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What Physicians Need to Know About On-Call Pay

Cortney Ikpe

Spending your weekend on call is one of the many challenges that come with life as a physician. But just as civil servants often rely on overtime to make up for an otherwise meager paycheck, on-call pay can help physicians boost their bottom line, not to mention take the sting out of giving up a family weekend to tend to patients. But on-call pay might not be what you expect, so it's important to get a clear understanding of your options upfront, rather than just counting on getting a nice fat bonus when you carry a pager.

Not All Doctors Receive On-Call Pay

Medical economics is a rapidly changing field. Just two years ago, 25% of doctors worked in solo practices, compared to 17% today. Doctors are flocking to employment in droves, but with that steady paycheck also come some cutbacks in other physician perks. About 60% of hospitals still offer doctors on-call pay. But an increasingly large number of hospitals are avoiding on-call pay. They've hired you to do a job, the justification goes, and part of that job is working on-call shifts.

Among doctors who do receive on-call pay, the nature of the pay also varies quite a bit. The majority, 35%, get on-call pay in the form of daily stipends, while 12% receive annual stipends, and just 7% receive hourly stipends. According to a recent compensation survey, $75 was the lowest median daily on-call pay, with high on-call daily stipends topping out at $2,400.

It Varies Widely According to Specialty

As any seasoned doctor knows, the myth of the wealthy physician is just that. And depending on their specialty, doctors may be flush with cash or just struggling to get by. Turns out that the same economic model holds true when it comes to on-call pay, too. Most hospitals rely on a supply-and-demand model to compensate doctors, which means that rare and in-demand specialties frequently earn higher on-call pay. And, as in most other areas of medical economics, surgeons tend to get the most.

According to the survey, the median daily stipend for on-call surgeons is a $1,000. This stands in stark contrast to the paltry median $150 stipend offered to family physicians. And though some hospitals have completely eliminated on-call pay for employees, the data suggests that, overall, the percentage of doctors receiving on-call pay is increasing. This may be due in part to the fact that more doctors are employees than ever before; after all, it's unlikely a physician will pay himself on-call pay when he's on-call for his own practice.

It's Up for Negotiation When You Get Hired

Compensation research suggests that, like with most other elements of your compensation package, you can get a better on-call pay rate if you're willing to negotiate when you're hired. Don't wait till you've signed the contract. Instead, critically evaluate what you bring to the medical facility and hire a physician contract attorney to properly advise you. Doctors with a stellar track record of recruiting new patients, a long history of above-average service, excellent medical training, or in-demand specialties are uniquely situated to ask for – and receive – more on-call pay. If you want to boost your on-call compensation rate, try one of the following strategies:

• Give a little to get a little. Try giving something else up, like extra vacation days, or a few thousand dollars in salary.
• Research what other people at your hospital are making. If you're getting low balled, be prepared to walk away.
• Offer to trade for a benefit you don't really need. For example, if you can afford to relocate on your own, try asking for higher on-call pay in lieu of relocation assistance.
• Leverage your other offers. If you've received a better on-call offer from a comparable employer, don't be afraid to speak up, especially if you know you're a highly desirable candidate.
• Ask about the specific terms of on-call pay, rather than just getting a ballpark figure. Then be willing to ask about changing these terms. For example, you might prefer an annual stipend instead of a daily one.

Knowing the Average Can Help You Negotiate a Better Deal

If the hospital you've chosen offers an average on-call stipend for your specialty of $150, you're simply not going to be able to negotiate them up to $1,000 – at least, not without giving something else up. Know the average figures for your area, your specialty, and your hospital. Some hospitals publish this data, and a wide number of medical research firms offer averages according to age, experience and specialty. Go into your negotiation session armed with this data, so you can be prepared to counter-offer if you're offered something significantly below average.

On-call pay might seem to be insignificant now, but when you're getting up in the middle of the night to deliver a high-risk pregnancy, you'll probably think otherwise. Don't be afraid to speak up and ask for more money; doing so will increase your job satisfaction, and make dealing with the challenges of on-call life infinitely easier.