What Does a Good On-Call Physician Schedule Look Like?

By Amy Engebretson

The typical answers I hear to this question are “It follows all our rules”, or “All the Doctors are happy”, and the ever-popular “It’s fair”.

What does that mean, really? How do you describe fairness and happiness within the confines of rules that may actually be preferences that change depending on circumstances?

In the art of Physician On-Call scheduling, the whole is more than the sum of its parts. Objective and subjective judgment must both be involved. But first, the parts (or elements) need to be identified and defined.

What do Good Physician On-Call Schedules Have in Common?

They all take into account the various detailed elements of scheduling and policies of the Group, use a repeatable process to generate the schedule, and they are evaluated with an experienced eye for the overall gestalt of the final piece.

Great physician on-call schedulers also use software to translate the “elements of scheduling” into forms that can be evaluated objectively, such as rules, frequency, spread, and tallies.

Where to start? The best two questions to ask an out-going Scheduler

    • What are the expected tallies and spreads for each of the various job assignments regarding each provider?
    • Why are they like that?

The answers will most likely involve the Elements of Scheduling and will get you started with documenting your Group’s Scheduling Process.

What Does an On-Call Schedule Look Like?

The first goal is to specify and document all the bits that go into creating a physician On-Call schedules, such as your clinical rules, special requirements, and human resources policies, so that every schedule the Scheduler builds automatically follows the expectations of your practice. Remember, it does not just rule, it also tallies over an agreed upon time-frame, limits on how many Physicians can be unavailable on a day, as well as other factors.

Elements to consider

1. Holiday Policies

      • What are your Primary Holidays? How about handling secondary Holidays?
      • Are Holidays scheduled differently in general?
      • Who decides the Holiday coverage rotation year to year?

2. Day Off Type Policies

      • How do you collect and document your Day off Requests?
      • How will they be approved? first-in/ first-out? by seniority? by random draw?
      • How many Providers are allowed OFF on any day (cannot take the call)
      • How far out do you schedule OFF information in advance?
      • Do you schedule Call first and take vacation requests after it is done, okaying vacation around Call already in place?

3. Swap Policies

      • How do you collect and document your Job-Swap requests?
      • Do both swap-parties need to “okay” the swap before it is approved?
      • Who has final approval?

4. Weekend Policies

      • Do you schedule weekends out further than weekdays?
      • Is there always a minimum number of Fridays (weekends) OFF after doing a weekend of call?
      • Are there any “If Friday then not previous Monday” rules?
      • How are Thursdays handled to avoid undocumented “three day weekends”?

5. Length of Schedule Rotation, Spread, and Tally Policies

      • How many months do you schedule at a time? Be sure to consider the number of Providers you are scheduling so your expected tally is mathematically reasonable for the period of time you have in mind. (Example: A tally for 27 weeks for 9 providers instead of six months will generally give better results.)
      • Do your On-Call tallies have to be equal for everyone on weekends, including part-timers? How about the total tallies for each job (weekdays plus weekends)? How about cumulative cross-job tallies?
      • How are weekends scheduled? For example, are weekends always Fri/Sat/Sunday for everyone? If not, why not?

6. Cross-Job Assignment Policies (how closely can they be assigned)

      • Which jobs are okay to do on Back-2-Back weekdays or weekends? Which are not?
      • How close can they be if different per Provider?
      • Are several jobs always covered on the same day depending on the Provider?

7. Repeating Patterned Assignments

      • Are there any part-time or pre-scheduled patterns for an individual provider? Ex. Dr. Smith always takes a call every third Wednesday unless on a vacation.
      • Are Templates for weekends okay? Are Templates okay for any part of the schedule?
      • Do re-occurring days off preferences make the schedule all but impossible to complete if anyone is on vacation

8. Load Factors and Shared Call

      • Do you share a call with another Group? At what rate?
      • Do you have part-time Providers or retiring Providers? How about maternity leave?

Key Takeaway: Even the most expensive, “intelligent” scheduling software cannot generate an on-call schedule if expectations are fuzzy and in flux. The more defined your Group’s expectations are, the more objective the schedule results can be.

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