QUESTION:        We employ physicians through a corporation affiliated with the hospital. One of our employed physicians recently submitted a request to the Chief of Staff, his friend, requesting that he be excepted from taking nighttime and weekend call due to “seniority” and years of service. The request was approved at the last MEC meeting. The physician now claims that he is exempt from covering the medical practice too, since an exception was granted. Is he right?

ANSWER:            The question you raise is not uncommon. The answer is that the physician is not right, but it is best to be clear in your employment contracts about the difference between ED call and practice call so there is no confusion or dispute.

The obligation to serve on the Emergency Department’s on-call roster arises from the Medical Staff Bylaws, Credentials Policy, and related documents (for example, the hospital’s on-call policy or EMTALA policy). Accordingly, any physician who wishes to be a member of the medical staff or exercise clinical privileges must agree to serve on the ED call roster that is developed in accordance with hospital policy (often by the department chairs, subject to approval of the MEC and Board). In your case, the physician in question has made arrangements through the medical staff leadership to obtain an exemption from the requirement in the Bylaws.

The obligation to “take call” for the practice is separate and aside from any obligations that a physician may have to the hospital or its ED. All physicians have to cover their practice, whether they are affiliated with the hospital or not. It is through this coverage that the practice’s patients are able to obtain after-hours consultation and advice regarding emergencies. The obligation to be on call for the practice does not arise through the hospital’s Medical Staff Bylaws or related documents. Rather, it is an obligation associated with employment. In turn, the medical staff leadership has no authority over whether your employed physician takes call for the practice and cannot grant the physician an exemption from such duties.

So there is no confusion or dispute, we recommend that your employment contract language state that the physician will be required to be on call for the practice, along with other practice physicians, according to the schedules established by the employer. The language should go on to state that, in addition, the physician must fulfill any obligations of medical staff membership or clinical privileges at all hospitals with which he or she is affiliated, including service on the hospitals’ ED call rosters.