Call responsibilities

[Hardcastle, Tim, Dr <tch at sun.ac.za>]

Ken

Wow - I might even get to pay the bills!  John and Ken, while this is clearly an American thing, just some international perspective from South Africa.

We get paid a government salary for a 56 hour work-week (including 16 hours overtime per week), irrespective of whether we are around for less (very seldom) or many more hours. We are expected to do whatever calls come our way (4 - 6 per month) and be available as the only attending on duty after hours covering trauma, non trauma emergency surgery and vascular surgery for acute problems. Sure, we have one resident on for each of those, plus the inevitable bunch of students and an intern and we don't have to be physically present during each and every operative case, but we must still be immediately available if required, plus we field advice cals from rural hospitals throughout our province with its 6 million people. Mainly (85 - 90%) of our patient load is uninsured. We partake in some aspects of SICU, but not all. We also have the adult regional burn centre in-house. I am the ONLY full-time trauma surgeon; the calls are shared with all the other surgeons in the small (11 people) university dept of General Surgery, so even the breast surgeon will feel OK doing a sternotomy or a damage control laparotomy. We see enough of those!

On the other hand we have a private sector dealing with insured patients, where each surgeon is fee-for-service, mostly in solus practice and therefore always on-call for one's own patients. You work a damn-site harder, but get paid for it. However, there is much less trauma seen in the private sector: the whole socio-economic factors predisposing to violence thing! Most surgeons do not do their own SICU work in the private sector - got to do with billing rules.

Mostly our patients appreciate what we do for them. Oh, and we have much less medico-legal wranglings: some small blessings make working in a "first-third" world country worthwhile.

Regards
Tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
ATLS  instructor and DSTC Cape Town Course Director
Intern program Coordinator: Surgery
M.Med (Emergency Medicine) Executive Committee member
Clinical Head (Director): Diana Princess of Wales Trauma Unit
Division of Surgery (General) Room 4064
Department of Surgical Sciences
Tygerberg Hospital / University of Stellenbosch
PO Box 19063
Tygerberg 7505
Western Cape
South Africa
e-mail: tch at sun.ac.za
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302



-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of KMATTOX at aol.com
Sent: Tuesday, December 04, 2007 10:52 PM
To: trauma-list at trauma.org
Subject: Re: Call responsibilities 



 
This is in response to a post cited below regarding emergency surgery call,  
etc.  
 
I have recently had an opportunity to discuss this issue locally, and  among  
many on this list server nationally.   Some desired to  remain nameless.    I 
came up with the following  information:   
 
1.    Many MANY surgical disciplines are positioning  themselves to perform 
only endoscopic or endovascular  procedures.    MANY also are positioning 
themselves to NEVER be  in a position to be put on any IN-hospital surgical call, 
and almost never have  to respond to coming to the hospital at night, week ends 
or on holidays.  
 
2.    Many new and training surgeons are very  uncomfortable with an OPEN 
ABDOMEN or a major trauma case.   
 
3.    For MANY reasons, the surgeon, the general  surgeon, the emergency 
surgeon, the acute care surgeon, the trauma surgeon  (choose whatever name you 
wish) is CURRENTLY and FOR THE NEXT 15 years will be  the most sought after 
specialist in most hospitals in the country; and the  rarest commodity.     AND as 
a base of the triangle of  hospital practice, this surgeon is the most 
valuable to the hospital  enterprise.   DO NOT UNDERSELL YOURSELF or be put into a 
position  where you feel that your value is under rated, 
 
4.    JUST to be in the hospital taking call and seeing  patients you should 
expect $100.00/hour to be paid to you by the  hospital.   This payment is a 
minimum for your TIME.  
 
5.    You should expect to receive payment for your  SERVICES.    That should 
be paid at (at least) a rate of 150% or  higher of allowable Medicare rates 
after ALL discounts, etc.   This  amount should almost be a guarentee be it 
from a carrier, the patient, insurance  companies, HMOs, or the hospital.   
 
6.    If the hospital is seeing non-pay patients as  part of its community 
commitment and expects you to be there, the hospital  should pay you this 
conversion factor for your services if the patient does not  have a the resources or 
insurance.   
 
7.    You should expect to keep all of what you collect  without having to 
share with the hospital.  You may have a group or medical  school plan that has 
some other arrangement.  
 
8.    More later
 
K 
 
In a message dated 12/4/2007 1:47:24 P.M. Central Standard Time,  
pjschu at bpthosp.org writes:

Folks,
I'm trying to benchmark expectations for nights on call for  the members
of my group based on practices around the country. We're a  small group
that does

1) All SICU staffing and call
2) 75% of  Trauma call (Level II)
3) All critical burn care (ABA verified. 310  admissions per year)
4) 80% of burn operative care
5) about 50% of  emergency general surgery in the hospital.







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