NPs and Call

Published

Request the opinions of any NPs working in primary care who are performing call as part of their duties. Is there any room to negotiate days off or compensation for taking a whole weekend of call plus office hours for the weekend on a rotating basis that are in addition to the full-time 5 day work week, or does this just typically come with the expected duties / long hours of the job? A lot of physicians act like call is a breeze, but in my opinion, it still takes up your time, cuts into your R&R, and can be challenging with acute situations. Just wondering if it's something worth negotiating especially if salary isn't stellar. Thanks.

Up Vote Up Vote ×
Specializes in Adult Internal Medicine.

Absolutely negotiate it.

Up Vote Up Vote ×
Specializes in FNP, ONP.

In my practice it is just part of the expectation to take call every 6th night and every 6th weekend, and there is no extra pay for it. It really is very simple though. I really do not do squat for people when I am on call. Some of the other providers do go more out of their way, most do not.

I tell everyone who sounds the least bit ill to go to the ED or UC. I do not fill any routine prescriptions because the rule is to call a minimum of 72 hours in advance for refills. If they don't do that they are out of luck and it is not my problem and I don't enable bad behavior. I can't do anything with home health or DME on a weekend even if I wanted to, so they are out of luck there too. I will absolutely fix a mistake if it is our fault, like a Rx didn't go through/got tangled up in the EMR and got lost. It happens. But the most I ever really have to do is reassure a Mom about a fever, give advice/instructions for OTC meds or something. If it isn't very, very straightforward, I simply tell them to go to UC. I can't eval people over the phone, so if there is any doubt at all, they need to be seen by someone who can lay hands on them. Absolutely no controlled Rx during off hours, for any reason whatsoever, I don't care if they are dying of cancer (they would have hospice if that were true, and I've been told that lie, among others).

I get irritated with people who wake me up for nonsense (constipated at 2am), and they know well that I'm irritated. They don't do it twice b/c I'm not especially nice. I once fired a patient for abusing the on-call "privilege."

The truth is, 9/10 nights and weekends I get no calls at all. Most of the time when I do get a call, it is right after the office closed and someone's rx didn't go through. I can count on one hand the number of times I've been called about anything significant. Call really isn't a big deal. I still live my life. I go to the movies, plays, ball games, restaurants, parties, skiing. I sometimes just tell the switchboard I wont be answering immediately for a while, and if the pt feels their issue cannot wait 2 hours they need to go to UC, the ED or dial 911, otherwise I'll call them back later.

I was on call last weekend and went to the Berkshires anyway. My phone works there, lol. I got one call. She had a cough, yada yada yada. I don't stay home and wait for the phone to ring. Life does not stop because I'm on call. I can't get drunk, but I don't do that anyway. I don't know why anyone sweats taking call. It isn't as though as NPs we are going to rush in and do a cath or crack a chest. It's cough due to cold for dog's sake.

Up Vote Up Vote ×
Specializes in Adult Internal Medicine.

I agree with BP, though my call is complicated by the fact when I cover call it's for four local offices and I have the inpatients to cover as well. I get about 10-15 calls on a weekday night if covering and I get 20-30 calls on a weekend if covering.

The vast majority are easy as BD outlined; make a set of rules and stick to it. Firmly tell patients when they are out of line (ie I got a call at 2am this morning from someone with a sore throat they had for 3 days). Anything remotely concerning goes to ED. The worst influx of calls is the hour or two after offices close or right after nurses change shifts at 7 and 11 and need new orders.

I would try and negotiate though, even if it's "expected". I got an extra week's vacation because of it.

Up Vote Up Vote ×

I'm guessing BlueDevil you likely make a nice salary and may have some higher rank in your practice, and therefore can have those call "rules" in place. If I in the past had come across like that on the phone to patients, my previous employer would have raked me over the coals. Patients would have immediately complained about me to the doc for not fulfilling their requests and it would have been a big scene in work. I agree with you about narcs and call. Have to disagree about it being a walk in the park. I'm a new grad and discussing patient conditions with ED docs / hospital docs in addition to regular patient calls, is not particularly easy while out and about. Maybe it's an experience thing but yes, I sweat call. There have been moments when the phone literally rang all day even to the point that it made bathroom breaks challenging. I was just curious about compensation of some time off particularly if salary excuse my language sucks.

Up Vote Up Vote ×
Specializes in FNP, ONP.

I am an independent provider. There isn't anyone for my patients to complain to about me. We take call for each other in order to help each other out. I don't work for them, they don't work for me. We share office space and durable medical equipment. We share some overhead expenses. We bill as separate entities and the physicians in the office do not have any sort of professional relationship with me. They can be rude as hell to my patients if they want to, and vice versa. We aren't, but neither are any of us going to meet a patient at the office on a Saturday afternoon because they forgot to fill their kids Concerta and said kid is bouncing off the walls (this was recently the expectation of one of my colleagues pts Mom. She was peeved. It's your kid. You forgot. Deal with it, Mom). There is one doc in our office that patients tell me quite rude when they call. I don't have it in me to be that obnoxious, but I'm kind of glad he is, if it discourages overall call numbers, lol.

If I got many calls a day or had hospital responsibilities, yes I'd expect additional compensation. I don't, and for the most part our patients are "trained" not to bother us for minutiae.

Up Vote Up Vote ×
Specializes in Adult Internal Medicine.

There is one doc in our office that patients tell me quite rude when they call. I don't have it in me to be that obnoxious, but I'm kind of glad he is, if it discourages overall call numbers, lol.

I am rarely rude but when I get a rude patient calling for an inappropriate reason I don't hesitate to be curt.

Similarity I have a provider that takes all for us that is very rude. He gets way less calls than the rest of us!

Up Vote Up Vote ×
Specializes in FNP, ONP.

Well patients never know who they are going to get when they call, they get our answering service first. So if a previous bad experience with Dr. Meanypants has them feeling a little timid about calling again and therefore they just take an ibuprofen and sleep off the complaint, or just go directly to UC, when I'm actually the one on call, well fine with me. So he can keep being Meanypants, and keep the call numbers down.

Honestly, I'm a little Meanypants myself for stupid stuff. Do not wake me up at 2am because you haven't pooped in 2 days. Do not. You will poop your pants when I'm done with you, so there is the upside, I guess.

Up Vote Up Vote ×

"Honestly, I'm a little Meanypants myself for stupid stuff. Do not wake me up at 2am because you haven't pooped in 2 days. Do not. You will poop your pants when I'm done with you, so there is the upside, I guess."

BlueDevil - that made me laugh out loud!!!! :yes:

Up Vote Up Vote ×

I have always negotiated something for taking call. Your off time is as valuable as your work time. Drs dont want to be on call as it disrupts their personal life. Guess what...you deserve to be compensated for giving up your personal time!

Up Vote Up Vote ×
+ Join the Discussion