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Pearls: Making Call Duty Fair

How to Avoid Infighting

By Elizabeth Woodcock, MBA

Physicians searching for work are increasingly identifying lifestyle issues as critical factors when making decisions about where to practice. Ranked first among such issues is call duty.

To help maintain a realistic schedule among your physicians that keeps them happily employed in your practice, you may want to fine-tune how you structure your call duty. These tips will get you started:

  • Assign first-call duty to nonphysician providers. Many physicians have hired nonphysician providers as key members of their clinical care teams. Extending the responsibilities of those providers to include the first stage of call is logical. Although sometimes practices make calls from referring physicians and ERs the sole domain of physicians, assigning less emergent first-call duties to nonphysician providers can significantly decrease a physician’s volume of patient calls.
  • Free call duty from age bias. In many practices, an unspoken benefit of retiring physicians is the reduction or elimination of call during their final several years at a practice. This puts an additional burden on a practice’s younger physicians. Similar issues may arise when part-time physicians request to discontinue call altogether. So before the next physician in your practice requests part-time status or decides to retire, determine how to restructure your call duty. You may also want to consider allowing the “sale” of call duty among your practice’s physicians. This often allows younger physicians who need the money to assume some call burdens from those docs willing to pay someone else to do them.
  • Equalize the burden of call. The amount of work call duty requires is highly dependent on when that duty is assigned. Weekday call is the easiest to handle, followed by weekend call and holiday call. To divide call fairly, assign a weight to each call time slot. For example, assign weekday call a value of 1, weekend call a value of 2, and holiday call a value of 5. Using these weights, ensure all physicians are assigned approximately the same “call value” for the calendar year. You may also want to rotate call duty for major holidays. Gather individual physician requests regarding their call preferences at least three months in advance, and compose call calendars at least two months in advance. Assign holiday call a year or more in advance; consider a five-year calendar for major holidays to allow for personal planning.
  • Finally, be forthright. When hiring new physicians, be clear about what their call duty will be, and outline those duties in writing. Being upfront about call will avoid future misunderstandings and can save you many potential headaches.

Reproduced with the permission of Physican Practice

Copyright (c) 2006 Physicians Practice Inc. All rights reserved. Republication or redistribution of Physicians Practice content, including by framing, is prohibited without prior written consent. Physicians Practice shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon.

Elizabeth Woodcock, MBA, CPC, is a professional speaker and consultant specializing in practice management. Elizabeth is a Fellow in the American College of Medical Practice Executives and is a Certified Professional Coder. She can be reached at or via Learn more about Elizabeth at



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