The Pros and Cons of Locum Tenens for Hospitalists
Michael Manning, MD, medical director of Murphy Medical Center in Murphy, N.C., needed a doctor. Tasked with building the hospitalist program for his 57-bed hospital 90 miles from the closest city, Dr. Manning turned to a locum tenens firm for help, and the company seemed to find a perfect fit. They found a physician who wanted to commit to a one-year stint. The physician was eminently competent, had lined up housing for the year, and, perhaps most important, was eager to serve the residents of seven rural counties in western North Carolina, northern Georgia, and eastern Tennessee.
Then the new hire had a change of heart and backed out of the position. As medical director, Dr. Manning has taken on up to 10 hospitalist shifts a month to cover the absence, and the hospital-employed group is now looking at paying temporary staffers even more as the nascent group struggles to reach its optimal staffing level. To Dr. Manning, the hope-to-heartburn scenario typifies the “two-edged sword” that is locum tenens.
“Overall, I would say it’s a necessary evil,” he says. “You’ve got to have your service staffed. You can’t go without physicians filling slots. The evil for us is the cost.”
The cost of paying temporary physicians over the long term can be overwhelming for cash-strapped hospitals and health systems. But that’s done little to stop hospitalists from becoming the leading specialty in the temporary staffing market, according to a proprietary annual review compiled by Staffing Industry Analysis of Mountain View, Calif., on behalf of the National Association of Locum Tenens Organizations (NALTO). Hospitalists accounted for 17% of locum tenens revenue generated in the first half of 2011, the report states. The only other specialty in double-digit figures was emergency medicine, which tallied 14% of the $548 million in revenue measured by the report. Survey respondents reported year-over-year revenue growth of 9.5% in the first half of 2011, with aggregate revenue generated by hospitalists jumping more than 34%.
A survey of hospitalists released in October showed that nearly 12% had worked locum tenens in the previous 12 months; 64% had done the work in addition to their full-time jobs.1 The survey, crafted by Locum Leaders of Alpharetta, Ga., was among the first to capture just how prevalent the practice of temporary staffing is and what motivates physicians to do the work.
The reasons hospitalists choose to work locums are as varied as HM practices. In the short term, hospital-based physicians are looking for geographic flexibility, higher earning potential, and the chance to “try something on for size before they buy,” says Robert Harrington Jr., MD, SFHM, chief medical officer for Locum Leaders and a SHM board member. Early-career hospitalists can use temporary work to determine what they want to do with their careers, while older physicians can use it to finish their careers focused solely on clinical care.
Regardless of motivation, hospital administrators can utilize temporary staffing to save money on health, retirement, and retention benefits, as well as costs related to training and career development. But staffing via locum tenens has downsides, too. Cost is the concern most commonly noted, with expenses including negotiated fees to locum companies and, depending on contracts, travel and lodging costs (most contracts cover malpractice costs, industry players say). Some critics question the quality of temporary physicians, while others worry about the potential of doctors distracted by their “day” jobs.
