Concerns have been expressed by patients, physicians, other health care providers and administrators about the responsibility of physicians to arrange for the care of their patients when they are away from their practices. This includes coverage of their practices after-hours, on weekends, and for more extended periods. It is still widely believed that quality and efficiency in health care is best served if the physician who knows the patient best is available to guide the patient to the most appropriate care. It is not adequate for physicians simply to direct patients to the nearest emergency department, unless they have made prior arrangements with the physician working in that emergency department to take care of their patients. This paper has been prepared to provide physicians with advice about applying this policy to their practice situation, based largely on feedback and suggestions received from physicians.
Emergency departments are the only point of access to specialist care after-hours.
Onerous on-call schedules are a major cause of physician burnout and ill health. There is no financial incentive to remain on-call. A designated colleague with a similar scope of practice is the most appropriate surrogate provider. Failure to make specific arrangements can lead to virtual abandonment of patients. The use of the telephone to advise patients is controversial.