Im Call Coverage/locuming

[ACHQ]

Hi

 

Just wondering from those who have either first hand experience, or personally know anyone who (is staff now) that has done IM call coverage.

 

Out of curiosity on average how much (and I know this is variable depending on volume, weekday vs weekend vs holiday) can you get for 1 night (in Ontario hospitals)? How much for weekend coverage/holiday coverage vs weekday?

 

Is is substantially more in rural areas?

 

On average how many consults overnight would one do? I've heard its between 15-20? what about a whole day (either weekday or weekend)?

[futureGP]

this is second-hand information at best

 

busy hospitals in GTA (i.e. Brampton/Mississauga) can go from 10-25/night. Over 24 hours, non-busy day medicine consults is 15-20 most places in big cities.

 

you bill what you get. basic consult fee + add on after-hours premium + emergency premium blah blah, i think some people quote 250-300 per consult overnight but it sounds like a lot, realistically let's say 200-250 per consult.

 

lets be realistic and assume 200 per consult and 10 a night, so 2000 is a good estimate. 

 

if you want to be accurate, just look at the latest OHIP fee guideline on IM consults and section on overnight/ER premiums and do the math.

 

Remember that's gross billings. Subtract tax and you get net pay / night. Probably around 1200-1500/night.

 

good times bois

[bloh]

This is a strange question and I'm not sure if you've phrased it correctly. Most hospitals have GIM consult services for off-service wards but no one does these consults over the night. These are elective so there's no urgency to them. If you're talking about admissions to medicine wards, then that depends on the hospital. Large hospitals will admit massive amounts of patients but it's usually split among multiple attendings and teams. No single attending will bill for the 15-20 admissions as that would obviously make the team far too bloated and unmanageable.

[ACHQ]

This is a strange question and I'm not sure if you've phrased it correctly. Most hospitals have GIM consult services for off-service wards but no one does these consults over the night. These are elective so there's no urgency to them. If you're talking about admissions to medicine wards, then that depends on the hospital. Large hospitals will admit massive amounts of patients but it's usually split among multiple attendings and teams. No single attending will bill for the 15-20 admissions as that would obviously make the team far too bloated and unmanageable.

 

I think you misunderstood my question. I was not asking about medicine consults to patients already admitted to non-medical subspecialities. I know those are usually non-urgent and done during the day.

 

I was wondering about GIM admissions specifically in NON-academic centres where I know there is only 1 Medicine staff overnight doing admissions from the ER, and many times covering the ICU as well.

 

My question is geared more towards locums and/or community medicine call coverage.

 

I have NOW heard from various people (PGY3, some CMRs, etc...) that for call-coverage can vary 2500-5000 a night

[bloh]

I think you misunderstood my question. I was not asking about medicine consults to patients already admitted to non-medical subspecialities. I know those are usually non-urgent and done during the day.

 

I was wondering about GIM admissions specifically in NON-academic centres where I know there is only 1 Medicine staff overnight doing admissions from the ER, and many times covering the ICU as well.

 

My question is geared more towards locums and/or community medicine call coverage.

 

I have NOW heard from various people (PGY3, some CMRs, etc...) that for call-coverage can vary 2500-5000 a night

I did understand your question. But your question just doesn't apply to Canada.

There's very few non-academic community hospitals, at least in Alberta. Even small ones like in grand prairie, almost always have rotating PGY3 residents. In any case, it's a law of numbers. How many patients can 1 staff member handle each and every day? Your admissions have to be counterbalanced by your discharges, else you get too bloated. I've worked as a hospitalist in towns with no GIM (i.e. I admit everything that comes in unless it needs a transfer into the city) and you'd generally get 2-6 admissions per day with a roster of about 20-30 patients. Depending on the time of day that'd be $150-400/admission. GIM fee codes are about 30% more I think. It's odd that you were given that number because at least in Alberta, if you cover call at night in community ICU/wards you get something like 120$/hour. You can't bill FFS if you aren't staff; the only people I've seen to be able to bill are fellows (PGY6 and above, ex someone doing trauma fellowship).

[ACHQ]

I guess my question was aimed to Ontario and more specifically GTA where there are tonnes of non-academic community hospitals, and the volumes from what I've heard 10-20 a night. The PGY-3's that told me this aren't ones who've done it but talked to staff who have.

 

I did understand your question. But your question just doesn't apply to Canada.

There's very few non-academic community hospitals, at least in Alberta. Even small ones like in grand prairie, almost always have rotating PGY3 residents. In any case, it's a law of numbers. How many patients can 1 staff member handle each and every day? Your admissions have to be counterbalanced by your discharges, else you get too bloated. I've worked as a hospitalist in towns with no GIM (i.e. I admit everything that comes in unless it needs a transfer into the city) and you'd generally get 2-6 admissions per day with a roster of about 20-30 patients. Depending on the time of day that'd be $150-400/admission. GIM fee codes are about 30% more I think. It's odd that you were given that number because at least in Alberta, if you cover call at night in community ICU/wards you get something like 120$/hour. You can't bill FFS if you aren't staff; the only people I've seen to be able to bill are fellows (PGY6 and above, ex someone doing trauma fellowship).

[medaholic]

Edit: see below reply. Can't figure out how to delete post.

[medaholic]

this is second-hand information at best

 

busy hospitals in GTA (i.e. Brampton/Mississauga) can go from 10-25/night. Over 24 hours, non-busy day medicine consults is 15-20 most places in big cities.

 

you bill what you get. basic consult fee + add on after-hours premium + emergency premium blah blah, i think some people quote 250-300 per consult overnight but it sounds like a lot, realistically let's say 200-250 per consult.

 

lets be realistic and assume 200 per consult and 10 a night, so 2000 is a good estimate. 

 

if you want to be accurate, just look at the latest OHIP fee guideline on IM consults and section on overnight/ER premiums and do the math.

 

Remember that's gross billings. Subtract tax and you get net pay / night. Probably around 1200-1500/night.

 

good times bois

 

This is the closest answer so far. Slight variations, average consult bills $200-300. Depending on volumes, busy nights can be 15-20+ consults. Add in ward/ICU coverage depending on your hospital, and you're looking anywhere from 2k (low) to 5k most nights, more if busier. Some places have additional stipends/ECG readings. This is gross billings.