Hidden traps in call coverage arrangements

You’ve recently joined a medical group with 10 physicians. The contract noted that call coverage would be “equally” split among the group, which is fine by you. You’ve done the math, and that translates into three to four days per month.

But once you start, you find out that the four physicians who have each been with the group more than 20 years are exempt from taking call. This means you’re splitting call coverage with six physicians, not 10, which is quite a difference.

“This scenario is all too common,” says Chris Brown, JD, an attorney with the Health Law Firm in Altamonte Springs, Fla. “Often, contract language is broad or vague, leading to incorrect assumptions about what the employer really has in mind.” Instead, doctors should “firmly narrow down” exactly what call coverage consists of, leaving nothing to chance or to the imagination.

Don’t be afraid to negotiate call coverage when your job search indicates call as a requirement. “Physicians should not be shy when it comes to negotiations.”  – Chris Brown, JD, Health Law Firm

Dennis Hursh, JD, managing partner of Hursh and Hursh PC, a law firm in Middletown, Pa., agrees. “I don’t use the word ‘equal,’ ” he says. “I prefer the word ‘equitable.’ ” For example, he says, if all members of the group are expected to be on call two days a week but you’re always stuck with Saturday and Sunday, the numbers may be equal but the arrangement isn’t equitable.

“I use language such as, ‘call coverage will be equitably allocated and will not exceed two days per week and one weekend per month’,” says Mr. Hursh, who is the author of The Final Hurdle: A Physician’s Guide to Negotiating a Fair Employment Agreement.

Don’t be afraid to negotiate call coverage arrangements or to be creative when doing so, he adds. “For example, you might agree to a certain number of days per month and negotiate extra pay if you are on call additional days.”

And be sure that you have an exact definition of “day.” Mr. Hursh recalls one client who accepted a position at a hospital. “The contract stated that he would be on call for a certain number of days every month,” he says. “He was shocked to discover that he was being asked to be on call at night. It turned out, the hospital defined ‘day’ as a 24-hour period, while my client thought it meant ‘daytime.’ ”

Generally, hospitals spell out their expectations in greater detail than medical groups, and their arrangements are more standardized. But that doesn’t mean you can’t negotiate. “I always tell physicians not to be shy when it comes to negotiations,” Mr. Brown says.

But before you start negotiating, nail down exactly what is on the table. Every practice is different, based on the number of physicians, their specialties and other unique factors. Because call coverage is such a crucial component of your work life, begin hammering out details in verbal discussions before you even get to the contract stage. Then make sure what you discussed is what is in your contract.

“Sometimes, the general language in your contract is deliberately vague, so flesh it out before you sign,” advises Mr. Brown. Because this is so important, he adds, it might be a good idea to ask an attorney to review the contract, just to make sure there is no ambiguity.