Equity helps distribute work fairly among physicians when creating schedules.
The goal of equity is to balance workload across group members while considering factors such as:
- Shift type: On-call, operating room, office, and other shift types.
- Shift timing: Days, evenings, weekdays, weekends, and holidays.
- Skills and eligibility: Members who can cover the shift.
- Staffing requirements: The number of members required for a shift.
- Shift weight: The relative effort of working one shift compared with another, such as working a Friday night shift in Emergency compared with working a Monday morning clinic shift in Endoscopy.
Equity does not mean assigning every physician the same number or type of shifts. A fair schedule may distribute work differently when physicians have different availability, responsibilities, qualifications, contracts, or work restrictions.
For example, two physicians may be expected to contribute the same overall workload but have different skill sets. Because the physicians qualified for different types of work, they may not receive the same assignments. However, the overall workload should still be distributed equitably.
Equity and equality
Equity is different from equality.
Equality focuses on distributing work proportionally based on available capacity.
When a schedule is optimized for equality and multiple physicians can perform the same shift, the shift is distributed among them based on their percentage of availability. For example, if one physician works 50% of a regular workload, that physician should receive approximately 50% of the shift volume that a full-time physician receives.
Other scheduling factors
Equity is only one factor used when creating a schedule. Other factors include:
- Coverage requirements
- Members who are available to work the shift
- Members who are qualified or eligible to work the shift
- Rules for assigning shifts
- Shift and member constraints created by the planner
The Planning tool uses your group's equity settings, along with scheduling rules such as coverage requirements, availability, absences, eligibility, and constraints, to help create a fair schedule.
What affects equity?
Your group decides which assignments should be distributed fairly. These assignments are called equity factors.
Equity factors often include shifts that are less desirable, more demanding, or unevenly distributed, such as:
- Night shifts
- Weekend or holiday shifts
- On-call shifts
- Shifts that require specialized expertise
- Shifts with different workloads, levels of complexity, or unit values
An equity factor can be based on:
- A time period, such as nights, weekends, holidays, or Fridays
- A shift type, such as on-call shifts, operating room shifts, or medical examinations
- A combination of a shift type and a time period
Each physician group defines its own equity factors. Because each group has different scheduling needs, there is no universal definition of a fair schedule.
Equity targets
An equity target defines the desired distribution for an equity factor during a scheduling period.
For example, your physician group might decide, or a contract may require, that each physician should work at least two weekends during a three-month period. In this example:
- Weekend work is the equity factor
- Two weekends per physician is the equity target
- Three months is the scheduling period
Equity targets can be expressed in the following ways:
- An absolute number, such as 10 on-call shifts
- A percentage, such as 25% of the group's full-time on-call coverage
Equity targets should reflect the group's agreed-upon definition of a fair schedule.
Exceptions to equity targets
The same target may not apply to every physician. A physician may have different scheduling requirements for reasons such as:
- A contractual coverage obligation
- A part-time schedule
- Responsibilities at another facility
- Required qualifications or specialties
- A temporary work restriction
- An agreed-upon preference or availability pattern
For example, a part-time physician may have a lower target than a full-time physician. A physician who is not qualified to perform a particular shift type may have a different target for that shift type.
Because of these exceptions, an equitable schedule is not necessarily an equal schedule. Schedulers should identify applicable exceptions and assign targets that reflect each physician's situation.
Distribute targets across a scheduling period
A target for an entire scheduling period can also be distributed across shorter intervals.
For example, a physician with a target of 18 night shifts over three months might have a monthly target of six night shifts. Distributing the target in this way helps prevent assignments from being concentrated at the beginning or end of the period.
The appropriate distribution depends on the group's scheduling practices.
Why equity matters
When demanding or undesirable assignments are repeatedly assigned to the same physicians, the schedule may seem unfair and become difficult to explain or justify. Clear equity targets help schedulers distribute work consistently and make scheduling decisions easier to review.
A well-defined approach to equity can help a group:
- Apply scheduling rules automatically and consistently
- Account for individual circumstances
- Identify uneven assignment distributions
- Explain scheduling decisions
- Review equity across multiple periods
- Adjust future schedules based on past assignments