I recently encountered a social media post discussion about declining physician on-call availabilities, and how it seems ever more difficult for patients and emergency departments to gain access to on-call services.^1,2,3

For rural hospital systems, lack of access is nothing new.^4,5 When rural patients present urgently or emergently with more critical, complex, or specialized needs, these services are frequently not available locally.⁶ This represents an ongoing availability quandary and escalating physician “shortage” problem that have plagued rural health systems for decades.^7,8

But now we are seeing expanding physician shortages nationwide and increasing difficulties with on-call availabilities even in urban and referral areas.^9,10

What’s Going On?

One postulate offered within this recent on-line discussion was that newer physicians are less likely to agree to, sign up for, or accept employment options that require “on-call” services, preferring to now work only “business hours.”

However, in my recent experiences, I find that frequently, it is the facility’s administrative managerial system that is doing away with physician on-call options, and this is being done for financial reasons!

For facilities, the maintenance of physician “on-call” access, along with any supporting staff, such as on-call nurses or other staff and infrastructure support that an on-call service may require, can become profoundly expensive. This is especially true for those services that provide more specialized or intervention-based services and/or may involve an entire on-call team.⁶

Specialists and subspecialists remain the most expensive and some of the shortest-in-supply physicians, especially proceduralists (and especially if they are now being paid by the hour, or involve enhanced on-call premiums), or an on-call “team” for a facility to support. In an era of increasing nationwide physician and nursing shortages, such services become even more costly to provide and maintain.

These on-call costs add to the soaring overall costs health care facilities are now facing challenged by declining federal and third-party payer remunerations, bundled payment limitations.¹¹ In addition, hospitals and health care systems are also having to prepare for ways to combat upcoming revenue losses and increasing unpaid bills evolving from the additional estimated 17 to 20 million Americans who are scheduled to lose Medicare, Medicaid, or Affordable Care Act health coverage over the next one to three years.^12–18

Adding to this conundrum, new federal regulations may possibly slow medical debt collections.¹⁹

Health care facilities thus anticipate that expense-side issues and unpaid medical bills will continue to escalate as revenues further decline. With on-call access being some of the costliest services to provide, uncompensated or undercompensated services rendered can be a huge disruptive factor for a facility’s financial bottom line.