Should orthopedic surgeons be compensated with a stipend or otherwise for taking call?
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Hospitals should pay on-call surgeons
Orthopedic surgeons should be reimbursed for taking hospital call. This will enhance the care given to orthopedic patients and consultant services.
In a recent “on-call compensation survey” from the Medical Group Management Association, a daily stipend can be via many different mechanisms based upon fair market value. Level-1 and specialist call fair market value will be higher than community/lesser level hospital and generalist call based upon need, volume and care. Orthopedic surgeons provide enormous value and revenue for the hospital. As a general rule, for every $1 a surgeon bills, the hospital collects $8. For every work relative value unit a surgeon bills, the hospital collects $145. For every patient treated, the hospital generates a $4,225 contribution margin. The average surgeon income per hour is $207. The average hospital generates about $3.3 million revenue a year from an orthopedic surgeon. Therefore, an on-call orthopedic surgeon should have a base pay for the “nuisance” of “carrying a pager” and work should equate to a surgeon “working overtime” with hourly rate, and/or potentially “triggers” for coming in to work night vs. day, weekend vs. weekday and specialty.
The on-call surgeon value and demand has become even more important. Several trends note decreasing care, value and profits for hospitals. Some estimates have noted that COVID-era staffing has shrunk 30%. To retain staff, salaries and on-call pay have increased. Staffing voids have been filled frequently with even higher paid travel staff. Therefore, efficient and timely care has become even more important for hospitals especially with a diagnosis-related group episode of care. From this shrinking access and increasing costs of staffing, many hospitals have limited or even eliminated services, which shifts the burden to available hospitals having orthopedic care for on-call and off-hours services. On-call surgeons have higher burnout rates and retention problems with unpredictable emergent/urgent patient schedules, inconvenient long hours and challenging work environments. This is compounded with the fact that about 16% of physicians quit or retired during the COVID-19 pandemic and shifted larger portions of work to ambulatory settings without call burden.Therefore, hospitals should appropriately pay the on-call orthopedic surgeon for providing on-call services, which could lessen burnout and burden, and, at the same time, improve hospital efficiencies, value-based care and profits.
- References:
- Althausen PL, et al. J Bone Joint Surg Am. 2009;doi:10.2106/JBJS.H.00592.
- Cherf J. A look at contemporary on-call compensation arrangements. https://www.aaos.org/aaosnow/2015/oct/managing/managing5. Published Oct. 1, 2015. Accessed April 20, 2023.
- Condon A. Orthopedic surgeons generate $2.7M in annual revenue – 10 key facts and figures. https://www.beckersspine.com/orthopedic/52452-orthopedic-surgeons-generate-2-7m-in-annual-revenue-10-key-facts-and-figures.html. Published Aug. 13, 2021. Accessed April 20, 2023.
- Vallier HA, et al. J Orthop Trauma. 2008;doi:10.1097/BOT.0b013e31815e92e5.
- Ziran BH, et al. J Orthop Trauma. 2008;doi:10.1097/BOT.0b013e31816bae67.
Clifford B. Jones, MD, FAAOS, FOTA, FACS, FAOA, FIOTA, is a professor of orthopedic surgery at Creighton Medical School in Phoenix, and chair of orthopedic surgery at Dignity Health Medical Group in Chandler, Arizona.
Compensation should be negotiated
Orthopedic surgeons are highly trained and skilled medical professionals who provide critical care to patients with musculoskeletal injuries and disorders. They are often required to take call as part of their job responsibilities, which means being available to respond to emergency cases outside of regular business hours. Given the nature of their work, it is only fair that they be compensated for taking call.
Being on call requires an orthopedic surgeon to make significant sacrifices in terms of their time and availability. They must be prepared to respond to emergency cases at any time of day or night, which can be a significant burden on their personal and professional lives. They must be ready to leave family gatherings, social events and other activities at a moment’s notice to attend to patients in need.
Furthermore, taking call can be emotionally and physically exhausting for orthopedic surgeons. They are often required to work long hours and deal with high-stress situations, which can take a toll on their mental and physical health. Compensation for taking call can help to offset these challenges and provide some recognition for the sacrifices that they make.
Call compensation can also attract and retain talented orthopedic surgeons. In many regions, there is a shortage of orthopedic surgeons. Offering compensation for taking call can make a job more attractive to talented candidates and help to ensure that health care facilities have access to the best possible medical professionals.
The appropriate compensation amount for an orthopedic surgeon taking call can vary widely depending on many factors, including the surgeon’s level of experience and expertise, the volume and acuity of the call schedule, and the compensation norms in the local market. This compensation should reflect the additional time and effort that the surgeon is putting in to be available.
Ultimately, the appropriate compensation amount for an orthopedic surgeon taking call is best determined through negotiation and collaboration between the surgeon and the health care facility or system. Factors such as the surgeon’s experience, the volume and complexity of the call schedule, and local market conditions can all be taken into account to arrive at a fair and appropriate compensation amount.
Justin Nabity, CFP, CLU, CHFC, is the founder and partner at Physicians Thrive in Omaha, Nebraska.
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