Call Pay in Medicine: Only 1 in 5 Physicians on Call Are Paid for It
I have taken call for more than twenty years, so I get what every physician on call goes through. You skip the glass of wine at dinner, you stay within a certain radius of the hospital, and you sit at your kid's game with your phone face up on your knee. Not working, but not exactly free either.
For most physicians in America, none of that is paid.
This is one of the most widespread and least examined inequities in physician compensation. About 42% of physicians report burnout, but the debate about what drives it rarely gets around to call. Part of the reason is that there is not much data on it.
Marit looked at call pay across 34 specialties, covering 15,626 physicians who report taking call. And just over 1 in 5 (22%) report they are paid for it. What emerges is a structural inequity in how medicine pays its physicians, and it often comes down to whether your presence generates billable revenue for a hospital. Often, but not always.
The specialties that get paid
Orthopedic surgery tops the list. Nearly half of orthopedic surgeons who take call, 48%, are paid for it, at a median of $1,075 per day. Neurosurgery is close behind at 47% paid, and has the highest daily rate at $2,200 median pay. Anesthesiology comes next at 41% paid, median $2,000.
Anesthesia is my specialty, so I know this part firsthand. A hospital that holds a trauma designation needs orthopedics and neurosurgery available around the clock, or it loses that status. An OR does not run without anesthesia. That coverage is what keeps a service line open, and hospitals have priced it accordingly.
The same pattern holds a step down: oral maxillofacial surgery (39% paid, median $1,000), urology (34%, $1,000), otolaryngology (33%, $750), and general surgery (30%, $1,174). Psychiatry sits in that range too, at 31%, and I will come back to it.
The specialties that don't
Now the other end.
Allergy and immunology: zero. Not one allergist who takes call is paid for it. Radiation oncology is at 2%, nephrology at 4%, family medicine at 9%. Eight more specialties sit under 10%.
These are not specialties without call burden. Nephrologists manage acute kidney injury and dialysis emergencies overnight. Rheumatologists field calls about medication toxicity and acute flares. Infectious disease physicians are the ones the hospital calls when nobody else can say what is wrong with a patient. In my experience, the family medicine physicians carrying the heaviest call are in small and rural markets, where there is nobody else to hand the phone to. All of them stay reachable and get interrupted, and almost none are paid for call.
The larger cognitive specialties sit in the same place, and they are where the volume is: internal medicine (13% paid), pediatrics (15%), neurology (18%). These physicians take overnight calls that require clinical judgment, and roughly six in seven are not paid for it.
Psychiatry breaks that pattern. It ranks seventh at 31% paid, ahead of general surgery, plastic surgery and gastroenterology, and nobody bills a procedure for a psychiatric consult at 2am. Hospitals pay where they need coverage guaranteed, and a psychiatric hold in the emergency department is one example.
In-hospital call deserves a separate conversation
One finding here deserves particular attention. A meaningful percentage of physicians across several specialties report taking call from inside the hospital, physically present in a call room or on the floor through the night.
There should be no debate about whether those physicians should be paid. When a physician gives up their night, their sleep, and their personal life to be physically present in a hospital, that is work. The fact that a significant portion of internal medicine, OBGYN, and anesthesiology physicians do exactly that without separate call compensation is one of the most striking findings in this data.
At-home call is a different and more nuanced conversation. The restriction on personal freedom is real (no drink, no travel, never fully present), but it is a lighter burden than a night in the building. Availability still has value regardless of where you are sitting when the phone rings.
The case for compensating availability
The argument against paying for call usually comes down to one claim: it is already baked into the base salary. That only holds if the base was negotiated with the call burden in mind. In most employed physician contracts it was not. Base salaries are benchmarked against industry data that treats uncompensated call as the norm, and the baseline is suppressed precisely because unlimited availability has always been the expectation.
Medicine has long operated on the assumption that physicians will absorb whatever is asked of them as part of the job. That assumption has roots in a genuine and admirable culture of patient-centered care. But it has also been exploited.
The fix starts with a simple principle. If a physician is doing work, whether that means a night in the hospital, a phone that has to stay on, or personal time given up to stay reachable, that work has value and should be compensated. Not necessarily at the same rate across every specialty and setting, but at a rate that reflects the cost of what is being asked.
What the data tells us
The Marit call pay dataset covers more than 15,000 physicians across 34 specialties. The pattern is clear enough. Call pay in medicine is not distributed based on burden. It follows revenue and coverage risk. The physicians whose presence opens the revenue tap get paid. The physicians who carry the cognitive load, manage emergencies by phone, and keep patients safe through the night mostly get nothing.
If you are negotiating a contract this year, treat call as a line item. Ask what the paid-call rate is in your specialty and your market before you sign, because the people on the other side of the table already know.
Methodology
Figures come from Marit's clinician-reported compensation data as of August 2026, covering 34 specialties and 15,626 physicians who report taking call, 3,448 of whom are paid for it. A specialty is included where at least 20 physicians reported taking call. Percentages describe the share of call takers who report being paid for call. A median daily call pay figure is published where more than five physicians in the specialty supplied an amount.
