Question Regarding being "On call"

[Briannaxox]

Good afternoon everyone, 

 

I have a question pertaining to what it means to be on call. Is this usually a contractual obligation if you work at the hospital? Is there any way to avoid it or do hospitals not give you a job if you don't want to be on call. Is the only way to circumvent this process is by having a private practice (FM, Plastics, Derm, etc.)? 

[A-Stark]

Generally speaking physicians are not employed by hospitals but obtain "privileges". There may or may not be a contractual agreement, as it depends on the type of practice and the size of the group. If you want to have access to hospital resources (diagnostics, clinic space, admission privileges, ORs, endoscopy time, stress labs, basically anything), there is an expectation to provide service in return. You can of course pay for all that stuff yourself and avoid call but you'll sure pay a lot more for that. 

[ZBL]

In addition to the above, often there will be requirements by the university as well. For plastics and derm as you mentioned, which tend to really only work in bigger cities with a university, doing call is part of the deal if you want to be affiliated with the university, which most plastic surgeons and dermatologists do. This is different from being a full academic staff - they still bill separately and can do private clinics, but if you want to say you are a clinical assistant professor, you will be doing call. The only way to get out of call is to go 100% private, which for plastics is near impossible, and for derm is actually quite rare - most will maintain some small connection to the university and cover call a few times per year. FM is the only one I can think of that maybe wouldn’t have true call, but technically you should be available for your patients still. It’s part of the job regardless of specialty in some sense. 

[NLengr]

9 hours ago, ZBL said:

In addition to the above, often there will be requirements by the university as well. For plastics and derm as you mentioned, which tend to really only work in bigger cities with a university, doing call is part of the deal if you want to be affiliated with the university, which most plastic surgeons and dermatologists do. This is different from being a full academic staff - they still bill separately and can do private clinics, but if you want to say you are a clinical assistant professor, you will be doing call. The only way to get out of call is to go 100% private, which for plastics is near impossible, and for derm is actually quite rare - most will maintain some small connection to the university and cover call a few times per year. FM is the only one I can think of that maybe wouldn’t have true call, but technically you should be available for your patients still. It’s part of the job regardless of specialty in some sense. 

There are tons of non academic community dermatologists that work outside tertiary care centers. Same goes to a lesser extent with plastics. They are beholden to a university to do call (the are beholden to the health authority though).

To be honest, I am not familiar with any university dictating call coverage. Every place I have worked it's the hospital or the regional health authority. They are responsible for providing the clinical services to the population.

[ZBL]

3 hours ago, NLengr said:

There are tons of non academic community dermatologists that work outside tertiary care centers. Same goes to a lesser extent with plastics. They are beholden to a university to do call (the are beholden to the health authority though).

To be honest, I am not familiar with any university dictating call coverage. Every place I have worked it's the hospital or the regional health authority. They are responsible for providing the clinical services to the population.

There are very few dermatologists or plastic surgeons outside of big cities. Yes they exist in smaller locations but not often. Anyway, I think it’s clear that most dermatologists are non academic, by which I mean they are fee for service with their own clinic and not paid by the university. However many of them still affiliate with the university by taking residents and doing teaching. Doesn’t make them true academic staff, but they get to call themselves clinical assistant professors - something to signify their involvement. Part of that is call. I don’t know if it’s a university or health authority thing, but I do know that most community dermatologists in my province still do occasional city wide call. The minority who don’t are the ones that don’t work with residents and don’t participate in any university or health authority related matters.

Plastics is a bit different because none have a 100% private practice, so most end up doing call at their hospital site as well. 

[A-Stark]

Well, speaking as an actual "clinical assistant professor" the university has nothing to do with my call requirements. Not in the slightest. 

There are plenty of community dermatologists around, even in rural NL. 

Generally speaking if you're not into being call, best choose a different profession. 

[NLengr]

2 hours ago, ZBL said:

There are very few dermatologists or plastic surgeons outside of big cities. Yes they exist in smaller locations but not often. Anyway, I think it’s clear that most dermatologists are non academic, by which I mean they are fee for service with their own clinic and not paid by the university. However many of them still affiliate with the university by taking residents and doing teaching. Doesn’t make them true academic staff, but they get to call themselves clinical assistant professors - something to signify their involvement. Part of that is call. I don’t know if it’s a university or health authority thing, but I do know that most community dermatologists in my province still do occasional city wide call. The minority who don’t are the ones that don’t work with residents and don’t participate in any university or health authority related matters.

Plastics is a bit different because none have a 100% private practice, so most end up doing call at their hospital site as well. 

I guess it depends how you define "big cities". Are you talking >100k? Or are you talking Montreal, Toronto and Vancouver?

Everyone has to participate in health authority matters, even if you are working in a private office in the community with zero affiliation with teaching. The only way to avoid that is to completely remove yourself from the public system. 

[Briannaxox]

To be absolutely blunt I feel like taking like 10-15 years out of your life after high school to grind and become a doctor when you could've been partying In college (well I know I could've) is punishment enough. I'd rather not reduce my quality of life further by being on call  I'm not particularly interested in family medicine but not being on call appeals to me. 

[robclem21]

2 hours ago, Briannaxox said:

To be absolutely blunt I feel like taking like 10-15 years out of your life after high school to grind and become a doctor when you could've been partying In college (well I know I could've) is punishment enough. I'd rather not reduce my quality of life further by being on call  I'm not particularly interested in family medicine but not being on call appeals to me. 

There are many people that share your opinion that call is not appealing, and that is completely fair. It is everyones right to choose a field because it may provide a better lifestyle that they are interested in.

That being said, call is not a punishment, and your training from undergrad to becoming a practicing physician is not punishment. People who enter this field or are preparing to enter this field, do so because they love it and because they enjoy the challenge. It is important to recognize that this line of work is a commitment that goes on for your entire life. If you aren't ready to accept that, then this is not the career for you. The work you put into becoming a doctor is more than compensated with salary, job security, and opportunities to do something you truly love. Yes, you could've partied all the time in undergrad, but becoming a doctor doesn't mean you can't ever have fun.

You should be able to strike a balance in your life. Having call, and being in school for 10-15 years after undergrad should not define your life. While it is a big part of it, part of your responsibility is to look out for your own mental health. Take some time to reflect on your lifestyle now and consider what you can do to make it sustainable. 

[A-Stark]

5 hours ago, Briannaxox said:

To be absolutely blunt I feel like taking like 10-15 years out of your life after high school to grind and become a doctor when you could've been partying In college (well I know I could've) is punishment enough. I'd rather not reduce my quality of life further by being on call  I'm not particularly interested in family medicine but not being on call appeals to me. 

Well to be equally blunt, call is part of your life as a physician in most specialties. Patients get sick after regular business hours and in the middle of the night. You can certainly find a type of practice that has less and/or easier call (e.g. public health, some family med) but you will make less money. That's not to say I'd recommend having a practice where you're highly dependent on call for income, but you have to be available. 

And, really, the major way of ensuring quality of life while doing your share of call is to avoid specialties like general surgery, neurosurgery, cardiac surgery and... you get the picture. But then it's always more reasonable in community practice. Yes I've had to go in at 2am to intubate a patient who's almost certainly not going to last another 24 hours, but so it goes. Most of the time I sleep through the night, while those consults after 6pm or on weekends are just that much gratifying when you understand call premiums. 

The bottom line is that you should expect to work if you want physician income. And work at sometimes strange hours. But not all the time. 

[MSWschnoodle]

On 10/10/2018 at 1:34 PM, Briannaxox said:

To be absolutely blunt I feel like taking like 10-15 years out of your life after high school to grind and become a doctor when you could've been partying In college (well I know I could've) is punishment enough. I'd rather not reduce my quality of life further by being on call  I'm not particularly interested in family medicine but not being on call appeals to me. 

You're not even in medical school yet and you are worried about call? This is putting the cart before the horse. 

Hate to break it to you, but depending on what province you are in and where you are practicing even family docs have a call group obligation. With very few exceptions you should absolutely expect that call shifts and weekend/holiday work will be part of your life as a physician. 

I'd also echo what others have said: so far you've expressed views that medical training is a punishment, are more concerned about the prestige of being a physician than the social accountability of the medical field and are already posting about disliking call before you've even done a call shift... it might be worth reflecting on whether or not medicine is really a career you want or if you have been drawn to an idea of what medicine is that is different from reality.

There are plenty of careers where you can make just as much as a physician with regular hours and won't be expected to be on call. Medicine is not this kind of career. It is a career where you can expect to sometimes work late (even when you have other things to do), sometimes treat patients without getting paid (even halfway into clerkship I've seen this arise multiple times) and do call (there are a few exceptions when you can potentially have no call as an attending, which others have talked about, but you'll still have multiple years of call in clerkship and residency before you get to that point). If this is going to be a major issue for your quality of life then it is worth thinking carefully about whether or not this is the career you want or if a different career might fit your goals and personal values better. 

[goleafsgochris]

You need to do pure outpatient work (generally) if you don’t want call. This is family, and tbh can be most non surgical specialties if you limit yourself to clinic work. Your income will suffer for it tho.

Also agree with others that this is incredibly naive/childish to worrying about this before even getting into med school. It’s like a first year poli-sci student worry about privacy when they get elected prime minister 

[rmorelan]

1 hour ago, goleafsgochris said:

You need to do pure outpatient work (generally) if you don’t want call. This is family, and tbh can be most non surgical specialties if you limit yourself to clinic work. Your income will suffer for it tho.

Also agree with others that this is incredibly naive/childish to worrying about this before even getting into med school. It’s like a first year poli-sci student worry about privacy when they get elected prime minister 

I can see some truth to that but I suppose you could argue when worry about it then? Once you get into medical school there is a very high chance you will be doing some field down the line that has call and once in it isn't like you can easily jump off (most people here and definitely yourself know that almost everything has call in it - the big players of anything surgical, family and internal medicine mostly have call in some fashion although of course you can modify it or minimize it). If you cannot handle any call at all then you are severely limiting your options down the road - probably someone that is about to put all the work into things to get ready to be competitive should know the impact of that choice going in