Off Hours Service- Part 1
Wada, Maurice
Description
Collection
Title:
Off Hours Service- Part 1
Creator:
Wada, Maurice
Date:
1/30/2014
Text:
Greetings,
I wanted to post replies to my recent request for feedback on how facilities deal with providing service after regular business hours, if there is such a thing, including weekends, holidays, and twenty-four hour coverage especially in emergency room situations. A big thank you to those of you who took the time to respond including several whose replies are not included per their request. Some of the responses have been edited to be more succinct and on topic and the names of responders were omitted to avoid any confidentiality issues. The replies will appear in two separate posts since they exceeded the 300 line limit.
We have a rotating on call schedule. We have a facility with three practitioners and two residents actively on call. Generally speaking the residents are on call every third week, the faculty members every fifth. There is a flat fee for carrying the pagers. Generally if we receive a call after 7 and the patient is stable, we try to fit it before clinic and rounds the following morning. If the patient is waiting discharge or is unstable, we make the drive. We try to make the delivery within two hours from the call.
We are a bit of an interesting scenario in which we are part of the bigger hospital system but act as a stand-alone company for all good intents and purposes. We are on call from 5pm to 8am Monday through Thursday each week, and on call Friday 5pm through the weekend to Monday at 8am. These call times rotate between staff members. During normal business hours we have a dedicated staff member to cover any hospital calls we get. We carry pagers that the hospital and ER staff have on our systems communication board (i.e. they can look us up when they need us). We are compensated for carrying the on call pager (whether we get called in or not). If you are busy or not you get the same so it's a roll of the dice. :) The other smaller facility I used to work for compensated on call employees with a flat weekly fee while being on call for similar hours as above. We have not ever experienced any use of outside staff at either place.
I would absolutely make sure that you are compensated for this service, whether it is rolled into a salary compensation package or hourly people earning overtime. Our salaries are adjusted for the number of called in hours that we averaged over a period of a year and in addition earn the hourly pager amount when on call. This keeps us feeling as though we are not being taken advantage of.
We are called overnight at times, but it is pretty rare. Some perspective on this might be helpful: in Fargo we are one of two main hospital systems for about 120,000 people in the immediate area. We have multiple life flight scenarios each week so we also see quite a bit of trauma patients from the whole region. (Mostly TLSO's and cervical type stuff) HALO's are still done, and we probably do 4-6 a year. Those are pretty much the only times we get called in really late since the doc's usually want the HALO applied ASAP. I have been here three years and can easily count on one hand the times our staff have been called in overnight. I like the four hour premium idea... might have to try and push some buttons around here.
We just offer compensatory time off at a later date. Our practitioners are all salaried so that is really our only option. On call duty is part of their job though and they know this when they accept the position.
We have a designated person On Call for one week at a time. During the week we are limited to coming in for TLSOs and hip abduction braces for discharging patients between the hours 5pm -8am Mon-Thurs. On the weekend (Friday after 5pm through Monday 8 PM), that On Call person fulfills any order that is needed. We can be paged for a cuff and collar on Saturday at 4 am and it is in our contract to provide the item. Our company compensates us well for being on call. We are compensated on a per day basis including holidays. For instance, for Thanksgiving were are paid for 4 days over the call weekend. We are also given one paid day off the week after our call week since we end up working 12 days straight. I do not know if my company would be comfortable with me giving out actual financial numbers, but I am compensated better than a full day's work (much better), but for a longtime CPO, I imagine it is slightly better than a day's work.
Although I have not been there for over three years, I can tell you about a hospital-based practice in Ohio that I was in for 19 years. One significant difference was that the primary area trauma center was at a different hospital, but many patients were transferred from the trauma center, at all hours, because many of the best surgeons in the area were at the hospital I worked for, and the trauma center outsourced all of their P&O activity.
When we were on-call, it was 24/7, one week at a time, but nighttime calls, particularly from the ED, were not common. Weekend calls were fairly regular, but in general, our off-hours call did not have nearly the same intensity as a trauma center/ED. Our P&O department was 15 people, with 4-6 clinicians/residents standing for on-call, out of an organization total of around 35,000 when I left, so we had no say about anything. To work there as a clinician was to be on-call, and to not show up for a call was a relatively short route to termination.
Regarding compensation, there was nothing beyond normal salary, either to stand for call or when actually called in.
Several institutional practices with whom I used to interact eliminated their in-house practices over the years, so you won't have much of an apples-to-apples group to compare with. Where I am at now, there is no additional compensation for being on-call, but it is a very small community, with no trauma center, and calls of any kind are rare, so the lack of additional compensation is no concern. You just have to be able to take the phone call, if needed, and be on site within 4 hours
One arrangement that I like is one that a former resident at our facility now has at her private practice. For each week she takes call, she gets 1/2 day of comp time, and then is also paid $75 for each time she actually comes in to the hospital. Her company recognizes that they will at times be paying more in total cost to have the on-call than it is generating in revenue, but overall it is somewhat profitable, and the hospital and its physicians are an important referral base that they want to keep happy. One of the practice principals told me that they would even accept a moderate loss in the on-call operations for that reason. They also didn't care who was on-call so long as it was covered, so if someone wanted the comp time and extra cash, they could take as much call as the other clinicians would let them. The clinicians were all assigned call, but they could trade whatever they wanted.
However, their hospital has only a level 2 trauma center, and things are quite different with a level 1, plus yours is an institutional practice, which further changes things. I don't which yours is, but I would suspect Level 1, and at least when I was in Ohio, I was told that institutional practices generally compensated less than private practices. I was never told why this was, although I have to admit that there were certain advantages to not having to hustle referrals and consults. And as another issue, no one else in the entire facility was compensated extra for taking call, not even the physicians.
I was once told there is no such thing as an emergency brace. If it is serious injury, they will be stabilized and admitted or can be splinted/cast and given a Rx to return to orthotics the following day or provider of choice for orthosis. A stock of soft collars and Philly collars or DC in trauma collar should suffice the majority of minor neck injuries.
It is usually a revenue drain as well to serve the ER population.
If you don't stock them they will have to wait anyway and if you contract it out they have the same problem. They used to send them home with an abduction pillow if it was a hip and admit anything more than a jewett or CASH for TLSO. Alas you are a teaching hospital so money comes in many ways...
I work for a surgical supply business that is getting into prosthetics, but they built their business on stock and bill shelves in ERs. Maintaining the stock and paperwork for billing can be tricky though.
I refused to work weekend and week night after hours. You have a life to live! Family first the world a very distant second!
In fact.... I told the hospital who wanted to contract services with my facility if the hourly wage was $2000.00 per hour... the answer is still no! Many people who get admitted into a hospital can wait until Monday to be seen. Can't tell you how many times I was called in to delivery items that could of waiting until Monday.
Maurice Wada, CO
Director, Prosthetics and Orthotics
UCLA Health System
<Email Address Redacted>
(424) 259-8551
Confidentiality Notice: This email message, including any attachments, is for the sole purpose of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure, or distribution is prohibited. If you are not the intended recipient, please contact the sender by email and destroy all copies of the original message.
________________________________
IMPORTANT WARNING: This email (and any attachments) is only intended for the use of the person or entity to which it is addressed, and may contain information that is privileged and confidential. You, the recipient, are obligated to maintain it in a safe, secure and confidential manner. Unauthorized redisclosure or failure to maintain confidentiality may subject you to federal and state penalties. If you are not the intended recipient, please immediately notify us by return email, and delete this message from your computer.
I wanted to post replies to my recent request for feedback on how facilities deal with providing service after regular business hours, if there is such a thing, including weekends, holidays, and twenty-four hour coverage especially in emergency room situations. A big thank you to those of you who took the time to respond including several whose replies are not included per their request. Some of the responses have been edited to be more succinct and on topic and the names of responders were omitted to avoid any confidentiality issues. The replies will appear in two separate posts since they exceeded the 300 line limit.
We have a rotating on call schedule. We have a facility with three practitioners and two residents actively on call. Generally speaking the residents are on call every third week, the faculty members every fifth. There is a flat fee for carrying the pagers. Generally if we receive a call after 7 and the patient is stable, we try to fit it before clinic and rounds the following morning. If the patient is waiting discharge or is unstable, we make the drive. We try to make the delivery within two hours from the call.
We are a bit of an interesting scenario in which we are part of the bigger hospital system but act as a stand-alone company for all good intents and purposes. We are on call from 5pm to 8am Monday through Thursday each week, and on call Friday 5pm through the weekend to Monday at 8am. These call times rotate between staff members. During normal business hours we have a dedicated staff member to cover any hospital calls we get. We carry pagers that the hospital and ER staff have on our systems communication board (i.e. they can look us up when they need us). We are compensated for carrying the on call pager (whether we get called in or not). If you are busy or not you get the same so it's a roll of the dice. :) The other smaller facility I used to work for compensated on call employees with a flat weekly fee while being on call for similar hours as above. We have not ever experienced any use of outside staff at either place.
I would absolutely make sure that you are compensated for this service, whether it is rolled into a salary compensation package or hourly people earning overtime. Our salaries are adjusted for the number of called in hours that we averaged over a period of a year and in addition earn the hourly pager amount when on call. This keeps us feeling as though we are not being taken advantage of.
We are called overnight at times, but it is pretty rare. Some perspective on this might be helpful: in Fargo we are one of two main hospital systems for about 120,000 people in the immediate area. We have multiple life flight scenarios each week so we also see quite a bit of trauma patients from the whole region. (Mostly TLSO's and cervical type stuff) HALO's are still done, and we probably do 4-6 a year. Those are pretty much the only times we get called in really late since the doc's usually want the HALO applied ASAP. I have been here three years and can easily count on one hand the times our staff have been called in overnight. I like the four hour premium idea... might have to try and push some buttons around here.
We just offer compensatory time off at a later date. Our practitioners are all salaried so that is really our only option. On call duty is part of their job though and they know this when they accept the position.
We have a designated person On Call for one week at a time. During the week we are limited to coming in for TLSOs and hip abduction braces for discharging patients between the hours 5pm -8am Mon-Thurs. On the weekend (Friday after 5pm through Monday 8 PM), that On Call person fulfills any order that is needed. We can be paged for a cuff and collar on Saturday at 4 am and it is in our contract to provide the item. Our company compensates us well for being on call. We are compensated on a per day basis including holidays. For instance, for Thanksgiving were are paid for 4 days over the call weekend. We are also given one paid day off the week after our call week since we end up working 12 days straight. I do not know if my company would be comfortable with me giving out actual financial numbers, but I am compensated better than a full day's work (much better), but for a longtime CPO, I imagine it is slightly better than a day's work.
Although I have not been there for over three years, I can tell you about a hospital-based practice in Ohio that I was in for 19 years. One significant difference was that the primary area trauma center was at a different hospital, but many patients were transferred from the trauma center, at all hours, because many of the best surgeons in the area were at the hospital I worked for, and the trauma center outsourced all of their P&O activity.
When we were on-call, it was 24/7, one week at a time, but nighttime calls, particularly from the ED, were not common. Weekend calls were fairly regular, but in general, our off-hours call did not have nearly the same intensity as a trauma center/ED. Our P&O department was 15 people, with 4-6 clinicians/residents standing for on-call, out of an organization total of around 35,000 when I left, so we had no say about anything. To work there as a clinician was to be on-call, and to not show up for a call was a relatively short route to termination.
Regarding compensation, there was nothing beyond normal salary, either to stand for call or when actually called in.
Several institutional practices with whom I used to interact eliminated their in-house practices over the years, so you won't have much of an apples-to-apples group to compare with. Where I am at now, there is no additional compensation for being on-call, but it is a very small community, with no trauma center, and calls of any kind are rare, so the lack of additional compensation is no concern. You just have to be able to take the phone call, if needed, and be on site within 4 hours
One arrangement that I like is one that a former resident at our facility now has at her private practice. For each week she takes call, she gets 1/2 day of comp time, and then is also paid $75 for each time she actually comes in to the hospital. Her company recognizes that they will at times be paying more in total cost to have the on-call than it is generating in revenue, but overall it is somewhat profitable, and the hospital and its physicians are an important referral base that they want to keep happy. One of the practice principals told me that they would even accept a moderate loss in the on-call operations for that reason. They also didn't care who was on-call so long as it was covered, so if someone wanted the comp time and extra cash, they could take as much call as the other clinicians would let them. The clinicians were all assigned call, but they could trade whatever they wanted.
However, their hospital has only a level 2 trauma center, and things are quite different with a level 1, plus yours is an institutional practice, which further changes things. I don't which yours is, but I would suspect Level 1, and at least when I was in Ohio, I was told that institutional practices generally compensated less than private practices. I was never told why this was, although I have to admit that there were certain advantages to not having to hustle referrals and consults. And as another issue, no one else in the entire facility was compensated extra for taking call, not even the physicians.
I was once told there is no such thing as an emergency brace. If it is serious injury, they will be stabilized and admitted or can be splinted/cast and given a Rx to return to orthotics the following day or provider of choice for orthosis. A stock of soft collars and Philly collars or DC in trauma collar should suffice the majority of minor neck injuries.
It is usually a revenue drain as well to serve the ER population.
If you don't stock them they will have to wait anyway and if you contract it out they have the same problem. They used to send them home with an abduction pillow if it was a hip and admit anything more than a jewett or CASH for TLSO. Alas you are a teaching hospital so money comes in many ways...
I work for a surgical supply business that is getting into prosthetics, but they built their business on stock and bill shelves in ERs. Maintaining the stock and paperwork for billing can be tricky though.
I refused to work weekend and week night after hours. You have a life to live! Family first the world a very distant second!
In fact.... I told the hospital who wanted to contract services with my facility if the hourly wage was $2000.00 per hour... the answer is still no! Many people who get admitted into a hospital can wait until Monday to be seen. Can't tell you how many times I was called in to delivery items that could of waiting until Monday.
Maurice Wada, CO
Director, Prosthetics and Orthotics
UCLA Health System
<Email Address Redacted>
(424) 259-8551
Confidentiality Notice: This email message, including any attachments, is for the sole purpose of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure, or distribution is prohibited. If you are not the intended recipient, please contact the sender by email and destroy all copies of the original message.
________________________________
IMPORTANT WARNING: This email (and any attachments) is only intended for the use of the person or entity to which it is addressed, and may contain information that is privileged and confidential. You, the recipient, are obligated to maintain it in a safe, secure and confidential manner. Unauthorized redisclosure or failure to maintain confidentiality may subject you to federal and state penalties. If you are not the intended recipient, please immediately notify us by return email, and delete this message from your computer.
Citation
Wada, Maurice, “Off Hours Service- Part 1,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/235972.
