Rethinking ENT Call Pay: Fair Market Value Should Include Fair Market Quality of Life

It’s a question I hear more than any other when I speak with otolaryngologists around the country:

“Am I being paid fairly for call?”

My answer: Probably not.

But—like so much in medicine—it depends. The details matter:

• Are you paid just for availability, or also hourly when you come in?

• Is your practice academic, employed, or private?

• How big is your hospital? What trauma level?

• Do midlevels, residents, or fellows take first call?

• How often are you on?

• Are you paid more for weekends and holidays?

• Does the hospital bring in locum tenens to reduce your call burden?

  
  

I’ve had hundreds of these conversations as a practicing ENT and as the head of a physician-run ENT locum tenens agency. The stories vary, but the theme is constant:

Hospital-mandated call coverage sucks.

It’s unfair. It's underpaid (sometimes unpaid).And it’s burning physicians out—fast.

Many ENTs carry guilt for even voicing this frustration. We were trained to believe 24/7 availability was part of the oath we took. But as call volume and complexity have exploded, the personal cost has become impossible to ignore. Nights of interrupted sleep, missed family time, and constant low-level stress aren’t just annoyances—they’re health hazards.

The Flawed “Fair Market Value” Argument

When hospital executives talk about “fair market value” (FMV) for call pay, they almost always mean fair market value dollars—not fair market value quality of life.

That’s a critical distinction. FMV pay should only be discussed in the context of an FMV call burden. In practical terms, that means:

• No more than one weekend a month for a low-acuity hospital.

• Less frequent than that for higher-acuity centers.

• If the daily call rate is less than $1,000, physicians should be paid an hourly callback rate in addition to the stipend.

  
  

Without those parameters, FMV numbers are meaningless. A hospital offering “market rate” pay for a schedule that wrecks your personal life is like offering you a market-rate salary for a job that also requires you to work nights at a second job for free.

If the Money Doesn’t Matter, the Sleep Does

Some ENTs tell me they could live with the money as-is, but what they can’t live with is the sleep deprivation, chronic fatigue, and constant disruption. In those cases, the best recommendation is simple:

Ask the hospital to bring in high-quality locum tenens ENTs to share or cover the call.

This isn’t a threat—it’s a solution. When done right, locums coverage can:

• Preserve physician health and retention.

• Keep hospitals from losing core ENT services entirely.

• Maintain community access to specialized care.

  
  

At ENT Surgery Solutions, we’re run by ENTs, and we only place top-tier otolaryngologists. We cover hospitals nationwide that recognize the value of supporting their staff with reasonable call schedules, often using locums coverage as part of the long-term solution.

The Cost of Ignoring the Problem

Hospitals that don’t adapt will lose their ENTs—either to part-time locum work, early retirement, or other communities that offer a better deal. And replacing a full-time ENT in a community is a lot harder (and more expensive) than bringing in a few weeks of call coverage.

The trend is already happening: more ENTs are moving to flexible locum tenens schedules with premium call pay and ultimate control over their availability. The hospitals left behind are forced into reactive hiring at premium rates—sometimes to the very locums they could have used proactively.

The Way Forward

If you’re unhappy with your call pay or schedule, your leverage is greater than you think—especially when you approach the conversation with:

1. Clear data on your current call volume and burden.

2. Defined benchmarks for FMV quality of life.

3. A reasonable alternative (like supplemental locum coverage) ready to present.

   
   

The conversation should never be just about dollars. It should be about preserving your ability to be a healthy, engaged physician—without sacrificing your nights, weekends, and sanity.

And if your hospital won’t meet those terms? You have options.