The perverse incentives work on both doctors and patients. Services provided at nights and on weekends when my family is free for social time with me is come at a higher personal cost and my time then is worth more to me. But instead of collecting more for off-hours services like any other service personel, I effectively collect less. So I don’t do it. I also avoid ER call for that same reason.

I did see a study that showed that people with HSA’s go to the ER a lot less. That makes sense, because having high deductible insurance and being financially solvent so they have to pay their bills, they have the proper incentive to avoid the ER except for emergencies. For everyone else there is a perverse incentive driving patients to the ER, and doctors aways from it.

If i have a patient who calls me on a weekend, I’d more often advise them to seek ER evaluation for something seemingly minor. This is because:

1-I’m not open weekends because, to me, it’s not worth it for $50/visit, compared to having a free weekend with my family; and

2-I don’t ever want any patient or family member to say I didn’t take their symptoms seriously. Referring them to the ER gives me the “I knew it could be serious and did everything I could” card.

I know it’s a waste of resources, but it simply isn’t worth the hassle & risk to handle things by phone off hours. I think this problem will not get better for many years.