Dr. Cram, who is a hospitalist, outcomes researcher, and division director, says that in an ideal world, it would make more business sense to have the hospital operating at full capacity around the clock, seven days a week. “But we don’t live in that world,” he admits. “It is hard to find ways to achieve ’round-the-clock staffing at the levels we’d like.”
He also concludes that there are “no easy answers” to the night-coverage conundrum. “But it might be prudent to think about incentives,” he says. “Perhaps we should pay more for staffing weekends, evenings, and holidays, or we could reduce the annual number of shifts we expect our nocturnists to do, relative to those physicians who staff days.”
Dr. Krisa says he, too, is biased toward an in-house coverage model, especially when programs reach a critical volume. “There is no substitute for the immediate ability to evaluate a sick patient,” he explains. “My feeling is that an in-house, 24/7 presence will become the standard.” TH
Gretchen Henkel is a freelance writer based in California.
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