To the Editor: In May 2007, I began working in an Australian public hospital as a permanent consultant endocrinologist and physician. There are many differences between the health systems of Australia and Sweden, where I previously worked. In particular, there are striking differences in on-call work for the rostered consultant.

In Sweden, the compensation (usually taken as leave) for every phone call, whether it was 1 minute or 30 minutes long, was half an hour during weekday hours of 4.30–9 pm and 7–8 am, and 1 hour during nights and weekends. Compensation also applied to ward rounds on weekends. I also received an on-call allowance of 6 minutes per hour during weekdays and 12 minutes per hour during weekends. During public holidays, rates were tripled. Every year, I earned 5–7 extra weeks on top of my normal 5 weeks of annual leave, some of which was used for well paid locum work, as private practice is almost non-existent in Sweden. Compensation could also be taken as payment; each department had its own agreement with staff on the preferred format, depending on staff levels and budget.

The on-call frequency was usually 1 in 10, and the physician on call was responsible for all general internal medicine patients. For most of my career I worked in a large tertiary referral centre,1 but the rostering and compensation were similar in local general hospitals, with the only difference being fewer subspecialties with their own on-call roster. The surgical specialties had the same system.

As in Australia, I was rarely called to attend the hospital, although contact during an on-call session was more frequent in Sweden (2–10 v 0–2 phone calls). Junior doctors in Sweden were more inclined to discuss patients and, in some wards, the nurses were instructed to call the physician on call first if the matter could be solved by phone. I was happy for every call, as I received extra compensation, but I never received any further phone calls once the on-call session finished.

In Sweden, I did ward rounds on weekends, either of all medical wards in the local general hospitals or only the general medical wards in the tertiary centre when I was physician on call. Before seeing patients, I did a paper round with the nurses, when we decided which patients I needed to see. Patients were not admitted directly under me, but under the specialists responsible for the wards during office hours. However, I was temporarily responsible for all medical patients in the hospital.

In Australia, at least in my current hospital, I have “my patients” in the wards (usually spread out over the entire hospital). If something suddenly happens to one of them, the intern, resident medical officer or medical registrar will phone me, even in the middle of the night or if I am away on leave. As the compensation is the same whether phone calls are received or not, and most medical patients are admitted under the physician on call, there is little incentive for the physician to volunteer for extra on-call sessions or to encourage junior doctors to phone.