How much do your specialist get paid for call?

[Brigade4Radiant]

I was talking to one of the Ortho guys and he states he makes 5k a night for call? I couldn't believe it does that sound right? Does the hospital get funding for this. I called one of my OBGYN friends and asked him and he states they get paid 3k for call on unassigned patients.

I always thought that they took call for free

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[thegenius]

I was talking to one of the Ortho guys and he states he makes 5k a night for call? I couldn't believe it does that sound right? Does the hospital get funding for this. I called one of my OBGYN friends and asked him and he states they get paid 3k for call on unassigned patients.

I always thought that they took call for free

5K is impressive. I don't know if ours makes that much. I heard NSG where I work makes 3K / night.

Take call 10x / month for 12 months and that is 360K - 600K / year. Makes you just want to just take call all the time.

 

[Frazier]

It depends entirely on the hospital and system. Some contracted groups at desperate hospitals make bank. Others in an employed model make their annual salary and that's it -- call is just part of their contract.

5k per call night is bonkers.
Good for them. Same economics that are getting some nurses crazy cash during pandemic.

Although reflecting on $$$ for call makes it extra annoying when said surgeon answers the phone with "ugh, WHAT?!" or interrupts you 10 seconds into the convo to announce "I'm not coming in tonight."

 

[southerndoc]

I've known of ophthalmology groups that get $30k/month for being on call. Know of hand surgeons making $4k/24 hour period for call.

It does exist, and I think it's determined by how desperately they're needed. Makes you feel great that some of the specialists are making more than you while they're sitting at home getting called in once per week (hand surgery), eh?

 

[alpinism]

Yep the neurosurgeons on call here make about five grand per day.

They come in maybe once per month for operations after hours.

 

[Brigade4Radiant]

I've known of ophthalmology groups that get $30k/month for being on call. Know of hand surgeons making $4k/24 hour period for call.

It does exist, and I think it's determined by how desperately they're needed. Makes you feel great that some of the specialists are making more than you while they're sitting at home getting called in once per week (hand surgery), eh?

I wouldn’t mind that much if they didn’t have an attitude when I call them for a post op patient.

 

[nexus73]

I'm a psychiatrist and I get zero for call. So I'm never coming in, until tomorrow around 11am probably. And the hospital seems fine with that.

 

[EctopicFetus]

Another model is they get x for being on call but make more for an “appearance fee” if they show up.

We can hate all day on them but in the end they make hospitals bank. Real crazy money. Because of that and the scarcity of those specialists they can be like progressive auto insurance and “Name their price”. Tbh neurosurgeons work like dogs. I have no envy. I was good friends with a few and they would routinely work 60-80 hour weeks as attendings 10-20 years out of training. If I worked 80 clinical hours a week I would make similar $$ to them and be constantly suicidal. I’m good with my schedule and $$.

Ours do well as mentioned it all depends on leverage. My old gig had a ton of Ortho pods around and a great payer mix. I think they got $1k.

 

[GassYous]

I've known of ophthalmology groups that get $30k/month for being on call. Know of hand surgeons making $4k/24 hour period for call.

It does exist, and I think it's determined by how desperately they're needed. Makes you feel great that some of the specialists are making more than you while they're sitting at home getting called in once per week (hand surgery), eh?

When you make millions for the hospital you can ask for the same

 

[DrOwnage]

Not all of these hospital subsidized calls are "at home." Some, if not a majority of the surgeons are in house during that time with the exception of ortho. You have to incentivize these calls though, especially in a 1099 model. The calls are non-productive units-wise a good amount of the time.

 

[doctalaughs]

I'm a psychiatrist and I get zero for call. So I'm never coming in, until tomorrow around 11am probably. And the hospital seems fine with that.

I’m a dermatologist and most hospitals in the region won’t give me a penny to be on call (I’ve inquired).

I realize it’s not like these specialties above - that 99.9% of the time derm services aren’t “essential” life/limb saving and the CEO doesn’t care if they admit extra patients for the wrong diagnosis (actually probably makes money for them).

That being said — as I’ve said before I do think derm expertise can improve patient care in the ED and inpatient settings in many instances. Just another example of how The US corporate-medical industry is purely incentivized for profit above patient care.

I do get a little annoyed when my hospitalist friends say they can’t get any dermatologist to help them with an inpatient consult because dermatologists don’t want to work any nights/evenings. I’d be more than happy to help if they paid me a fair rate to be on call- but I’m definitely not doing it for free!

 

[Siggy]

Also, on-call means you have to take patients. Not on call means you can refuse consults for uninsured patients.

If you have enough business to not take call, why would you take on uninsured patients (i.e. take call) without the hospital helping to cover the cost?

 

[thegenius]

Because you only have to see the patient once, or maybe twice. Once out of the ER setting you don’t have to see them anymore. So you are getting paid to see uninsured patients, funding comes from a different patient.

Like the uninsured appy, you do surgery and probably required to see them once as an outpatient for follow up and to remove staples. But you aren’t required to see him again 2 months later when he has RLQ pain

 

[nexus73]

Because you only have to see the patient once, or maybe twice. Once out of the ER setting you don’t have to see them anymore. So you are getting paid to see uninsured patients, funding comes from a different patient.

Like the uninsured appy, you do surgery and probably required to see them once as an outpatient for follow up and to remove staples. But you aren’t required to see him again 2 months later when he has RLQ pain

Unless you see someone with necrotizing pancreatitis that requires months of hospitalization. With multiple returns to OR for debridement.

 

[DarkHorizon]

I was talking to one of the Ortho guys and he states he makes 5k a night for call? I couldn't believe it does that sound right? Does the hospital get funding for this. I called one of my OBGYN friends and asked him and he states they get paid 3k for call on unassigned patients.

I always thought that they took call for free

Where is this? I’m Ortho trauma in a major metro area and the busiest level I trauma pays $1800 for call here. I take call at 3 trauma centers. My level I pays $1500 and a level II pays $1000. The other level II pays nothing as it’s a “privilege” to be taking call there.

The only place I know that pays $5k for level 1 Ortho trauma call is university medical center in Vegas, and believe me, those guys earn it.

 

[southerndoc]

Where is this? I’m Ortho trauma in a major metro area and the busiest level I trauma pays $1800 for call here. I take call at 3 trauma centers. My level I pays $1500 and a level II pays $1000. The other level II pays nothing as it’s a “privilege” to be taking call there.

The only place I know that pays $5k for level 1 Ortho trauma call is university medical center in Vegas, and believe me, those guys earn it.

It's $5k for being on call, but they also get wRVUs for procedures performed, correct? Not everyone is a no payer.

 

[Brigade4Radiant]

Where is this? I’m Ortho trauma in a major metro area and the busiest level I trauma pays $1800 for call here. I take call at 3 trauma centers. My level I pays $1500 and a level II pays $1000. The other level II pays nothing as it’s a “privilege” to be taking call there.

The only place I know that pays $5k for level 1 Ortho trauma call is university medical center in Vegas, and believe me, those guys earn it.

In the South East

 

[DarkHorizon]

In the South East

This has to be a very busy level I center I assume without residents. I would be surprised if it’s anything less than that. And these guys likely earn that 5K heavily.

 

[DarkHorizon]

It's $5k for being on call, but they also get wRVUs for procedures performed, correct? Not everyone is a no payer.

Yes, you are correct. Mine is the same. Call pay to be on call, RVUs on top.

 

[Postictal Raiden]

Neurology. Two large West Coast metros. 500-1000/night to take call (mainly stroke). Not enough.

 

[bronx43]

Neurology. Two large West Coast metros. 500-1000/night to take call (mainly stroke). Not enough.

I’m still shocked that there are neurologists who sign up for this stuff. If I was neuro, I would just open up shop and see a bunch of headache and neuropathy patients during banker hours. Those patients aren’t exactly pleasant to work with but at least you get to go home at 5 and sleep full nights.

 

[end stage fibro]

Hospitalist but know a few figures - for a fact. 600 bed large community hospital (mothership downtown but not a name brand place)

Nsgy- 1 group, 6k /24hr period 😮
Ortho- lotta groups, 2k
Uro- 1 group, 1k

Everyone else 750 or less. Stemi call used to be compensated but became a race to the bottom and now earns a big zero bucks. about 6 groups sharing it

 

[EctopicFetus]

Not all of these hospital subsidized calls are "at home." Some, if not a majority of the surgeons are in house during that time with the exception of ortho. You have to incentivize these calls though, especially in a 1099 model. The calls are non-productive units-wise a good amount of the time.

what specialty are you cause this isnt true is any hospital.

Urology - at home
Vascular - at home
Ophtho at home etc etc. You think they are in the hospital for their 24 hour call?

 

[anonperson]

Because you only have to see the patient once, or maybe twice. Once out of the ER setting you don’t have to see them anymore. So you are getting paid to see uninsured patients, funding comes from a different patient.

Like the uninsured appy, you do surgery and probably required to see them once as an outpatient for follow up and to remove staples. But you aren’t required to see him again 2 months later when he has RLQ pain

Typical scenario for OB call. This hospital gives $1500 for 24 hr call for unassigned patients.

The usual unassigned patient is typically a raging drug addict (usually meth) with no prenatal care with multiple co morbid conditions. Think BMI > 40, HTN, DM, and a bad attitude to go with it.

When I was taking call, the unassigned patient I was stuck with was high on meth in acute respiratory failure, intubated in the ED. She was so fat, ED physician couldn't tell she was pregnant until after when the HCG came back.

Bad tracing, urgent c section.
Baby did terrible and died in NICU. Patient did fine after a week.

Above patient was uninsured so no one got paid.

Also, appendectomy has a 90 day global so surgeon is on the hook for 3 months.

If these patients bounce back, which they often do because they are such a mess, you will get re consulted.

 

[thegenius]

Typical scenario for OB call. This hospital gives $1500 for 24 hr call for unassigned patients.

The usual unassigned patient is typically a raging drug addict (usually meth) with no prenatal care with multiple co morbid conditions. Think BMI > 40, HTN, DM, and a bad attitude to go with it.

When I was taking call, the unassigned patient I was stuck with was high on meth in acute respiratory failure, intubated in the ED. She was so fat, ED physician couldn't tell she was pregnant until after when the HCG came back.

Bad tracing, urgent c section.
Baby did terrible and died in NICU. Patient did fine after a week.

Above patient was uninsured so no one got paid.

Also, appendectomy has a 90 day global so surgeon is on the hook for 3 months.

If these patients bounce back, which they often do because they are such a mess, you will get re consulted.

Does the surgeon make any money for the uninsured appy?

 

[DrOwnage]

what specialty are you cause this isnt true is any hospital.

Urology - at home
Vascular - at home
Ophtho at home etc etc. You think they are in the hospital for their 24 hour call?

The stipends for the quoted specialties you gave above will not be as significant as they make up a small minority of the cases. The bread and butter general/trauma/neuro cases are what go on from 8pm-7am and those specialties are in house usually at decent sized centers. I can't remember in the past 2 years doing a call/urgent optho case. Maybe 2-3 true urology call cases in the middle of the night in 2 years. Vascular almost never. Those guys aren't getting the numbers you are quoting to take call.

 

[nexus73]

Does the surgeon make any money for the uninsured appy?

If you’re employed on RVUs you get the RVUs. If you’re in private practice I assume you get nothing.

 

[anonperson]

Does the surgeon make any money for the uninsured appy?

You can get wRVU credit if employed and that is how your contract is structured.

If in private practice or your contract is based on collections, consider the surgery "on the house."
Patient won't pay a cent.
Surgeon, anesthesia, pathology, and the hospital all take it in the pants.

 

[southerndoc]

Stemi call used to be compensated but became a race to the bottom and now earns a big zero bucks. about 6 groups sharing it

Must've been taken over by an EM CMG.

 

[Brigade4Radiant]

This has to be a very busy level I center I assume without residents. I would be surprised if it’s anything less than that. And these guys likely earn that 5K heavily.

No residents but it isn't a level 1 trauma center it is a community hospital and they often refer difficult cases to the trauma center though

 

[DarkHorizon]

No residents but it isn't a level 1 trauma center it is a community hospital and they often refer difficult cases to the trauma center though

These guys have a fantastic deal. This is exceptional and they are best to keep quiet. Most non trauma centers will pay 2k most, and that’s in dire need with no one around. 5k for no trauma Ortho call is pretty ridiculous honestly. I can easily do non trauma call up to Q2, heck, I take 10-12 days of trauma call, including level 1 trauma.

Edit: you can take q3 call here and make average orthopod salary just in call pay. Damson.

 

[bronx43]

Everyone else 750 or less. Stemi call used to be compensated but became a race to the bottom and now earns a big zero bucks. about 6 groups sharing it

wait so IC only makes the RVU from the cath but no stipend? That’s rough… get woken up for a false alarm and only pull a few hundred while having to work the following full day

 

[EctopicFetus]

Typical scenario for OB call. This hospital gives $1500 for 24 hr call for unassigned patients.

The usual unassigned patient is typically a raging drug addict (usually meth) with no prenatal care with multiple co morbid conditions. Think BMI > 40, HTN, DM, and a bad attitude to go with it.

When I was taking call, the unassigned patient I was stuck with was high on meth in acute respiratory failure, intubated in the ED. She was so fat, ED physician couldn't tell she was pregnant until after when the HCG came back.

Bad tracing, urgent c section.
Baby did terrible and died in NICU. Patient did fine after a week.

Above patient was uninsured so no one got paid.

Also, appendectomy has a 90 day global so surgeon is on the hook for 3 months.

If these patients bounce back, which they often do because they are such a mess, you will get re consulted.

Global period is an insurance thing. If that bomb of an appy gets done at hospital a but presents to hospital b it’s not uncommon for hospital a to not take the patient back. It’s way more common when hospital A is an HCA site and patient has no insurance. Just saying.

 

[EctopicFetus]

The stipends for the quoted specialties you gave above will not be as significant as they make up a small minority of the cases. The bread and butter general/trauma/neuro cases are what go on from 8pm-7am and those specialties are in house usually at decent sized centers. I can't remember in the past 2 years doing a call/urgent optho case. Maybe 2-3 true urology call cases in the middle of the night in 2 years. Vascular almost never. Those guys aren't getting the numbers you are quoting to take call.

I didn’t quote a bunch of numbers. I think u have me confused with someone else. When. U say in house u mean residents or the attendings. Cause I work at a 80+k volume Ed now and another 50k plus, last job was a level one trauma center and another 50k+ Ed and I trained at u of Arizona and 0 vascular or ophtho or neuro attendings were regularly in house from 8pm on. Are you saying that at “decent sized “ centers neuro gen surgery (not trauma) vascular and ophtho are physically in the hospital from 8pm to 7am. If so I literally don’t know a single hospital in the us where this is true.

 

[anonperson]

Global period is an insurance thing. If that bomb of an appy gets done at hospital a but presents to hospital b it’s not uncommon for hospital a to not take the patient back. It’s way more common when hospital A is an HCA site and patient has no insurance. Just saying.

There is also the issue of post op follow ups. If you cut the patient, you own them, especially for any outpatient issues. Wound infections, pain, etc.

This can be a major pain. Usually the patients are unreliable and don't really follow up but it's no guarantee.

I agree that if they have a major post op issue and end up elsewhere, it's not an issue but that can be variable.

 

[thegenius]

You can get wRVU credit if employed and that is how your contract is structured.

If in private practice or your contract is based on collections, consider the surgery "on the house."
Patient won't pay a cent.
Surgeon, anesthesia, pathology, and the hospital all take it in the pants.

What I'm getting at is the surgeon or OB or ophtho IS getting paid to see these patients. Whether money comes from Aetna, Meidcare, UnitedHealth, Medicaid, or the hospital, the on-call doctor is getting paid.

3K to be on call is good money. If an on-call doctor relied solely on a 3K stipend by the hospital to take call 10 days a month, they would be making $360,000/year. You find me a doctor that makes $360K/year working 10 days / month and I'll give him a high-5 and standing-O. Maybe the hospital takes it up the arse as they are not being reimbursed for it, but we are referring to the on-call docs. 3K/shift is excellent money. We should tell all consultants who don't want to come in to an ER consult that they are making good money to be on call.

 

[thegenius]

These guys have a fantastic deal. This is exceptional and they are best to keep quiet. Most non trauma centers will pay 2k most, and that’s in dire need with no one around. 5k for no trauma Ortho call is pretty ridiculous honestly. I can easily do non trauma call up to Q2, heck, I take 10-12 days of trauma call, including level 1 trauma.

Edit: you can take q3 call here and make average orthopod salary just in call pay. Damson.

precisely

 

[thegenius]

There is also the issue of post op follow ups. If you cut the patient, you own them, especially for any outpatient issues. Wound infections, pain, etc.

This can be a major pain. Usually the patients are unreliable and don't really follow up but it's no guarantee.

I agree that if they have a major post op issue and end up elsewhere, it's not an issue but that can be variable.

It can be a pain but can't be MORE work for the surgeon or specialist...often less. These patients don't show up to the clinic and instead show up to the ED to have their chronic pain managed, have their stitches out, etc.

 

[Brigade4Radiant]

These guys have a fantastic deal. This is exceptional and they are best to keep quiet. Most non trauma centers will pay 2k most, and that’s in dire need with no one around. 5k for no trauma Ortho call is pretty ridiculous honestly. I can easily do non trauma call up to Q2, heck, I take 10-12 days of trauma call, including level 1 trauma.

Edit: you can take q3 call here and make average orthopod salary just in call pay. Damson.

They also take call for our sister hospital they do a lot of bone and joints and have a big ortho group. This community hospital isn't small at all just not a trauma center.

 

[anonperson]

What I'm getting at is the surgeon or OB or ophtho IS getting paid to see these patients. Whether money comes from Aetna, Meidcare, UnitedHealth, Medicaid, or the hospital, the on-call doctor is getting paid.

3K to be on call is good money. If an on-call doctor relied solely on a 3K stipend by the hospital to take call 10 days a month, they would be making $360,000/year. You find me a doctor that makes $360K/year working 10 days / month and I'll give him a high-5 and standing-O. Maybe the hospital takes it up the arse as they are not being reimbursed for it, but we are referring to the on-call docs. 3K/shift is excellent money. We should tell all consultants who don't want to come in to an ER consult that they are making good money to be on call.

What I'm getting at is the surgeon or OB or ophtho IS getting paid to see these patients. Whether money comes from Aetna, Meidcare, UnitedHealth, Medicaid, or the hospital, the on-call doctor is getting paid.

3K to be on call is good money. If an on-call doctor relied solely on a 3K stipend by the hospital to take call 10 days a month, they would be making $360,000/year. You find me a doctor that makes $360K/year working 10 days / month and I'll give him a high-5 and standing-O. Maybe the hospital takes it up the arse as they are not being reimbursed for it, but we are referring to the on-call docs. 3K/shift is excellent money. We should tell all consultants who don't want to come in to an ER consult that they are making good money to be on call.

Yes. They are getting paid by the stipend which technically covers the non paying patients. They shouldn't give you push back when called.

I can't speak for all specialties, but at least in OBGYN, in Southern California, community hospitals can't find call coverage for $3000 to $4000 a 24 hour shift because of the all too common hypothetical/ real life patient I described.

It's good money but not worth the headache.

Ask me where my one case that's currently in litigation from?

 

[FutureInternist]

I’m a dermatologist and most hospitals in the region won’t give me a penny to be on call (I’ve inquired).

I realize it’s not like these specialties above - that 99.9% of the time derm services aren’t “essential” life/limb saving and the CEO doesn’t care if they admit extra patients for the wrong diagnosis (actually probably makes money for them).

That being said — as I’ve said before I do think derm expertise can improve patient care in the ED and inpatient settings in many instances. Just another example of how The US corporate-medical industry is purely incentivized for profit above patient care.

I do get a little annoyed when my hospitalist friends say they can’t get any dermatologist to help them with an inpatient consult because dermatologists don’t want to work any nights/evenings. I’d be more than happy to help if they paid me a fair rate to be on call- but I’m definitely not doing it for free!

😏

 

[turnupthegas]

The quoted numbers may be an average of what they collect for a “call day”. They may get 1000-1500 stipend for call plus whatever they bill for whatever case they do. No case, then no 5k.

 

[emergentmd]

I was on MEC and we discussed this all the time when certain specialists would not take call including Optho/ENT/NSG. Its a game of chicken. If all the NSGs band together and refuse to take call, they just up the rate until they get coverage. What typically happens is.

1. Specialty group band together, refuse to take call until a number is met.
2. Hospital complain, whine, then meet their demands
3. Hospital then will recruit that specialist to take call then driving the call amount down.

I think 3-4k/24hrs was the top number I saw but when you take call, you essentially take call for the WHOLE system which was about 5 busy hospitals. So it is not like they have a NSG or ENT take call at each hospital which for 3-4k/24 hr is a great deal. You take call essentially for the whole system so when you look at it this way, it isn't really a great deal.

 

[EctopicFetus]

I was on MEC and we discussed this all the time when certain specialists would not take call including Optho/ENT/NSG. Its a game of chicken. If all the NSGs band together and refuse to take call, they just up the rate until they get coverage. What typically happens is.

1. Specialty group band together, refuse to take call until a number is met.
2. Hospital complain, whine, then meet their demands
3. Hospital then will recruit that specialist to take call then driving the call amount down.

I think 3-4k/24hrs was the top number I saw but when you take call, you essentially take call for the WHOLE system which was about 5 busy hospitals. So it is not like they have a NSG or ENT take call at each hospital which for 3-4k/24 hr is a great deal. You take call essentially for the whole system so when you look at it this way, it isn't really a great deal.

Depends on the payer mix and depends on how busy the docs are. I know or Ortho and hand guys who took call a bunch out of residency / fellowship until their practices grew.

 

[emergentmd]

Depends on the payer mix and depends on how busy the docs are. I know or Ortho and hand guys who took call a bunch out of residency / fellowship until their practices grew.

Sure, but my point is many of the docs who took call didn't sit at home all day collecting 3-5k/shift for a single hospital. They typically took call for the whole system and so some days were quite busy. Plus, most trauma patients typically are poorly insured. I mean the 2am Jaw fracture typically is not a well insured pt

 

[southerndoc]

Sure, but my point is many of the docs who took call didn't sit at home all day collecting 3-5k/shift for a single hospital. They typically took call for the whole system and so some days were quite busy. Plus, most trauma patients typically are poorly insured. I mean the 2am Jaw fracture typically is not a well insured pt

The 2 am jaw fracture rarely - if ever - needs to be seen in the ER. I personally have had a jaw fracture, and I followed up with OMFS in a few days. Almost all are "open" by nature and very few require immediate surgery.

None of our specialists cover call at multiple hospitals within our health system.

 

[EctopicFetus]

The 2 am jaw fracture rarely - if ever - needs to be seen in the ER. I personally have had a jaw fracture, and I followed up with OMFS in a few days. Almost all are "open" by nature and very few require immediate surgery.

None of our specialists cover call at multiple hospitals within our health system.

My experience is the uninsured jaw fracture isn’t gonna follow up as an outpt. Needs eval. The point I think is they functionally cover a whole system. Say ent is on call at hospital a and they are the only ent in a 10 hospital city. They functionally are covering 10 hospitals and their ent emergencies.

 

[emergentmd]

The 2 am jaw fracture rarely - if ever - needs to be seen in the ER. I personally have had a jaw fracture, and I followed up with OMFS in a few days. Almost all are "open" by nature and very few require immediate surgery.

None of our specialists cover call at multiple hospitals within our health system.

Our system of 6 hospitals, 3 FSER had one group take Plastic hand, ENT, Optho call. The likely did not have to take call for each hospital, but they sure got them all transferred to them.

 

[emperor tamarin]

Brother is orthopod south Florida. Private practice.
Wide range of call stipends, from 500 bucks for call to 3k. Doesn't seem to correlate with how busy/trauma load - seems mostly just how bad the hospital needs call coverage.
If he gets called and it's something that can follow-up he just looks at the XRs, ED splints the distal radius or whatever and they can see him in his office. They won't do that if they are uninsured usually and will go elsewhere.
If it is emergently operative ie hip fracture or open or whatever, he will go see them and operate and he bills for that via normal collections- so he gets paid if they have insurance and if not then it's tough.
Some of the quieter shops he rarely has to do anything. He takes a fair amount of call and the stipends can be a big income for them down there.

 

[RustedFox]

Brother is orthopod south Florida. Private practice.
Wide range of call stipends, from 500 bucks for call to 3k. Doesn't seem to correlate with how busy/trauma load - seems mostly just how bad the hospital needs call coverage.
If he gets called and it's something that can follow-up he just looks at the XRs, ED splints the distal radius or whatever and they can see him in his office. They won't do that if they are uninsured usually and will go elsewhere.
If it is emergently operative ie hip fracture or open or whatever, he will go see them and operate and he bills for that via normal collections- so he gets paid if they have insurance and if not then it's tough.
Some of the quieter shops he rarely has to do anything. He takes a fair amount of call and the stipends can be a big income for them down there.

Yep.
The land of seniors and their Ortho needs.