The Comedy of “Home Call”

An overheard conversation between a hospital CEO and his henchman Johnson about home call.

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A wood paneled office comes into focus

The CEO spins his chair away from the desk to the window and sighs heavily.  “Alright Johnson, the urologists are complaining again.  How do we fix this overnight call problem?”

Johnson shifts in his chair and glances down at the sheaf of papers in his lap.  “What problem is that, sir?”

The CEO continues looking out the window and gestures absently with his hand.  “Well they’re saying overnight call is too tiring.  They don’t want to do it anymore.  They say they don’t have energy to hang out with their kids and that sleep deprivation is unhealthy.  You know, the typical complaints.  What’s their deal, anyway?  How much is this call coverage costing us?”

The camera focuses onto Johnson, who looks a little sweaty

Johnson shuffles the papers and mumbles, “Well they’re actually on ‘home call,’ you know.  It’s a pretty good deal for us.  Since they don’t technically have to sleep in the hospital, we don’t have to pay them for all the phone calls they get from the nurses or the primary care docs. We do still pay them when they operate or come to the ER at night.  But since they have the option of going home after the consult, they still have to work the next day.”

The CEO spins back around and glares at Johnson over his desk.  “You know a few of them told me that the consult pay isn’t worth the money?  One of them emailed me at 3AM after a stent placement.  I mean, how often are they having to do stuff like that?  We shouldn’t give them any concessions if it’s not a real problem.”

The camera pans to the papers in Johnson’s lap

Johnson pulls out a paper from the pile on his lap and squints at the writing.  “When we looked at it the last time, our urologists are in the hospital after midnight about half of the time they’re on call.  Our hospital serves over half a million patients, so it can get busy.  A few of them have already retired early or left the medical group because they hate it so much.”

Lock in your rate while you can!

The CEO winces visibly and rubs his temple.  “Dammit. Why did we even gather that info?  I know they hate being up after midnight, so do I.  But it’s too damn expensive to hire more surgeons or pay them for the whole night.  The new ones want more money, better lifestyle, less work hours.  Whatever happened to just doing the work that needs to be done?”

Johnson leans back in his chair and says, “It’s true, boss.  This Great Resignation is infecting medicine too, not just the warehouse workers.  It’s like seeing a million American die of Covid over the last few years has driven everyone crazy.  All people want to do now is find meaning in their life and retire early.”

There is a pregnant pause until finally…

The CEO takes a deep breath and squares his shoulders.  “Well we can’t have that.  We have a hospital to run, after all.”  As if coming to a decision, the CEO opens the desk drawer and pulls out a file folder.  “Here’s the plan, OK?”

Johnson takes the folder and quickly skims through the contents.  His eyebrows raise and he gasps.  “This is brilliant! It’ll buy us… years of status quo.”

The CEO relaxes and a smile touches his lips.  “That’s right.  I don’t relish doing this, but we can’t have all of surgeons just quit because they don’t like home call, and we can’t afford to hire more of them to spread out the work.  So we stall.  Tell them we’re working on hiring some physician assistants to help them when they’re on call.  Assign them two… no three training modules on resilience.  Send them advertisements for new homes and cars.  Tell them their kids should only go to private school.  A doctor in debt is a doctor we can count on.”

Johnson stands up and starts walking quickly to the door.  “You got it boss.  It’s a good plan. It’s a great plan, even.”

Johnson opens the office door and the camera pans back to the CEO

The CEO calls out:  “And one more thing.  Keep them away from those finance and real estate blogs like the Darwinian Doctor.  We can’t have the doctors becoming financially independent.  That would be a disaster.”

Johnson nods and disappears through the door.  The CEO sinks back in his chair and closes his eyes, “Just a few more years. As soon as I pay off the boat, I’m out of here…”

— The Darwinian Doctor

This is a work of satire. Any resemblance to your own hospital (or mine) is purely coincidental. I can’t say you’ll get a lot of these if you subscribe to my mailing list, but you never know!

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