Beer me!

Philip Betbeze, Senior Editor-Finance , October 29, 2007

Strange headline for a healthcare finance column--I'll grant you that. But amazing things can happen when you take the time to meet over a beer after work. Some of the tension of normally adversarial relationships just flows out of the room over a cold glass of your favorite malt beverage.

In the case of a couple of harried hospital executives, a trip to the local tavern turned out to be just what the doctor ordered in the contentious decision over how hospitals can afford to pay for call coverage. Doctors' compensation has been increasing more slowly over the years, and many who participate in the medical staff model have less and less tying them to the hospital. Many of them don't have to perform surgeries in the hospitals' facilities anymore, and call coverage brings low- or nonpaying customers into their professional time. Doctors these days, I'm hearing more and more, have a desire to "have a life" and not work the 60-70 hours a week of their predecessors. Further, if a community hospital won't pay for call, in many communities, another one down the road will.

It doesn't matter whether you or I think doctors should cover call as an obligation to their local hospital granting them privileges for practicing there. To an increasing number of hospital executives, the demands are there, and they don't have much in the way of a stick to force doctors to take call coverage. And other than precious cash, they don't have much of a carrot, either.

Hospitals are caught between a rock and a hard place on this issue. If they operate an emergency department, most have no choice in whether to arrange call coverage for a variety of specialties. Used to docs covering call for nothing, many hospitals find paying anything to be a huge cost center. And once they pay that cash, there's nothing tying the doctor to the hospital to cover call the next time except the promise of more cash. It's almost a no-win situation. Until now.

Which brings me back to the beer and the story I detail in the October issue of HealthLeaders magazine. Two hospital executives trying to hatch a plan for call coverage on the back of a napkin--a plan that would compensate physicians for their time, defer that compensation from taxation, and allow the hospital a small measure of protection from physician competition. Sound too good to be true? It isn't. Not when two smart people get together to try to solve a pressing problem.

Philip Betbeze is finance editor with HealthLeaders magazine. He can be reached at

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