Great question. Something my own organization is struggling with and my former organization in another state tried to do and failed. The major question is what does your organization want to be. The former is Walmart model – the latter is Apple model. Both are very successful and profitable but also very different with different goals. Your organization has to pick and choose one of them and stick to it. Trying to do both within a single system will be like chasing two rabbits – you may catch none
Compensating for on call especially if the specialty involves coming in to do procedures or surgeries off hours is something that has to be preserved, unless it is rolled into the overall compensation package. Every other field does that. Separating calls that require just carrying the pager/cell phone but does not involve coming to hospital and those that involve coming in will be helpful. Consider setting up parameters – for those specialties who do not have to come in off hours – on when a specialist should be called. Have these individual specialties come up with the criteria that will minimize the number of elective calls they get at night. This may make calls without compensation acceptable for them.
This is a very prevalent problem in US especially with mergers of hospitals into large health systems and employed model for physicians. We have a RVU based model with 10% for quality and 10% for good citizenship and this has been miserable. Ultimately the hospitals have to decide on what exactly they expect from their physicians. If offering high quality complex procedures are part of the goal and vision, then retaining highly skilled, quality physicians is the KEY. If having the ability to provide all services to all patients in the community is the goal, then standardizing salary will work. But an important thing to remember is not to hold physician responsible for metrices that they cant control.
You mentioned there appears to be a cardiology floor in your hospitals. If these beds are full and creating a long wait in the ER, then one consideration for cardiology floor patients is to figure out what % of these are taken up by low risk patients admitted for “rule out MI” or “rule out CHF” or Syncope etc. If many of the beds in floor are taken up by these low risk patients, consider creating a “chest pain unit” or “Clinical decision unit” with rapid rule out protocols in one corner of the ER or in adjacent space – in conjunction with cardiology – for early discharge of patients from these units. This will avoid admission of these pts to the floor and can free up the beds.