FMV, Call Burden, and the Changing Landscape of Ophthalmology Call Arrangements

For some specialties and markets, rapid evolution in the healthcare industry is seeding significant overhauls in call coverage arrangements. One specialty experiencing these broad shifts is ophthalmology. The American Academy of Ophthalmology (“AAO”) has attributed these shifts in large part to the rise of ambulatory surgery centers (“ASCs”). Historically, ophthalmologists provided hospital call as part of their medical staff duties. Now, many ophthalmologists perform a large percentage of their cases in an ASC and are reluctant to sign on for traditional call coverage assignments. This can leave hospitals, especially Level 1 trauma centers, which are required to provide 24-7 ophthalmology coverage, in a lurch. The result? Some hospitals have created a new medical staff position: the ophthalmic hospitalist. These physicians may be employed or independently contracted to provide clinical services within a shift-based framework, negating the need for call arrangements with outside private practice providers.

Ohio-based ophthalmic hospitalist Dr. Craig Czyz provides services as an independent contractor for several hospitals, helping to meet their ophthalmic call coverage demand. He believes that many of his ophthalmology colleagues don’t realize that traditional ophthalmology call arrangements may, in fact, cost them financially in the long run. In early November, Dr. Czyz presented a talk at AAO 2023, the academy’s annual meeting, on the ethical, legal, and contractual complexities of ophthalmology call coverage. In his presentation, Dr. Czyz cited benchmarks reported in our 2023 BFMV Physician Call Coverage Burden and Compensation Survey, and he later shared his perspective on ophthalmology call coverage with us. Dr. Czyz continues to work with AAO to inform Academy members of the ethical and legal responsibilities within typical call arrangements, along with the often misunderstood financial ramifications.

Considering the vast range of services provided across medical specialties, being “on-call” means different things for different physicians. In some cases, physicians equate “taking call” to sleepless nights and around-the-clock obligations, perhaps staying on-site for 24 hours. In other circumstances, it means going home to handle nonstop phone consults, review stacks of electronic exam results, or take inevitable moonlit trips back to the hospital to scrub in or conduct rounds. And, for some physicians, it means spending the evening at home while maintaining availability and readiness to provide services (but rarely needing to do so). The spectrum of physician call burden is broad, multi-faceted, and affected by numerous factors.

Given the continuum of demands, determining fair market value compensation for physician call coverage services involves assessing the burden being imposed. Call coverage burdens vary across medical specialties and within specialties; unique facility characteristics, such as size, trauma level, degree of mid-level provider involvement, and patient volumes, may place vastly varying demands on physicians. The various quantitative aspects of call burden, such as the number of phone calls, trips to the facility, and days per month on-call, can be used to compare one scenario to another or to market benchmarks. The BFMV Physician Call Coverage Burden and Compensation Survey is unique in that it provides call burden statistics in addition to compensation data.

At BFMV, we conduct our national direct-to-physician call coverage survey every year. This project provides valuable insights that inform our fair market value appraisals. We also believe it helps responding physicians, who receive a free copy of the Report, in their contract negotiations. We are always open to feedback from participants, and we welcome opportunities to deepen our understanding of the realities affecting the benchmarks. For more information about our annual call survey or assistance with determining fair market value compensation for physician call coverage arrangements, contact BFMV.