Insanity Defined: the On-Call Schedule

"Insanity: doing the same thing over and over again and expecting different results."

What are three things all successful schedulers and physicians seem to have in common?

    • Strong personalities
    • Great political / inter-personal instincts
    • A thick skin

Successful Schedulers and Physicians want to do the right thing, in the best way possible. They have strong ideas about how to get things done, and will stand up for them.


    • Sometimes, this also means not being quite as open to new ideas as often as they could be
    • Sometimes the “new idea of the week” has a passionate advocate that over-rides other voices.

How does this affect your call schedule?

Let’s just get it done faster, the Scheduler. More often than not, this type of Scheduler wants to have the exact same results, using the exact same creation process . . . just automated. More than likely the Scheduler has already been through the “rule wars” with the Providers and it’s not worth the political capital to revisit them. There may be concrete rules, but probably just as many “unspoken rules” that this Scheduling veteran knows are true and has the scars to prove it. Room for change is narrow.

Give me more of the same, the Provider. This physician may want to have the exact same layout, colorization, and access as he had before. He is already busy and has minimal time to hassle with something “new”, even if it will ultimately save him time. He may want the schedule printed/delivered as always. However, many physicians are also demanding mobile delivery “their way”, such as SmartPhone subscriptions or iPad access. Successful improvements are narrowly defined from a personal point of view.

Make it different, the Newbie. The newest member of the Physician or Scheduling team with his bright ideas may have just the thing! Being the newest member, he may not know the backlash of previous change attempts. He may not be able to get buy-in from the other Providers, but has strong criticism of the current on-call schedule and methodology. He may have come from a “high-tech” group with great software and IT support. He may be an in-demand specialist. He has high expectations and wants to implement change yesterday, if not before. If not heard and accommodated, he may simply leave the group.

The insanity? They want different, isolated results, but don’t want to change anything. Or expect their “little change” will not cost anything and will minimally impact anyone else.

When does this happen? This grid-lock seems to frequently occur during transition times such as two Groups merging, gaining or losing a key specialist, or going from a manual scheduling system to an automated on-call scheduling system.

What options do they have?

1. Document current reality

Write down all the rules for all the Providers so see. Document the “obvious” ones and “minor” ones also. Pick the brains of the previous Scheduler and the more senior Physicians in the group. Include a history of past Holiday assignments and Job tallies.

2. Share the current reality

Involve all the Physicians in this documentation process, since there may be some undocumented assumptions out there. Include the various “silos” within the group that the on-call schedule impacts as well.

3. Discuss a new reality within a group meeting

    • List the “new” call rules to discuss as well as old ones. Make sure the list remains available to all parties.
    • Include ideas from your newest Physicians, since they are fresh from the “outside” with possibly a different way of doing things.
    • Senior providers may need to manage strong-willed voices, so everyone is heard.
    • Use the 3 Whys to uncover new ideas and support old assumptions.

4. Consider a professional mediator rather than throw in the towel.

Key takeaway:

Continuing to appease everyone by keeping things the same and wishing for different results is insane. Change may be painful, but the long-term happiness and stability of the Group are at stake.


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