Chances are if you’ve seen any medical drama then you’ve probably heard the expression “doctor on-call”. But what does it mean exactly? And what can you expect as a future physician (or healthcare worker) being asked to work on-call?
We’ll dive into all that in this article. Here’s what else we’ll cover:
- How on-call works
- What types of doctors work on-call
- If you can make more money working on-call
But we’ll also discuss a couple of other things and hopefully help make this one of the more definitive guides to on-call work in medicine out there.
As a med student myself, I appreciate the need to demystify buzzwords and medical jargon. Not only for the sake of future doctors and nurses but also for patients too!
Ready to get started? Let’s go!
How Does On-Call Work For Doctors?
On-call work can mean different things depending on how senior (or what type) of doctor you are. For resident doctors, on-call typically means staying in hospital overnight (or working a really long shift) to care for patients. For attendings it can mean taking calls from home. There is no typical on-call shift!
Because of its complexity, on-call can be one of many things. Usually, it involves one (or some) of the following:
- Working beyond “normal” hours or shifts (mainly nights and holidays)
- Taking “calls” (these can often be pagers) from other hospital/medical staff to help direct patient care
- Assisting a more senior doctor with their duties and responsibilities
- Being in proximity to the hospital/clinic
- Not having any other activity (work or leisure) scheduled in for that time
Obviously on-call work can look very different between doctors. Certain specialties may not require a ton of on-call work (especially those limited on emergencies, like dermatology), while others (like surgery or anesthesia) might. Things also depend on where you work (opening hours, private vs. public etc).
Most junior doctors will struggle to avoid on-call shifts early in their careers. It’s almost seen as a rite of passage for emerging physicians to do their duty this way before climbing the ladder to seniority later on.
For that reason it’s not unheard of for some doctors to work on-calls as long as 24 hours or more!
Tips for Working On-Call
Some of the best tips for surviving on-call shifts involve the same types of things that go with maintaining general health and wellbeing. Working long hours though (especially those at night) does call for some extra care.
Here are some key tips for working on-call as a doctor (or healthcare worker):
- Hydration (take regular water breaks)
- Nutrition (especially foods that provide slow release energy)
- Learn (take full advantage of the increased autonomy and chance to work more closely with others)
- Don’t dread the pager or phone (pause, breathe deep and respond)
- Comfort (durable shoes, breathable scrubs etc – for more recommendations check out my guide on the best shoes for clinical rotations)
- Caffeine (not a necessity, but can help keep you productive)
Dr. Hope shares a bunch more excellent tips in the video below. Well worth a watch!
Do Med Students Work On-Call?
Depending on what med school you go to, you may be required to work on-call shifts in your teaching hospital. It’s also something common in several American and international medical schools. Especially as it’s seen as a good way to gain exposure and working experience.
Key reasons why this is the case can include:
- Most on-call doctors are overwhelmed by the work load
- On-call doctors can become easily fatigued (especially with long shifts)
- Med students are a flexible commodity for teaching hospitals
Because of these factors, med students often get the chance to try their hand at procedures (or have more autonomy) that they might not otherwise get on daily clinical rotations.
This is also the reason why many med students actually request the opportunity to work (or shadow) on-call!
Not all attendings will require you to do your on-calls as a med student either. Standards have relaxed in North America in recent years, meaning many salaried staff take a more sympathetic approach to med students.
Med students are rarely forced into accompanying residents or attendings on their own grueling shifts like they once were. Legally enforced “capped” hours and individual school policies protect from the multiple day on-call’s of the past.
Here’s what the Liason Committee of Medical Education (LCME) had to say on this issue back in 2016…
The LCME expects that medical schools develop and implement policies and procedures regarding the amount of time medical students are required to spend in clinical and educational activities during clerkships (LCME Element 8.8). Most medical schools use the ACGME duty hours requirements (as contained in Common Program Requirements, VI.G) as the basis for their policy.
Medical schools are expected to have procedures to collect data on medical student duty hours and to address situations where the school’s policy is violated. Medical students may voluntarily exceed the duty hours limits based on their motivation to learn.LCME, 2016
At most schools those duty hours cap out at about 80 hours a week, averaged over 4 weeks.
Do Nurses Work On-Call?
Just like doctors, nurses also work on-call.
For them, on-call looks much the same. It involves working outside normal working hours, often on longer or extended shifts, and involves being in close enough proximity to a hospital or clinic.
Similar to physicians, different types of nursing lend themselves to different on-call commitments. Nurses working in areas like GI or Cath Lab, Dialysis, Recovery Room etc., may find themselves required to work more on-call shifts than others.
Rural nurses may also find themselves more on-call than those in inner-city jobs.
On-Call Medicine Challenges
On-Call medicine typically refers to a team that’s ready to respond or on duty at the time of emergency.
For physicians tasked to work in these teams (their schedules are normally set by hospital rotas), working on-call can be particularly stressful.
The biggest challenges include:
- Stamina (being able to stay alert working long hours)
- Competence (being able to maintain quality of care in the face of possible fatigue)
- Expertise (having wide enough knowledge and experience to deal with any potential case)
To help combat these issues, many physicians can take support from training, colleagues, supervisory assistance and expertly communicated hospital/clinic protocols and procedures.
Apps, reference materials, and other resources can also help maintain care standards and reduce medical negligence.
On-Call Vs. Home Call
One of the big confusions surrounding on-call shifts is that of the idea of “home call”.
For the layman they are essentially the same thing. Both require physicians being on hand to respond to emergencies (“calls”). The only difference being home calls don’t require the doctor to be present at the hospital or clinic.
Depending on the hospital, there can be a preference when it comes to scheduling doctors to work on-call over a home call. Given some of the challenges above, especially concerning fatigue among doctors expected to stay overnight at hospitals, home calls can sometimes appear a more sensible option.
Busy residents working call for long hours can be adversely affected by sleep. Allowing some to work at home (or even to provide a more healthy balance between on-call vs home call), can help keep physician productivity levels up and mistakes down.
On-call rooms have something of a reputation for housing hospital shenanigans.
But rather than being seen as a fictional place of mischief that’s overly-dramatized by one too many hospital TV shows, they’re actually fairly conservative places.
Designed to provide refuge for doctors working on-call, most rooms are simple in nature with a bed, sofa or couple of chairs to rest.
They’re also rather unique to America (Source), Canada and a handful of other international countries. The European Community, for instance, due to a 2003 working directive that effectively banned on-call work, has no need for dedicated hospital rooms for this reason.
Here’s how a typical on-call room looks in an American hospital…
The key features of an on-call room include:
- Bed or sofa
- Communication systems
Nothing too complicated!
Types of Doctors Not On-Call
Choosing a medical specialty that provides a good quality of life is a common concern for med students and others interested in the profession. On-calls? Don’t usually make for that!
To help guide you in that decision then, here is a list of the types of doctors who don’t typically do a whole lot of on-call…
- Diagnostic Radiology
- Radiation Oncology
- Plastic Surgery
It’s worth bearing in mind that a lot of things factor in to what types of doctors do on-call or not. Those working in private clinics that hire hospitalists for example, won’t usually be required to do on-call. Nor will those working shift work (EM, intensivists, etc.)
It’s down to how you contract with your hospital or employer that determines how much/how little on-call you’ll be asked to do.
How Often Are Doctors On-Call?
How often a doctor works on-call is largely dependent on two factors:
- What their specialty is
- What the details of their contract are
Beyond that, there’s no one answer. On-call hours will be determined on a hospital-doctor basis and will differ across all institutions.
Rural doctors (or those in understaffed areas) can maybe expect more on-call work.
As for how often doctors may get called (or paged) during an on-call? That’s often case-dependent too.
Obviously things like national holidays or catastrophic events see a rise in emergency cases, meaning increased calls for physicians working during those periods.
Most doctors report at least several calls per night, however. While home call doctors might have to come in-person emergencies once or twice a week depending on the severity of the situation.
How often you’ll get called tends to depend a lot on grade and medical specialty.
On-Call Doctor Salaries
One common misconception about on-call is that doctors (or other healthcare workers) get paid more for working it.
This isn’t always the case.
According to the data, around 60% of hospitals offer doctors on-call pay (Source). How much of an increase that is on usual pay is open to debate. It’s usually agreed that any stipends (increases) depend on specialty and the simple economics of supply-and-demand.
Something that is encouraging surrounding the idea of on-call and adequate compensation is the idea that it’s usually open to negotiation.
Physicians can ask for better on-call pay rates in their contracts when being considered for jobs.
Do On-Call Doctors Sleep at the Hospital?
On-Call doctors can sometimes sleep if they’re not required to complete any duties or attend any emergencies.
Those working under the supervision of other doctors will usually have to ask permission however. It’s generally frowned upon to head to the on-call room and sleep as a junior without clearing it with an attending or more senior resident.
Is There Any Downtime Working On-Call?
One of the perks of on-calls is that (although it is possible) you won’t have to be responding to something every waking minute of the job.
In your downtime you can read, relax, sleep or do whatever else keeps you in close contact to potential emergencies and responsive to calls.
A lot of physicians/medical students use this time for important study too!
Born and raised in the UK, Will went into medicine late (31) after a career in journalism. He’s into football (soccer), learned Spanish after 5 years in Spain, and has had his work published all over the web. Read more.