How many doctors to accredit?

One of the questions that we don't actually get asked, but we have strong views on, is how many people should be on the roster.

Who is on the roster?

In most private hospitals, anyone who is accredited to work at the hospital is asked to do a minimum number of on-call shifts.The core group of doctors in any private hospital are the ones who have regular surgical lists. These doctors could have as few as one half-day session in the four-week cycle, or as many as a couple of whole days in theatre each week.The second group are doctors who stay on the accreditation list but do not have any regular work. Depending on the size of the hospital it might be that two-thirds of the accredited doctors never do a surgical list.

The cost of large on-call rosters

Many hospitals see this as a free option, to provide greater flexibility without costing any more. We have good examples to refute this notion. Apart from the increased administration cost of maintaining a larger accreditation list, it can affect the behaviours of the doctors on the on-call roster.As the the proportion of doctors on the accreditation list who have no theatre sessions increases, we have seen evidence of the increased cost:

• It becomes harder for the Head of Department to know, manage and influence his or her doctors, for instance when there is a need to pull some strings to fill a difficult shift at short notice.
• It is prima facie evidence to the doctors that there is little threat of having accreditation withdrawn in the event of poor behaviour, for instance for failing to meet roster obligations, or excessive billing once on call-back.
• We have seen examples of lesser attention being paid to shift reminders and requests to fill gaps.
• Although we have no expertise to comment on clinical matters, we have heard the story of the doctor summoned for an emergency call-back who had to ask where the operating theatres were when they arrived, as they had never previously visited the hospital!

In some cases we have seen doctors self-selecting their shifts for the very end of the roster period, 12-16 months away. And then - if they have not managed to secure a theatre list in that time - resigning at short notice once they receive the shift reminder a week or a day before the shift. This does not seem to happen at hospitals where the senior administrators and Heads of Department are seen to actively prune their accreditation lists.(photo courtesy of The Times-Picayune)