Here is a practical way to handle the issue of when a physician can get off the call schedule and any financial penalty that may attach:
Physicians aged 55 and 15 years with the practice can go off call (on January 1st of the year after the year in which they turn 55). The first year they go off weekend call and the second year they go off weekday call.
A penalty is assessed every year after they’ve gone off-call. The penalty is a percentage of their compensation package. Examples of annual percentages are say 5 (the first year off call), 8, 10, 15, and 20 (the 20% persists until the physician retires). The penalty is then shared equally by the remaining physicians on call. In some practices, the doctor is dinged 20% every year.
In addition, consider allowing the same physicians (age 55, 15 years) to take vacation time in addition to the maximum amount allowed all physicians. They can pay an additional penalty of 0.5% per day (2.5% per additional week).
Finally, remember to cap the call penalty, generally at 20% for most practices.