Call Coverage Requirements in Physician Employment Agreements

Call coverage requirements in physician employment agreemnts need to be carefully examined. MGMA benchmarks can help to establish reasonable boundaries.
call coverage requirements

Call coverage requirements

Call coverage requirements in physician employment agreements can lead to some nasty surprises. There are some physician employment agreement negotiations you just never forget. One of my more memorable negotiations involved representing a new physician, just out of fellowship, who was offered a position at a solo private practice. The practice’s current owner was ready to expand and wanted help with his 24/7 call coverage schedule.

Like most first offers, the draft agreement initially
presented wasn’t perfect – but it didn’t seem particularly horrible, either.
One of the goals of a good physician employment agreement is that it be crystal
clear on the parties’ rights and responsibilities. This offer was a little
fuzzy on several points, and I requested that the practice’s attorney clear up
the ambiguities. One of the fuzzy points was assignment of call coverage.

The draft agreement simply provided that the employer would
assign call coverage. There was no mention of how, exactly, call coverage would
be assigned. I requested a specific schedule, or, at a minimum, a provision that
call coverage would be equitably allocated.

However, when the other side presented the first revision,
the offending language was unchanged. The practice’s attorney rather sheepishly
explained that his client wasn’t willing to agree to allocate call coverage
equitably. Since the solo physician had been practicing alone for six years,
doing 24/7 coverage, he intended to assign 24/7 coverage to the new physician, “at
least for the first few years.” The attorney was concerned that “there could be
an argument” that the arrangement was not equitable.

Needless to say, more negotiations were in order.
Eventually, I convinced the other side that they would never get anybody to
help the physician unless he was willing to share call coverage. If we had not
straightened that issue out, my client would have been miserable in the new
position.

Smaller employers are likely to require much more
flexibility in scheduling. If the practice only has three physicians, for
example, call coverage is likely to spike several times throughout the year.
Each time 1/3 of the physicians (i.e., each physician) takes vacation or CME
time off, the call coverage will probably significantly increase for the
remaining two physicians, who are temporarily doing the work of three.

Larger employers may provide an expected call coverage
schedule (e.g., one night every eight and one weekend per month). These
schedules will rarely be firm commitments. However, sometimes the employer will
be willing to stipulate that call coverage will not exceed some limit (e.g.,
one night in four or two weekends per month).

The Medical Group Management Association (MGMA) publishes benchmarks for call coverage in various specialties. These benchmarks provide information on unpaid call coverage hours per week, as well as hourly, daily, and annual compensation for call coverage. Citing the MGMA benchmarks in a physician employment agreement review can be very helpful in negotiating a fair physician employment agreement. If call coverage isn’t specified, or if call coverage appears to be more than the median unpaid weekly hours, I always cite the benchmarks and request additional compensation for call coverage beyond median when I perform a physician contract review and MGMA compensation analysis.

Call coverage requirements in private practices can be complicated. Frequently senior partners will enter a glide path into retirement. That is, at some point the senior partner may stop taking call. In a larger private practice, increased call coverage may be negligible for the remaining physicians. However, in a smaller practice, removing one physician from call coverage can have a material impact. 

When negotiating a physician employment agreement, you have to balance the desire for a workable call coverage schedule for the new physician with quality-of-life concerns for the senior physicians. Sometimes the new physician simply has to “pay dues” with the understanding that when that physician is nearing retirement there will be payback. MGMA benchmarks can be useful in this scenario – although the new physician may be taking more call coverage than they really want, at least we can try to negotiate additional compensation for the additional burden.

No matter how well we negotiate provisions concerning call coverage requirements, I have found that the newest physician always seems to end up with call coverage on Christmas. Isn’t that a freakish coincidence?

You may also be interested in my posts about letters of intent in physician contracts and the “standard” physician employment agreement.

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Dennis Hursh

Dennis Hursh

Dennis Hursh has been providing healthcare legal services in Pennsylvania since 1982. Since 1992, he has been a physician's lawyer serving as Managing Partner of Physician Agreements Health Law, the first law firm in the country to focus exclusively on physician employment agreements. Dennis has devoted his life to serving physicians and medical practices. He is the author of the definitive book on physician contracts "The Final Hurdle - a Physician's Guide to Negotiating a Fair Employment Agreement, and a frequent lecturer on physician employment agreements.

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    How It Works

    After purchasing the physician contract review, you will receive an email asking you to transmit the agreement and any concerns you have to me. Many physicians do this by email, but I will be available by phone, too. In three business days from the time you purchase the Physician Prosperity Program® and transmit the draft physician employment agreement along with any concerns you have about the agreement and the information I will need to perform the MGMA analysis, you will receive a detailed physician contract review letter from me.

    After you receive my physician contract review letter, you will have the opportunity to discuss it with me, to make sure all of your concerns were met, and to correct any factual inaccuracies, or to point out things that were verbally promised but didn’t make it into the physician employment agreement. These discussions, and revisions of the letter following these discussions, are included in the initial fixed fee.

    Once you are completely comfortable with the physician contract review letter, you transmit the letter to your potential employer.