Detractors also note that using temporary physicians can have a deleterious effect on teamwork, as more transient workers are less invested in an institution’s mission, vision, and long-term goals. Patricia Stone, PhD, RN, FAAN, who has studied the use of agency nurses, says that how well a locum tenens worker integrates into a team setting depends on how willing that person is to bond with colleagues.
“There are things that happen in a hospital for which a team is needed,” says Stone, director of the Center for Health Policy and the PhD program at the Columbia University School of Nursing in New York City. “The nurse needs to know how much she can count on that physician. The physician needs to know how much they can count on that nurse.”
Hospitalists = Prime Targets
The use of locum tenens in HM has skyrocketed in recent years, as the number of hospitals adding hospitalists has grown. And, for now, it doesn’t seem like there’s any end in sight, particularly as cost-conscious hospitals look for ways to save money.
“Trees don’t grow to the sky, but…we’ll be very curious to see what the next survey tells us about how the second half of 2011 did,” says Tony Gregoire, senior research analyst for Staffing Industry Analysts. “But as of yet, we just can’t speak to any plateauing. It just seems like there is more room for growth here. The big factor will be supply shortage because there is such demand for hospitalists.”
To wit, the 2011 Survey of Temporary Physician Staffing Trends found that 85% of healthcare facilities managers reported using temporary physicians in 2010, up from 72% in 2009.2 And the number of facilities seeking locum tenens staffers is rising, despite the “downturn in physician utilization caused by the recession,” the report added. Some 41% of those surveyed were looking for locum tenens physicians in 2010, up 1% from the year before.
Brent Bormaster, divisional vice president of Staff Care of Dallas—whose firm publishes an annual report, the 2011 Survey on temporary staffing trends—says that the use of temporary staffing makes economic sense in a growing specialty such as HM because it allows programs to start up and staff up more quickly. And because turnover can be an issue in the early days of any group, temporary staffers can either fill in while the group recruits a permanent physician or can step in when a physician leaves, giving the practice time to run a proper search.
—Brent Bormaster, divisional vice president, Staff Care of Dallas
“You can still maintain your continuity of staff and continuity of care,” Bormaster says. “All the while, you’re still recruiting for your permanent physician and permanent replacement, which may take upwards of six to eight months.”
The temporary staffing market in HM has grown so competitive in recent years that one large hospitalist group started its own placement division for physicians. Robert Bessler, MD, president and CEO of Tacoma, Wash.-based Sound Physicians, says his company launched Echo Locum Tenens of Dallas in August 2011 to take advantage of the firm’s economies of scale. Sound employs more than 500 hospitalists and post-acute physicians, and partners with about 70 hospitals nationwide (see “DIY Locum?”, right).
“We felt there was an opportunity to be a niche provider to serve our own needs … to fill the short-term demand for temporary help, whether we’re starting up a program quickly or have a gap in coverage due to illness or maternity leave or something else,” Dr. Bessler says. “We found that we could build a more accountable model by having it be part of our organization.”