I work in the telecom end. One of the things my staff does is maintain the myriad of on call lists, from the engineers who fix gas lines to surgeons, to PACU and OR clean up crews. The surgeons—general to ortho and Nuero generally have a primary and a back up.
My folks are the ones who coordinate emergency surgeries. We are not a trauma center, so it’s mostly appendicitis and broken hips.
What I see are the docs switching out their calls regularly. The Med Services office would usually be able to juggle the coverage for one guy for a night.
Every hospital is different, and I get that. But my experience has been that given a days notice, coverage isn’t a major deal.
That’s a long answer for a small part of this.
Maybe in your area, it works out. Not in other areas.