On-Call Schedule: When equal is not fair!

So, you're ready to get moving on your next schedule, eh?

    1. You have had “the meeting” and know who is covering the Holidays. Check.
    2. You know who is unavailable due to vacations, CME or other things that take them out of call, and have those requests assigned. Check.
    3. Now, how about those weekends?

I have had several calls lately where weekends no longer need to be “fair”, or are fair in some way other than being equal in the tallies.

When is equal no longer fair?

Increasingly, younger Physicians want a better balance between work and their young families, so are opting for part-time work. While many groups still expect these providers to cover the same number of weekends as everyone else, this is no longer automatically the case.

Combine that with the increasing number of senior doctors transitioning out of on-call (having put in the required number of service years) or semi-retiring and opting out of call. This is especially hazardous if there isn’t a ”ramp down” plan in place for this scenario.

Some groups take care of the weekend problem by sharing call with another group and merging the schedules together on-line, so it looks like one unit. Each group may take a different percentage of the work-load depending on the number of Physicians in each group.

Others hope to solve it in part by merging with another physician group altogether, only to discover that each of the original Providers from each group wants to maintain their “old group” status quo regarding weekends, and have real difficulty considering themselves all one new “family”.

Scheduling on-call assignments for the newly merged or transitioned group can be difficult, or easy… your choice.

You may need to hire a Physician Consultant to referee the meeting, but getting a handle on weekend scheduling expectations and rules is crucial. If you don’t, missed expectations will sabotage everything else over time, building a list of resentments and “I Owe You’s” that will make scheduling the on-call needlessly challenging or impossible.

If you want help, STRIP! Yep, strip down all those rules to a common core. Pick your battles. What really needs to be covered to continue essential services, and what is “nice to have?” What are “we will always do this” vs “we have always done this” rules… and what is a preference or strong suggestion held by one or two Providers?

Rules by Consensus, Committee, or by Command? Are you letting Doctor Difficult who is a founder make a mess for everyone else? What was ok for the original start-up 4 doctor group may not work so well in a growing merged group of specialized, smart Providers who are also used to running their own show.

Use decision-making tools to help get it done, maybe sticky dots, an eraser board, and a respected Physician to referee… but get it done. Remember, it’s not just about the rules, it tallies over an agreed upon time-frame, and also limiting how many Physicians can be unavailable on a day. Document the agreement and rules in writing! Be prepared to review this document on a regular basis, perhaps once a year.

Schedule those most difficult weekends and/or providers first.

I’ll bet this goes without saying for most seasoned schedulers, but I’m always surprised by those who think software can automatically figure out the exact job/ provider combo you want on a very specific date when it comes to “randomly” scheduling weekends that are not truly random. Rather than write a dozen rules, often it is simpler to manually pre-assign those weekends for Doctor Difficult or Retiring Physician or Very Part-time Doctor when they are outliers compared to all the other providers. This will not only save you time generating the schedule; you will also know exactly why you picked Doctor A instead of Doctor B for that specific date. You may also find a Template Scheduler, or simply pre-running your physician scheduling software for those specific dates will do the job.

After you have pre-scheduled the outliers, run your call-scheduling software for the rest of the weekends. That’s where you save time when “fair” no longer means “equal” but is actually some percentage of the over-all weekend on-call coverage. Make your tweaks as needed, then go on with the next “layer” of scheduling.

Consider turning out more weekend schedule than weekday schedule, perhaps even a year’s worth.

The more weekends you can schedule ahead of time, the more satisfied Providers seem to be. Why? Because they can plan ahead for those family events, they know the tallies were fair to start with and there is a documented trail of Provider Requests if they become “unfair” later. Lastly, it encourages Providers to turn in their requests earlier to the scheduler, or work vacations around the schedule if it’s handily “published” on-line or in their SmartPhone. This generates a natural “reward” system that benefits the Providers, their families, and the Schedulers.

Key Takeaway

Scheduling weekend on-call coverage is tricky when “fair” does not mean each physician has equal weekend tallies. It requires planning and cooperation within the Physician on-call Group. Documenting agreed-upon rules is essential, but also be sure to review them so you don’t get caught without a plan in place when change happens.


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