Another reason for the growth in temporary staffing may be the appeal it has for physicians who want to focus simply on clinical care, says Dorothy Nemec, MD, MSPH, a board-certified internist who runs MDPA Locums in Punta Gordo, Fla., with her physician assistant husband, Larry Rand, PA-C. The couple started their temporary staffing firm in 1996 and has authored a book, “Finding Private Locums,” that outlines how to launch a career in locum tenens.3
“When we started our own business, what we found was we were able to do what we are trained to do, and you don’t have to deal with the politics,” Dr. Nemec explains. “You don’t have to deal with all of the other things that you get involved with when you’re in permanent practices. So you can devote all of your time to taking care of patients.”
The Cost Equation
The biggest question surrounding the use of locums is the cost-benefit analysis, a point not lost on hospital executives and locum physicians who answered Staff Care’s last report. Eighty-six percent of those surveyed said cost was the biggest drawback to the use of locum doctors, a dramatic increase from the previous year, when just 58% pointed to cost as the largest detriment. Locum physicians can gross 30% to 40% more per year for the same number of shifts as a typical FTE hospitalist.
But Dr. Harrington believes the ability to earn more money continues to push physicians into working locums. “Hospitals now realize that they have to have a hospitalist program,” Dr. Harrington says. “The issue for them is more around reimbursement and where that money is going to come from.”
Bormaster, of Staff Care, says that while the higher salaries for locum physicians can seem like an expensive proposition, the cost has to be viewed in context. Because the typical temporary physician is an independent contractor, compensation does not include many of the costly expenses tied to permanent hires.
“You’re paying us on an hourly basis, and you don’t have any ancillary benefits, healthcare, 401(k), malpractice insurance, anything like that,” Bormaster adds. “All you’re doing is paying straight for the hours worked or hours produced by that hospitalist that is contracted with us.”
Surveys show part-time and temporary physicians’ lack of familiarity with their work setting can be detrimental. It’s shortsighted to undervalue the role continuity plays in the hospital setting, as it can lower the quality of care delivered and impact both patient and worker satisfaction, says Stone, the Columbia University nurse-researcher.
“It’s not necessarily the cheapest way to go because of the decreased quality,” she says, adding she hopes the topic is one tackled in future research. “It needs to be looked at. The hospitalist environment has just grown so much….How to do it right? We just don’t know enough about it yet.”
Is the Sky the Limit?
It is often said that HM is the country’s fastest-growing medical specialty. Combined with the recent reduction in resident work-hours at academic centers and the impending physician shortfall nationwide, there may be a perfect storm looming.
“Supply will eventually adjust to the demand, but that demand is only going to keep increasing,” says Gregoire, the senior research analyst.
MaryAnn Stolgitis, vice president of operations for Boston-based national staffing firm Barton Associates, says hospitals and healthcare organizations will often have little choice but to continue using temporary physicians to bridge personnel gaps.
Stolgitis says that beyond the supply-demand curve, another factor in temporary staffing’s growth is the increased desire of physicians to generate additional revenue. The exact motivation will vary, from new physicians looking to pay off increasingly burdensome student loans to late-career physicians looking for financial security as they transition into retirement. Others will enjoy the idea of traveling the country via a spider web of locum tenens positions.