Models Differ
Mark Dotson, vice president of recruiting at Cogent-HMG, says his company instituted a “travelers” model in October of 2009 to reduce its locum tenens usage. Travelers, he says, are hospitalists licensed in several states who can be placed in different programs, most within driving distance. Some request a remote location, such as one Cogent-HMG hospitalist who resides in Dallas and has been commuting to Great Falls, Tenn., for more two years.
Dotson explains that the company’s travelers “are not typical locums who may just say, ‘I’ll be here for two months and then I’m out of here.’ They are employed by us, get full benefits [plus a 10% premium over regular employees] and training from our academy,” he says. “They are looked upon as part of the team when we place them in a program, and not an interim solution.”
Travelers contribute to program stability and improved quality and productivity metrics, Dotson adds. In Great Falls, for instance, the hospitalist team, which includes a traveler on every rotation, has regularly met its quality performance measures and RVU requirements since being fully staffed. Dotson estimates that 10% of the hospitalists hired by Cogent-HMG last year were travelers, and he’d like to see that percentage grow to 25% to meet increasing demand.
EmCare Inpatient Services in Dallas takes a different approach. They use super-commuters only for short-term startups, says CEO Mark Hamm, who’s “never been an advocate of flying people in and out. You don’t ever get the continuity that you need within the practice.”
To establish trust with referring primary-care physicians (PCPs), hospitalist programs need to comprise 80% to 90% of residential hospitalists, he says. Otherwise, EmCare becomes “just a staffing company and not a partner” with client hospitals. This is especially essential when it comes to hiring medical directors, he says, who must be present for meetings and administering program operations.
Listen to Pisarski
Dr. Bennett and his wife “on assignment” in Alaska.
A Good Fit
So who are the super-commuter hospitalists? Dotson, of Cogent-HMG, says that the majority of those willing to travel tend to be single. Hospitalists who are in between residency and starting a fellowship find this type of assignment provides consistent scheduling, income, and benefits to them and their families. Another contingent: mature career hospitalists with grown children.
Eric Kerley, MD, FAAP, FACP lives and works primarily in eastern Tennessee, where he is a full-time medical director. He saw his friend and colleague Charles Barnett, MD, taking assignments in Wyoming, and thought traveling for work “sounded interesting.”
“I’m a Southern boy who has lived my entire life between Orlando [Fla.], Tennessee, and Texas,” he says, “so I picked my locations based on places I would want to go.”
Dr. Kerley’s first yearlong assignment, in 2009-2010, was in central Alaska at a 75-bed facility. He worked as a nocturnist. “To see minus-20-degree Fahrenheit temperatures and frozen rivers, and days that are 22 hours long, that was pretty amazing,” he says. Being away for one week a month is really not much different than a week of day shifts at home, he adds.
Dr. Barnett began super-commuting four years ago from his home in Knoxville, Tenn., to Gillette, Wyo. Traveling to Wyoming is his regular commuter gig—he stays at the hospital—and he enjoys working in another environment.
The away time also works for his marriage, he says. “Just before I leave for an assignment, my wife’s ready to see me go,” he says. “And then, when I come home, she’s anxious for me to be there, so it’s sort of like a honeymoon once a month for both of us.”