Earlier this year, BFMV decided to conduct a direct-to-physician call coverage survey for a number of reasons. Perhaps the primary reason was that we wanted to better understand the "burden" of off-site/unrestricted call coverage generally, and more specifically, how (and if) it impacts compensation. For this reason, we surveyed physicians directly rather than facilities, since physicians are the party with direct knowledge of a variety of burden-related factors (phone calls received, in-person activations, etc.) The following is a list of four insights from the survey:
1. The physicians most likely to receive a stipend for providing call coverage services are highly paid surgeons.
This may not be surprising - but the survey supports the idea that highly specialized surgeons (neurosurgery, vascular, orthopedics, etc.) are more likely to receive a stipend than other physicians who also provide off-site call coverage. The specialties with the highest percentage of respondents receiving a stipend consisted almost exclusively of highly paid surgical specialties, while primary care and non-surgical specialists were less likely to receive a stipend in almost all cases.
2. Physicians with higher burden are more likely to receive a stipend than those with lower burden within the same specialty.
The more you do, the more likely you are to get paid. For all specialties, we compared the median average in-person visits reported by physicians who receive a stipend with those who do not. For 15 of the 24 specialties with sufficient responses, the stipend recipients reported higher average in-person activation volume per shift, at the median, than the pool of non-stipend recipients. The opposite was true for only three specialties.
3. Physician employment is another key factor in determining whether or not a stipend is paid.
Generally, hospital- or health system-employed physicians are less likely to receive a stipend for providing call coverage than independent physicians. This is overwhelmingly true for a few higher paid specialties, like vascular surgery, where 90% of reported stipend recipients were independent, while only 20% of uncompensated respondents were independent. Orthopedics, neurosurgery, hand surgery, and international radiology are other examples of specialties where employment had a major impact. For many other specialties, however, the impact of employment was relatively minor.
4. Physicians with higher burden receive higher stipends; however the correlation is weak in many specialties.
The more you do, the more you get paid. When we graphed each of the burden statistics relative to compensation, the charts for most specialties look much like the ones for plastic and reconstructive surgery below:
The resulting regression equations almost all run up and to the right, indicating correlation - but the correlation isn't particularly strong, with significant variation visible within the data. We calculated r-squared for each specialty, which is a measure of correlation (or fit), representing the percentage of the variation that is explained by the linear model from 0% (no fit) to 100% (total fit).
Only a handful of the equations accounted for more than 50% of the variation, which indicates one or both of the following is correct: 1) factors other than burden have more impact on call coverage compensation, and/or 2) there is a lack of relevant information available to the negotiating parties to appropriately match compensation with burden. My hunch is that #1 is a little bit correct - there are certainly other factors that impact call coverage compensation - but that #2 is more likely to be the primary culprit.