List Archives

Mon Sep 14 17:18:18 BST 2009

Norm,
My own personal simplistic answer to the bottom line is YES.
Ron
________________________________
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of McSwain, Norman E Jr.
Sent: Monday, September 14, 2009 12:07 PM
To: Trauma-List [TRAUMA.ORG]
Subject: RE: Backup Call Pay

The payers must in some way establish equality in pay to some extent---
The things which need to be addressed are:
- the endocrine surgeon who never comes in at night and works 50-60 hours each week vs the trauma surgeon who takes in house call and works 95 hours each week. should both receive the same pay.
- the endocrine surgeon operates on paying patients (fee for service and insurance) and the trauma surgeon operates on non-paying patient. the endocrine surgeon brings in much more money to the hospital/institution than does the trauma surgeon. Should pay be based on work done or money retrieved?
- If the surgeon does work extra for non-paying patient should (s)he receive extra pay? In other word should one be paid by the amount of work done. If a surgeon works 3 in house call 24 hours and another works 8 similar work shifts, should they be paid the same or should there be a differential. should the trauma surgeon be paid more than the endocrine surgeon based on time spent in the hospital?
-Should a surgeon be paid a smaller amount for being on call than a surgeon who is not on call?
- Should an on call surgeon be paid extra if they come in and see a non-paying patent vs the surgeon who is on call and sees only paying patients

Bottom line should a surgeon be paid in relationship to the amount of work that they do

Norman

Norman McSwain MD
Trauma Director, Charity Hospital
Professor of Surgery, Tulane University
New Orleans LA
504 988 5111
norman.mcswain at tulane.edu<mailto:norman.mcswain at tulane.edu>

________________________________
From: trauma-list-bounces at trauma.org on behalf of Gross, Ronald
Sent: Mon 9/14/2009 10:12 AM
To: 'Trauma-List [TRAUMA.ORG]'
Subject: RE: Backup Call Pay

Norm,
You are, as usual, absolutely correct: this on call thing IS extra work, and especially if it is in-house.  We have built it into our contract, and there is a stipulation as to the number of calls per month you are mandated to do, after which you will have a salary line increase per call.  What that "over and above" is will vary from institution to institution, but I would suggest that 5 nights of in-house call is about all that pretty much everyone will currently accept these days as being their limits.  As my last shop, I was up to 7 and 8 in-house calls a month, with two weekends a month pretty much shot.  As I said - that WAS my last shop........even I have my limits!
Ron

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of McSwain, Norman E Jr.
Sent: Monday, September 14, 2009 11:02 AM
To: Trauma-List [TRAUMA.ORG]
Subject: RE: Backup Call Pay

Consider the following in your deliberations. When you are taking
in-house trauma call, this is work in addition to those who are surgeons
and currently do not stay in house every few night away from family and
friends. It is additional work

Most physicians who do 'fee for service' get paid when they operate
after hours. Most trauma surgeons do this work for free and never get
paid. Should there not be compensation for extra work.

Salaried surgeons should have in their job description if in-house call
is required or not and how often they are expected to come in after
hours. That way the surgeon will know up front what is expected of
him/her. One day, the US surgeons will be forced to adhere to the 80
hour work week, as is required of the residents. Many physicians outside
of the US already have hour limitations and do this already but with
different hour requirement. Should surgeons, who are required to take
in-house call, be paid an additional salary for staying in house vs a
dermatologist ( as an example) who would never expect to work after
hours?

The discussion should separate 1)In-house call, 2) at home call but
most of the call nights come in at least once or twice, and 3) at home
call and come in only 1 ever month or so.

Norman

Norman McSwain MD
Professor, Tulane School of Medicine
Trauma Director, Charity Hospital Trauma Center
norman.mcswain at tulane.edu
504 988 5111

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Bjorn, Pret
Sent: Monday, September 14, 2009 9:29 AM
To: Trauma-List [TRAUMA.ORG]
Subject: RE: Backup Call Pay

Bravo on both accounts.

Paying a stipend on top of privileges sets a crippling precedent.  You
can't un-push that domino, and your trauma center will suffer for it.

And as for shotgun diagnostics (although I missed the origin of this
tangent), there should be dedicated instruction in all critical care
curricula with regard to timing and yield of various labs and imaging.

We are inclined to blame "defensive medicine," but I suspect that at
least part of the problem is intellectual laziness: ("Don't think!  Run
tests!")

Pret Bjorn, RN
Bangor, ME USA

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Gross, Ronald
Sent: Monday, September 14, 2009 8:40 AM
To: 'Trauma-List [TRAUMA.ORG]'
Subject: RE: Backup Call Pay

I DO NOT agree with call pay for any physician.  We all have hospital
PRIVILEGES, and with those privileges come OBLIGATIONS. IMHO, taking
call is just one of the obligations that should be pay-back for the
privileges.  Teaching our up-coming colleagues that every test ordered
by them should (1) be reviewed/examined by them personally, and (2)
should be ordered knowing that the results WILL affect subsequent
management is just another obligation that we seem to have forgotten
about.

OK, I will shut up now and yield my soap box to Dr. Mattox!

Ron

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