Managing ED call during maternity or paternity leave

Dear Colleagues:

A hospital I recently visited has been struggling over ED call, an experience many hospitals share. A gastroenterologist had gone out early for maternity leave due to pregnancy complications, triggering a debate over whether the remaining gastroenterologists would pick up her previously scheduled call slots or simply leave them uncovered. One of the remaining gastroenterologists had made arrangements before her maternity leave several years previously to do extra call to “pay back” her colleagues for the call she would not take during her maternity leave. This gastroenterologist happened to be responsible for making up the call schedule and had assumed that the physician who is currently on maternity leave would do the same. However, no one discussed this with her. In fact, she had no intention of paying back any call missed during her maternity leave, and the medical staff had not adopted a policy on the matter. The result: conflict, incriminations, and the risk of uncovered call slots.

This situation makes another case for the 5 Ps:

“Our Policy is to follow our Policy. In the absence of a Policy, our Policy is to create a Policy.”

The challenge of covering open call slots for physicians on maternity or paternity leave, whether planned or due to unexpected complications, will increasingly arise for every hospital. Currently, approximately one-third of US physicians and 50% of medical school classes are women. Thus, medical staffs must prepare to accommodate more maternity leaves. In addition, medical staffs cannot discount that more fathers are taking paternity leave than they did in the past.

Just to be sure we are politically correct in how we frame this challenge, and in the spirit of full disclosure, I must share with you that when my first child was born in 1985, I took three weeks of paternity leave, a decision that shocked the 65-year-old physician whose practice I had recently joined. He shook his head and said, “Why on God’s green earth would anybody want to spend time with a child under the age of two? They can’t even talk yet.” At that moment, I knew I was facing a generation gap that could not be bridged. But my partner’s reaction is only different in degree from some of the reactions physicians taking maternity and paternity leave today face, especially regarding making up missed call.

Is maternity leave like any other medical leave of absence? If so, there is a precedent for not making up missed call. However, medical leave is infrequent and usually involves an illness, accident, or other misfortune for the physician, which creates an outpouring of compassion and a willingness to help out. Child birth is not a “bad thing,” nor is it infrequent, so some people believe that physicians should repay ED call after they return from maternity or paternity leave. It is a great service to all of us when parents take time out of their careers to bear and raise children. So how should these physicians be treated?

For some, it’s a no brainer that a mother or father returning from leave should not have to pay back any call missed during the leave. For others, it’s assumed that the physician will pay it back. The key is to have clear expectations up front. Without reference to employment law issues (on which I profess no expertise), it is appropriate for physicians who are or will be sharing call to openly discuss how call coverage for maternity or paternity leave will be handled in advance of when the situation arises. But note this is usually a discussion among physicians who share call coverage for their practice(s), and is most often handled with a sense of shared responsibility and willingness to collaborate. This is not often the case for unassigned ED call. Increasingly, physicians seek every opportunity to reduce or eliminate responsibility for unassigned ED call. So when a physician’s maternity or paternity leave creates additional ED call burden for others, conflict and resentment can result.

That’s why the best strategy is the 5 Ps. A reasonable policy could be to allow the physicians in each specialty to work call coverage out among each other. After all, the key to a good coverage arrangement is collegial relationships among those sharing the call. But sometimes competition, personality conflicts, and lack of trust make this difficult. Add to this mix the understandable resistance to accepting extra ED call burden, and the result is not pretty. Therefore, for many medical staffs, an open discussion that results in a policy is the best approach.

All the best,

Richard A. Sheff, MD, CMSL, chair and executive director of The Greeley Company, a division of HCPro, Inc. in Danvers, MA.