As an internal medicine physician, I’ve spent years watching one quiet assumption extract more unpaid labor from physicians than anything else in our system. It’s not charting. It’s not meetings. It’s not metrics.

It’s call.

I wrote a post on my LinkedIn page about my thoughts regarding call. It resonated with many physicians, and I received many messages. It became clear that being “on call” is something that is rarely spoken about or even understood in the nonmedical world. However, the messages I received from numerous physicians in different specialties who stated they retired early, or changed jobs to nonclinical work (even taking a pay cut) were unexpected. I want to share this post and some additional thoughts here about this term “on call.”

There is a word that has quietly allowed the medical system to extract labor from physicians without acknowledging it as work. That word is “call.”

For decades, we’ve accepted call as an unspoken obligation, a badge of honor, a rite of passage, the price of wearing a white coat. But in modern employed medicine, call has become one of the most exploited concepts in our profession.

Historically, when physicians owned their practices, call made sense. You covered your patients because your practice depended on it. But today, most physicians are employees. They do not own the practice, yet they are still expected to provide free or deeply discounted labor because “that’s just part of the job.”

Let’s be honest about what call is

Call is labor. Call is a shift. Call requires vigilance, disrupted sleep, and legal responsibility.

And in many specialties, if you want to keep hospital privileges (the very ability to practice your craft) you have no choice. You must take unassigned ER call. You must accept responsibility for patients you have never met, even as an employee, often without additional pay. No other profession requires unpaid labor as a condition of access to your workplace.

Some specialties have rewritten this model. Hospitalists, for example, turned call into shift work. You are paid for each hour of a defined block (most commonly a 12-hour shift, sometimes 24). That structure is why the work is tolerable, not because the work is easier, but because it is recognized as work.

What if surgeons, cardiologists, orthopedists, and obstetricians demanded the same recognition? What if post-call days were mandatory? What if hospitals acknowledged that fatigue is a patient-safety issue, not a character test?

We hold human lives. We are accountable for outcomes. Yet, we are expected to work overnight and return the next morning as if nothing happened, while pilots, airline crews, truck drivers, and virtually every other industry have regulated rest.

Call is not charity. Call is not a privilege. Call is labor. And labor must be paid, fairly, transparently, and with built-in rest protections.

If medicine wants to address physician burnout, workforce shortages, and early retirements, we must stop pretending that language is harmless. Words shape systems. The word “call” has been used to deny physicians compensation, autonomy, and rest.

It is time to name it, and then fix it.

Voices from the front lines

Some of the messages I received from physicians:

“Your insights into the expectations surrounding call resonate deeply, at a time when physician well-being must be a priority.”

“This hits the core of why burnout persists. Until call is treated as paid, with rest protections, we will continue to lose more physicians.”

“No lies told. Appreciate your perspective.”

“Call is what made me stop operating at 55.”

“I switched to OB hospitalist, as I was not able to carry on with call responsibilities.”

A call to our CEOs and administrators

Hospitals have long benefited from the euphemism. As long as it’s called “call” and not “work,” it becomes optional, expected, and unpaid. Language has protected a system that extracts labor from the very people it depends on.

If you truly believe physician well-being matters, if you say burnout is a crisis, if you want to retain physicians instead of watching us scale back, retire early, or walk away, then you cannot keep relying on invisible labor to sustain your staffing model.

Here is what must change:

• All call must be explicitly compensated (including unassigned call).
• Mandatory post-call rest must become a safety rule, not a favor.
• Transparency in call distribution; no quiet inequities.
• Eliminate privilege-based unpaid labor requirements.
• Treat call like every other type of work: measurable, billable, respected.

Corinne Rao is an internal medicine physician, working as an independent contractor at several health care facilities, the owner of an internal medicine practice, and a member of FlexMedstaff. In her spare time, she is a ballroom dancer.