Want to be paid for call? Fine. Take away from your normal shift pay and distribute it as a call-pay. You can play whatever shell games you want. At the end of the day, the group brings in a certain amount of income. That income is divided up. The group needs to staff the ED 24/7. Those shifts are divided up. Now if coverage falls through at the last minute, someone is going to need to step-up. Pay your admin, pay an incentive, pay a PRN physician, pay in lost income and maybe a lost contract, pay in lawsuits attributable to being distracted on the job, whatever.

Some of this is arguing semantics and different practice set-ups will have different optimal call logistics. But whatever mental gymnastics people want to play doesn't change that creating barriers to people calling out when they need to and running a critical function with no firm back-up plan is archaic.

I mean you could Interpret it that way. These are admin physicians who receive a stipend anyway for other administrative tasks... they are not receiving extra just to be the admin on call for any particular day. To put it in perspective, I wouldn’t want their job despite the stipend, because it is more than just being on call.


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[TooMuchResearch]

On average, less than 1 day per month. Some people request more of them as the odds of getting called in are low and we get paid.

I haven't carried a pager since I was a resident and don't intend to start anytime soon. I thought that was the greatest thing about EM when I started and I still do today. The ability to leave work behind, turn off my phone and not worry about being called back to the hospital. It's glorious. If I felt like working, I would have worked an entire shift and earned 6-10x what they are probably paying you guys to be on call. I can't believe any of you doing routine call are ok with it. How many days a month are they requiring you to take call? Craziness.

 

[TooMuchResearch]

Staffing company? SDG, it's our money to spend. Just like we like staffing heavy and having time to chat and take breaks. We could staff lighter and make more money, but we like our coverage the way it is.

No you can’t work and how can you watch your kids if you get called in you have to get a back up babysitter. Also it is it is not a day off if you’re on call. You don’t need to justify what you do on off days same as justifying when you call off.

It’s not a random Tuesday being on call means calls for nights weekends and holidays so that means you can’t visit your folks for Christmas as well.

In academics who do call they also get vacation time as well. If you are doing call your hourly rate should be higher. It is the staffing company's responsibility to staff the ER let them do it why else then do they get all this money?