Practice Notes

Meeting ED call commitments as physicians grow older



Krista Teske

Hospitals have long struggled to provide adequate specialist coverage in the ED. In a 2012 survey by Sullivan Cotter and Associates, 58% of hospital survey respondents reported difficulty finding enough physicians to provide call coverage.

One force behind the continuing challenge is the aging physician workforce. According to the AMA, about 42% of the one million doctors in the U.S. are older than 55, up from 35% in 2006. Over a quarter of hospitals allow older physicians (those over age 60) to opt out of participating in ED call rosters, placing a greater burden on younger physicians and leading to medical staff tensions.

To address the issue, some medical groups are linking new call coverage policies for older physicians to retirement planning.

  • This is the second post in a two-part series on physician leadership succession planning. See the first post to review strategies for capturing potential with the next generation of physician leaders.


The benefits of an internal opt-out agreement

Hospital-dictated call coverage opt-out agreements often remove physicians from call coverage panels but fail to specify how long these older physicians can continue to practice, leaving younger physicians filling shifts indefinitely.

GI Associates—a 26-physician independent gastroenterology group in the Milwaukee region—devised their own opt-out plan to address the issue. Their agreement allows every physician the opportunity to stop taking call at age 60, provided that the group feels there are an appropriate number of physicians remaining on their ED call team.

The catch? While the agreement relieves older physicians of the call coverage burden, it also sets their 5-year retirement plan into motion.

The policy brings four benefits to the group:

  • It reduces the burden on younger physicians.
  • It defines a 5-year period for recruiting and training new physicians while older physicians prepare for retirement.
  • It lessens the pressure on administrators to monitor aging physician competency.
  • It standardizes group discussion about the size of the ED call team and how it will be impacted should older physicians choose to opt-out.

While this model has been successful for GI Associates, some groups fear that this policy will push experienced physicians out of the group in the midst of physician shortages. Group administrators should consider these factors in conjunction with local hospital call coverage policies prior to implementing group-based opt-out policies.

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For further guidance on physician succession planning, check out our related post.