On-call duty is part of practicing medicine. Patient needs don’t stop at 5 pm, so hospitals rely on night and weekend coverage to keep care moving. But unreasonable call expectations can contribute to burnout and, at times, compromise patient safety, and they have increasingly become a flashpoint in employment negotiations.
I recently teamed up with Dr. Rob Anderson, the physician founder of Marit Health, the anonymous salary transparency site for medicine, to analyze and take a closer look at call data reported in their physician salaries. In this post, we’ll break down what call schedules look like, typical pay rates, and how physicians can use this data to negotiate call terms that are fair and sustainable.
PS: A more detailed version of this post was originally published in two parts on Marit Health. Part 1, Part 2
What makes call so fraught?
Call touches every part of a physician’s life. It interrupts sleep, family time, and recovery between shifts. When call is excessive, fatigue builds, decision quality suffers, and the risk of errors rises. Despite this, many employers treat heavy call as an unstated expectation bundled into base salary. Understanding the market for call duties and how compensation works can help you advocate for a structure that is sustainable for you while ensuring high quality care for your patients.
The three dimensions of call
When we talk about call, three variables matter most:
a) Frequency: how often you are on call
b) Location: in-house coverage versus home or beeper call
c) Compensation: whether there is additional pay, and how much
The Call Burden Index
To compare different specialties on apples-to-apples terms, we created a weighted Call Burden Index. It blends three signals from physician-reported salary data on Marit: the percentage of physicians who take call in that specialty, average call days per week, and the proportion of call that is in-hospital versus from home.
Specialties with highest call burden
Hospitalists, Infectious Disease Physicians, and Nephrologists rank near the top. Hospitalists average about 2.1 call days per week with roughly two-thirds in-hospital. Every nephrologist in our current sample reported taking call, averaging about 1.6 days per week. Infectious disease physicians report high rates of required call at a near every-other-day cadence and often in-hospital. Because hospitals depend on these specialties for year-round coverage – and typically have only a small pool of credentialed physicians – the call burden concentrates among a few, amplifying fatigue and limiting flexibility.
Specialties with lighter call burden
Dermatologists, Urgent Care Physicians, and Preventive Medicine Physicians sit at the lighter end of the spectrum. About half of dermatologists report taking call, averaging about 1.4 days per week. Urgent care physicians average about 0.9 days per week across a smaller share of clinicians who take call at all. Preventive medicine has the lowest rate, and when call is required, it’s taken from home.
Who Gets Paid for Taking Call
While call is common, getting paid for call is not. Across all specialties in our dataset, only about 19% of physicians report any additional compensation for call. That single number hides large differences by specialty and by setting.
Specialties most likely to receive call stipends
Surgical and procedural fields are more likely to see call pay. Orthopedic surgery is near the top, with roughly 43% reporting paid call. Neurosurgery is close behind at about 39%. Urology and Anesthesiology also show relatively high rates of paid call. In these fields, hospitals have a clear need for immediate, specialized coverage, which strengthens the case for separate compensation.
Specialties least likely to receive call stipends
Cognitive and outpatient-oriented fields rarely see separate call pay. Rheumatology, Allergy, many primary care settings, and even Nephrology often handle frequent call with no stipend, either because employers consider it part of base duties or because coverage can be shared informally across a group.
How much is paid when call is paid
Among those who receive call pay, the range is wide. Average per-diem rates reported span from a few hundred dollars to more than $2,000 for a 24-hour period. Neurosurgeons average approximately $2,045 per on-call day. Radiologists average about $1,845. Pathologists average around $1,700. These are specialties where on-demand coverage is scarce, hospitals are motivated to secure it, and the operational risk of being uncovered is high.
At the other end of the spectrum, Endocrinologists average roughly $363 per day, when paid. Family Medicine Physicians average around $455, and Infectious Disease Physicians around $533. Many physicians in these fields receive no separate pay at all, even when call is frequent.
Tactics for Negotiating Call Effectively
Based on my experience helping thousands of physicians negotiate contracts, here are a few practical and data-driven approaches to negotiating call:
- Lead with patient safety – Frame your request around quality of care. Fatigue from excessive call degrades performance, which puts patients at risk and increases institutional liability. Reasonable limits, predictable recovery time, and reliable backup coverage support better outcomes.
- Define a baseline and an exception – Propose a structure that separates baseline call, which is part of the role, from excess call, which triggers compensation or time off. One option may be to set a monthly cap on call days, with a per-diem stipend or a guaranteed post-call day off once the cap is exceeded. Alternatively, you could request a differential rate for weekend and holiday time, or for in-house vs. home call, so that your compensation more fairly reflects the burden.
- Use market data to calibrate the ask – Cite current benchmarks from Marit’s physician salaries and any other sources you trust. For example, hospitalists average 2.1 days per week with about 67% in-hospital, while OB/GYNs average 1.4 days with about 45% in-hospital. If your schedule is well above peer norms, request either compensation, lower frequency, or guaranteed recovery time.
- Bring in experienced support – Call terms affect staffing, compensation, and patient safety. A physician contract attorney can help translate operational expectations into clear, enforceable language and avoid vague, one-sided clauses.
Want To Dive Deeper?
If you want to compare your specialty’s call burden and call pay, start with your specialty’s salary page on Marit. Review distributions for frequency, location, and compensation from anonymous physician submissions. A few targeted examples from comparable peers can be more persuasive than broad averages.
You can also review our blog post on call coverage requirements.
By Dennis Hursh, Esq., Physician Agreements Health Law, and Rob Anderson, MD, Marit Health
Rob Anderson, MD, is a practicing Anesthesiologist at NAPA (North American Partners in Anesthesiology) in Richmond, Virginia, and a co-founder of Marit Health, a Pay Transparency Platform for Medicine. Marit is a free, community-powered anonymous salary solution for physicians and APPs.
