Not necessarily in terms of how often, but do you treat via call? do you convert to video? do you have a triage service (if so who?). Do you field your own patients or as part of a group? Ways to reduce demands and pages from patients? Legal risks?
Thanks!
Posted Nov 18, 2023, 7:18 PM UTC
My spouse did own call 24-7-365. If taking a trip, would arrange someone else to cover it. Trade favors. Rarely would patients call but yes it would be for dumb stuff. Two memorable ones, got called for a statin refill as well dysuria with someone who was started on treatment a day before wondering why it was not yet better. Both calls at 1AM. The problem with the call center is it does not know how to triage.
Until last year all calls came to the physician on c all in the group. We would be on for a week at a time every 6-8 weeks. 1/3 were pointless and I told them to call back in the morning. 1/3 were pointless and I told them to go to the ER. And I actually did something for the other 1/3rd. Averaged 2-3 calls per evening and about 8-10 on the weekend
Last year we signed up for an RN service to intercept all our calls and it’s been pretty good. Cut down about 75% on my call volume and the ones that get through are more like 1/2 pointless now instead of 2/3
This still seems frustrating lol
I’m in private practice (gen peds) with 12 partners so call is 1/13. We pay for peds specific after hours triage through the children’s hospital and they can page us if they have a question but it’s very rare. We have inpatient peds privileges but rarely admit, though we’d be on call for any inpatient questions from the hospital as well. On average we get 0 calls after we’re done with clinic in the evening. Occasionally a critical lab value or an RN from the triage service needing something on a more complex patient. The triage service is expensive but worth every penny, especially as parents have a pretty low threshold to call after hours and it’s a heavy call burden to triage that would be quite overwhelming to come to us directly.
Things have really changed for the better. When I started out 27 yrs ago, we rotated call in the group avg one night a week, one weekend a month, and parents would call alllllll night long. Before the days of cell phones, I slept on the sofa so the beeper wouldn't wake up the whole house, and I wouldn't get but 10 minutes between calls. Then had to work the next day. Throw in driving to the hospital for c section coverage or ER admission, which required peds to be there.
On Super Bowl Sunday it would be dead until half time, then a flurry. The last ones I got to were pissed off that the game had already started 😂.
We got some crazy calls. My very first post residency call was a parent worried about "ringworm", before you could get anything otc. I reassured her and said come tomorrow and we'll prescribe cream if that's what it is. She said but what if it makes a ring around his body tonight? I said it won't do that but it wouldn't matter if it did, we'll still do the same thing.
She said but he'll die if it makes a ring around him. I said no, no he won't die. She said are you sure? I said yes. But by that point I was thinking wtf, did I miss a derm lecture? 😅
Now I have no night call at all. The APCs cover it but even they hardly get calls. I so much do not miss those calls. I spent 20 years being tired all the time.
did the kid die?
No! Whew! Dodged that bullet 😅
I'm employed in a group with 7 other physicians. We do not provide prescriptions or refills after hours. We do not convert to "visits". We provide basic medical advice and warn that our advice is limited as this is neither a visit nor in person. Most calls I either advise calling back in the am or going to Urgent Care/ER. That's what they are there for. Occasionally I'll make advice on OTC things they can try until the am when they can call.
Honestly I think the biggest key is all the partners agreeing. If a few do scripts and others don't it creates unreasonable expectations for patients.
we have a call service but patients get through to us if they insist, and hospice/snf calls come.
At a community health center, we do 7 days of call; about 5-6 weeks per year. There is a nurse triage service the clinic pays for which is helpful. Can turn a longer call into a telehealth to bill if you ask the patient.
At my last job (which I have since left) in private practice primary care group we would cover our own patient/ after hours calls during the week and would take weekend/ holiday call q4-5 weeks where I'd cover calls for my 3 physician and 2 NP colleagues. We couldn't afford an answering service. I would maybe get 1-4 patient calls during the week and would get 0-5 per day on weekends from patients, ER, home health, lab. I ALWAYS let the call go to voicemail so I could triage and also avoid giving patients the impression that we were sitting around waiting for a call. My voicemail message outlined that after hours calls were for urgent medical problems only, that we could not refill controlled substances or help with appt rescheduling etc, and to give me 30 min to return a call before calling back. We were encouraged to convert calls for new medical problems to virtual visits so we could bill, but if I was out running errands etc I wouldn't bother. There was a strict no controlled refill after hours policy but I did make an exception once when a colleague messed up a prescription during business hours and the patient was facing a holiday weekend of opiate withdrawal. I would have to set boundaries with some patients on inappropriate use of the after hours line, which mostly worked. The hardest days were the day after Thanksgiving and 12/26 since the office was closed-- would just get back to back calls from 8am to 12pm-- so an extra half day of mostly uncompensated work! The worst was when the answering system was messed up and no one knew how to fix it so I would get patient calls while on vacation in Mexico. There was no way to transfer the call to someone else so I just took care of it. Good riddance to that job! Hope this helps!
I take my own “call” 24/7 365 but zero pt calls. If doc/radiology/lab are calling it comes to me, if pt call it gets documented and followed up next business day like any other pt case. There are urgent cares for urgent matters and emergency rooms for emergencies.
My call center screws up sometimes and puts a pt call through but each of the 3 times it’s happened in the last 4 yrs it’s been something that I was glad got put through to me. Get maybe one call on critical results every quarter or so and honesty don’t think I’ve had a physician to physician call outside of normal business hours.
Wow, are you solo/DPC group or employed?
I’m employed and this sounds very different from what I’ve ended up with or what I’ve heard from other peers
Employed. No idea how any PCP allows pts to call them night and day. You want concierge medicine go pay for it.
I’m with you. I’m looking at other options with my group as there is not even nurse triage for 10-12 hours overnight and patient calls are expected to come through — in my mind, outpatient calls after hours either are UC/ED tonight or can wait till next day and that’s what it sounds like you have in place
It is a shared call so it’s not every night but it does mean you’re getting calls from patients you know nothing about
I might have nightmares about that now. This sounds like the kind of ghost story meant to scare interns told over a campfire.
I hate that Primary Care gets paid like urgent care (based on encounters only), but are expected to provide free longitudinal care on their own time.
Really, why bother, just do urgent care and stop working when they stop paying you (after your last patient visit).
Same for me, but I was self-employed until I retired at the end of 2022. Patients that wanted to be able to speak with an MD 24/7/365 and were not content with the availability of advise nurses with their insurance, urgent care centers and ER's could go to Kaiser.
Even in a kaiser, you only get a call-center nurse for advise (though they do have ER docs that they can consult if needed).
As someone else posted, if a patient truly wants 23/7 physician availability, that's called a concierge practice, which are available, for a price.
"But... but don't you CARE?" says the patient that demands instant access and resolution to 100s of problems they won't take responsibility for after multiple discussions.
I had a goals of care discussion at 11:30 at night once. Then our group did away with outpatient call.
Amen to the urgent care & emergency care bit. Our residency has a night call system and it’s the dumbest thing ever. It just makes me resent patients having too much access to me and I can’t wait to be in a job setup where they can’t call me.