Addressing the Compensation Conundrum for Otolaryngologists on Call

to negotiate.”

Dr. Strasnick agreed, noting that third-party assessments of fair market value are skewed by sample size and variations in benchmark data. He recommends thinking in terms of how to fairly apportion the downstream revenue you’re generating for the hospital by delivering the service. It can be difficult to obtain that data, but it’s worth the effort to consider things such as patient acuity, call frequency, number of calls, number of ED visits, malpractice impact, and payer mix.

Talk with other specialists. When negotiating call compensation for otolaryngologists at Swedish Medical Center, Dr. Sniezek talked with urologists who served the system. “It was really helpful for us to learn how our sister specialties are compensated and what their call burden is,” he said.

Determine your red lines as well as points you’re willing to compromise. “For us, the burden of call was more important than actual compensation for call,” Dr. Sniezek said. “We would negotiate on compensation, but we would not exceed q nine call [call more than once every nine days].” Other points you may be able to negotiate include time off after call shifts and access to support staff during call coverage.

Identifying and emphasizing shared values can be key to a successful negotiation. “A lot of people approach call coverage and compensation from a confrontational standpoint,” Dr. Strasnick said. “I recommend a collaborative approach.” Describe how giving physicians the resources they need contributes to excellent patient care, a stable, satisfied physician workforce, and the system’s bottom line. Propose a solution that meets the hospital’s needs as well as yours.

“We needed to have a mechanism by which our physicians would not experience burnout, and they would feel that they were adequately compensated for the increased work that they were performing on behalf of the hospital,” Dr. Strasnick said.  “Working alongside our hospital partners to properly evaluate the respective benefits and burden of the call obligation, our academic otolaryngologists now do receive compensation for call.”

In Seattle, it took more than eight months for the otolaryngologists at Swedish Medical Center to arrive at a satisfactory call agreement. Physicians employed by Swedish agreed to take two days of call per month without compensation; beyond that, they will receive compensation, and their call burden will not exceed q nine. All otolaryngologists who have privileges or operate at the hospital will share the call burden, proportional to their use of hospital facilities; they will be compensated at a rate a bit higher than physician employees.

Dr. Sniezek’s advice for other otolaryngologists negotiating call coverage and compensation? “Be very thoughtful, but very firm, about what you’re willing to negotiate and what you’re not willing to tolerate,” he said.   

Jennifer Fink is a freelance medical writer based in Wisconsin.