Title
Adopt a Resolution to Amend the Personnel Policies and Practices Resolution No. 98-394 to Revise Section A.12.7: On Call Pay for Physicians, as Indicated in Attachment A.
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RECOMMENDATION:
It is recommended that the Board of Supervisors adopt a resolution to amend the Personnel Policies and Practices Resolution No. 98-394 to revise Section A.12.7: On Call Pay for Physicians, as indicated in Attachment A.
SUMMARY:
Natividad Medical Center recommends an amendment to the Monterey County Personnel Policies and Practices Resolution No. 98-394 (PPPR), Section A.12.7: On Call Pay for Physicians, as indicated on Attachment A to appropriately compensate physicians for their on call assignments.
DISCUSSION:
Hospital operations require that physicians be scheduled for on call assignments to ensure immediate response to patient care needs. Physicians in both the X and U Units who are scheduled for on call assignments receive On Call Pay. Unit U physicians, who are at-will contract employees, receive On Call Pay as a matter of the terms and conditions of the physician's individual employment agreement, which incorporates the PPPR by reference. When a physician is scheduled "On Call" s/he is required to hold him or herself available either on or off campus for immediate response. The method and amount of such payment is dependent upon the physician's specialty (e.g., "In-house" call is paid for a 12-hour shift, as the physician must remain on campus; however, "Off-campus" of per day call is paid for a 24-hour shift, as the physician is not required to remain on campus).
Since the On Call rates paid to physicians have not been reviewed and adjusted since they were established, they are no longer sufficient to pay NMC's highly qualified employed physicians for their on call shifts. As a result, NMC recommends an amendment to the PPPR language (as indicated in Attachment A) to increase the off campus call rate for Pediatricians to $800 per 24-hour on call shift, and the in-house call rates for Internal Medicine physicians to $1,440 per 12-hour on call shift (based on market rate of $120/hour), and OB/GYN physicians to $1,620 per 12-hour on call shift (based on market rate of $135/hour). The data source for the recommended rates listed above is the 2011 median hourly rate per the Medical Group Management Association (MGMA), which historically has been used by NMC to determine compensation for physicians. The Monterey County Auditor-Controller's Office recommended that these on call shifts be paid in lump sum payments, so the proposed new PPPR language reflects the total payment for on call shifts for all physician specialties on a per shift basis, rather than per hour.
In addition, the payment method for OB/GYN Back Up Call is further defined in this recommendation for clarification purposes. If an OB/GYN physician is scheduled as a "back up" s/he is not required to remain on campus, nor is s/he paid for hours while scheduled on call. A minimum two (2) or four (4) hour "call back" payment (as indicated in Attachment A) will be due only upon arrival to the hospital after being called in, and multiple calls within the same two (2) or four (4) hour period will be counted as the same minimum. Only time spent beyond the minimum will be recorded as additional hours worked and paid at the rate of pay indicated in the PPPR (see Attachment A for full language).
The on call pay for physicians in the Cardiology specialty is no longer utilized and NMC recommends that it be deleted.
Approval of this recommendation will allow NMC to recruit, motivate, and retain qualified physicians in each of these specialties to provide immediate response to patient care needs during on call assignments.
OTHER AGENCY INVOLVEMENT:
The Monterey County Auditor-Controller's Office reviewed this recommendation and provided input on method of payment, which NMC considered and included in the proposed new PPPR language. In addition, under advisement of the Auditor-Controller's Office, the effective date of this action will be November 17, 2012 to allow time for staff to complete the required modifications to the current system.
FINANCING:
All costs associated with this action were included in the NMC Budget for FY 2012-2013 and will not require any additional General Fund subsidy. In addition, the approval of this action will allow NMC to use employed physicians to cover more on call shifts, resulting in less use of locum physicians. The hourly rates for locum physicians are substantially higher ($95-$115 per hour more than the increases proposed in this recommendation, depending on specialty), and decreased use of locum physicians will result in a cost savings to NMC.
Prepared by: Janine Bouyea, NMC HR Administrator (831) 783-2701
Approved by: Harry Weis, NMC CEO (831) 783-2563
Attachments: Attachment A - Proposed Changes to PPPR Section A.12.7 - On Call pay for Physicians