Yeah. The "standard of care in the community" in any major US metro area for anyone prescribing serious meds is that, once you send the patient off with the script, you are the captain of the ship. You own it and everything that subsequently occurs--whether you personally wish to acknowledge this fact or not.

So, yeah, you can suck at your job and push people off to the ED because you are too lame and pathetic to take responsibility for your patients, BUT, if something untoward or bad ever were to happen and you were not available and you had not empaneled someone to cover for you in your absence, there will be an armada of clincians who will be delighted to step forward in court and say that what you did does not meet the minimum stnadard of care in that town. Someone has to take the calls. Doesn't have to be you, but it has to be someone. You can't toss people out the door on Clozaril and not be responsible and available. If a neutropenic patient called you and you did not answer and they died or got super sick, you are toast. Even dermatologists, which I was the surgical version of for many moons, prescribe extremely dangerous medications and must be available when the rare emergency does occur. And they do. So, most reasonable clinicians take their own calls or, if they are truly "off," someone responsible is assigned those calls while they are absent.

Just my personal take and experince, of course. I freely admit to being very old school on such matters.