You're Managing My On-Call Schedule With a 3-Ring-Binder?

Out-of-date hospitals manage on-call for the Doctors with binders whereas modern hospitals manage on-call for their Doctors customers using technology.

If you are a specialty provider such as a Cardiologist or OB/GYN Doctor, what type of service do your patients receive at 3 a.m. when they present in the ED? How important is this to you? This will depend on the type of Hospital that you affiliate with.

What I have found is that US Hospitals that have not improved the process of managing on-call for their specialty physicians in the ED are doing a disservice to their specialty provider’s customers.

Are you aware that every hospital ED, Telecom Department, and Medical Staff Office that I have spoken with over the past five years still manages the on-call information with a 3-ring-binder? Yes, a plastic 90-cent binder. To further explain this, when your office call schedule creator completes the call-schedule they will mail, fax, or email a paper copy of the schedule over to the hospital. This document will be 3-hole-punched and placed in a 3-ring plastic binder along with every other specialty in your medical community (usually15-20 schedules). Someone’s job-duty at the hospital will be to manually transpose the information from your and other schedules in the binder and create a “daily call sheet” usually in Excel. This is then faxed or delivered to critical areas of the hospital and medical community.

25 years ago when physicians were on-call to build their practice and patient base, this worked well. Doctors considered on-call as part of their medical community obligations. Swaps were few and far between and Doctors helped each other out and were happy to communicate changes to the hospital.

Don’t get me wrong; in 2011 Doctors still help each other out, but make no mistake that on-call is no longer desirable in helping a physician build his or her practice. Nowadays most late-night ER calls for a general surgeon will be stitching up a drunk-persons face that does not have insurance. Not only will they not follow-up with the Surgeon at their office in three weeks to get their stitches out, but they will not pay for their ER visit. This is a loose/loose for the Doctor. This is a contributing factor for providers not wanting to be on-call. This is also why many do everything they can to get out of call or try to pawn off the patient onto another service so they do not have to come in.

Although being on-call is not desirable, it is necessary for the community and part of most contracts physicians have with the hospitals that give them privileges. With that said, how do you make the best of a rotten situation? Remember that not all people who present in the ED are like the case I described above. Many of them will be productive members of our community. What type of service do they deserve?

In my opinion, they deserve the same level of service that I provide my customers, the best possible. The same level of service that you as a health care provider demand from your insurance agent, legal firm, cleaning company, and other service providers, the best.

When was the last time that you went to visit your accountant during tax time and the front desk worker had to sift through a 3-ring binder to find out who you were there to see? And what if it took then 30 minutes to figure that out? Thank god it’s not an emergency right? That would seem ludicrous in 2011 with the type of technology available today. How can your customers be getting the best service if the front line does not have access to accurate information? The answer is, they’re not.

As a specialty physician, you need to demand that your Hospital has an up-to-date on-call management system, to be sure that your customers are helped as efficiently and effectively as possible, every time.


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