The hospitalist group for which I serve as medical director just voted to decrease weekday compensation and increase weekend and holiday compensation. This will be budget neutral; that is the total compensation paid across all doctors over a year will be the unchanged, but those who work more weekends will earn more salary than those who work fewer.
This issue doesn’t come up for many practices, such as those that follow a 7-on/7-off schedule, since each member of the group will work the same number of weekends making a shift differential unnecessary. But for groups that follow a more flexible and varied schedule it can be difficult to ensure each doctor works the same portion of weekends and holidays, and money is a way to offset the scheduling inequity.
Design and implementation of the weekend differential shouldn’t be very difficult, but managing it on an ongoing basis will require some additional work to ensure that the number of weekday and weekend shifts is tracked each pay period (for compensation purposes we previously we just counted total shifts without regard to whether they were weekends). Andthings like last minute schedule swaps such as for coverage for sudden absence could lead to a failure to capture whether it was a weekend or weekday shift.
One concern is whether it could now lead docs in the group to become unhappy if they work too few weekends, and see a decline in income as a result. “I didn’t ask to work fewer weekends and am being penalized financially as a result.” And beyond that, there is a risk, though probably very small, that as a group we will just focus on whatever seems to be the next inequity in the practice and try to address it with some sort of compensatory fix, whether it is money or something else. That could lead to increasing complex systems that cost too much in time and effort to be worth implementing them to level the playing field on a relatively minor inequity in the practice.
If doctors in all specialties may soon be working more weekends, it will be interesting to see what other specialties decide to do about a weekend compensation differential. Most don’t need it now because they distribute weekends evenly (or the new, non-partner, docs take more weekends, etc). But that could change.