Physicians are leaving clinical practice earlier than before, at an average age of 48, with stress and administrative burden among the top reasons, according to American Medical Association research.
For community and rural health systems, call burden compounds that pressure. A specialist covering every other night, or every third, is hard to keep and harder to replace.
Midland-based MyMichigan Health serves 26 counties, 65% of which qualify as health professional shortage areas. Over the past 18 to 24 months, the system has tested a community call model that pools specialist coverage across its hospitals, according to Sunita Vadakath, MD.
The approach grew out of necessity. About four or five years ago, the system lost a cardiologist in one community with no immediate replacement, according to Dr. Vadakath, senior vice president and chief strategy officer at MyMichigan. Cardiology physicians pooled calls to cover the gap. It worked, and that early experience shaped the structured version in place today, she said.
Cardiology, orthopedics and medical oncology now run on the model. It is part telehealth, part logistics and protocol. At a single hub such as MyMichigan’s comprehensive cardiovascular program in Midland, cardiologists remain on call in person.
At a community hospital, the emergency department physician and hospitalist follow the system’s algorithms to determine whether an incoming patient can be admitted and kept locally, then consult the on-call cardiologist via telehealth. If the patient needs a higher level of care, the cardiologist directs a transfer to the hub.
Orthopedics follows a similar logic. A patient can be “tucked in” for the night, Dr. Vadakath said, with care handed off to the local orthopedic surgeon the next morning for a consult and procedure, if one is needed.
The model is for after-hours only. During regular hours, specialists do their usual inpatient and outpatient work: clinic, rounding, consults and diagnostics.
Before fitting a specialty into a community call model, the system pulls data on how often a specialist needs to appear in person, as well as patient volume data and the comfort level of the ED and hospital staff.
Not every specialty fits. Trauma-level status is the first filter, because trauma regulations dictate which specialties must be physically present. State rules carry the same weight, according to Dr. Vadakath. ST-segment elevation myocardial infarction care, for instance, requires an in-person physician, so two nearby sites cannot share a physician. Neurology is another specialty that MyMichigan approaches cautiously with the model.
The specialties that work best are the ones where a hospitalist can stabilize and admit a patient overnight, then hand off care to the specialist in the morning.
The part of the model most systems underestimate is the medical staff infrastructure. Pooling call coverage means a specialist may treat patients across facilities in different counties, and each of those facilities has historically run its own medical staff and its own credentialing process.
At MyMichigan, that has not been a barrier, because the system already credentials physicians at multiple locations.
“We do have separate medical staffs in each of our locations. So, yes, if you are planning to do the pooled call model, you’d have your physicians credentialed at the different locations,” Dr. Vadakath said.
The credentialing reach across sites is what makes pooled call coverage workable, and at MyMichigan, it was in place before the call model leaned on it. The system is now moving toward a single, systemwide medical staff, which she said would make the credentialing process far easier and more convenient.
The payoff has shown up in physician sentiment. Early on, physicians pushed back on the model. But now, they approach leadership asking whether their specialty can adopt a protocol model, Dr. Vadakath said. She likened the shift to telehealth adoption: heavy resistance before the COVID-19 pandemic, standard practice after.
The model has also turned a workforce liability into a recruiting advantage. The system is transparent with candidates about which specialties run the model.
“If you’re doing a 1-in-2 or 1-in-3 call, and you have the option to slip into a community call model that could potentially take that up to 1-in-5 or 1-in-6 … that is something that is very attractive to specialists,” Dr. Vadakath said.
Her caution to systems considering the model is to build it with physicians from the start.
“Make sure you get your physicians [involved] right from the get-go and build a model with them,” she said.
The other non-negotiable is continuity of care, down to whether a local orthopedic surgeon has time for a next-day case or is tied up in the clinic. Those details, she said, are what make the process work or fail.
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