2021 Statement on Taking Stipends for Call

May 2021

In 2004, the Canadian Association of General Surgeons (CAGS) accepted a position statement from the CAGS Professionalism Committee about practicing Surgeons relinquishing their on-call duties to new graduates after payment from those graduates. The statement said in part: “The members of the CAGS Professionalism Committee are in unanimous agreement that the practice of a surgeon accepting payment from a junior colleague to relinquish call commitments is unethical and violates moral principles.” The link to that statement is provided below.

CAGS On-Call Position Paper

The Workforce Task Group, a working group of the CAGS Board and of the Professionalism Committee, would now like to update that statement and confirm the principles that it identified.

Over the last decade, General Surgery practice has continued to evolve. For example, Acute Care Surgery as a Subspecialty has developed, matured and expanded. Subspecialization and training the “General” General Surgeon are both recognized as very important in our discipline.  Changing demographics, practice sharing, an emphasis on work life choice and physician wellness have influenced General Surgery practice as they have influenced the Medical Profession overall.

These changes have seen new practice patterns in our Specialty that may see a surgeon working 2 weeks out of 4, sharing office space or perhaps only borrowing office space on a part time, as needed basis. In addition to that new approach, the traditional full time equivalent Surgeon who works five days a week every week, takes call and runs their own small business also commonly exists.

Whatever changes have occurred in the practice of General Surgery since the last statement on this sensitive subject of the “on-call-ogist”, recent data from large surveys of the Royal College of Physicians and Surgeons of Canada and from CAGS continue to show that up to 20% of newly graduating General Surgeons are having difficulty finding appropriate positions for which they are trained. There are many factors involved and the Workforce Task Group is trying to address them with the recommendations approved by the CAGS Board in February, 2020.  Primary among those recommendations is that CAGS continues to emphatically condemn the practice of giving new graduates on call work without access to resources for an elective practice or a plan on how to achieve that objective. For example, in Acute Care Surgery, where work may not meet the previous definition of full time and where office and business responsibilities differ from traditional practice, the Acute Care Surgeon still should be a functioning member of the Department with resources commensurate with their role. That Surgeon, identifying their career goals, should have an understanding and agreement on what the long term commitment is from the Department, in line with those goals. There are many ways to achieve this, such as with practice sharing or mentorship. Simply offering on call work with nothing else while the existing practising Surgeons maintain their access to resources and to their practice is not how we should be treating our future colleagues.

Surgical leadership across the country should remain aware of this worrisome trend, and work to identify solutions that support our growing workforce.