By Frank Phillips
The advent of managed care has created many exciting changes and opportunities within the health care field, particularly affecting the ways in which physicians practice medicine. One result has been the increased use of locum tenens, or temporary physician staffing, which has become more popular among physicians and health care institutions over the last ten years.
Prior to managed care, physicians typically were locally-based health care providers. It was the “norm” for physicians to graduate from residency and begin a solo, fee-for-service practice. However, now, there are a variety of options from which physicians can choose, one being locum tenens.
Locum tenens, a Latin term meaning “one holding a place,” has become an alternative to full-time practice, and a viable career option for physicians in all specialties. One overriding benefit is that it gives physicians the freedom and flexibility to practice medicine at their discretion, without practice hassles.
Physicians choose temporary work for a number of reasons. Permanent positions come with various stipulations and many physicians enjoy the freedom to practice “when they want, and where they want.” A temporary position gives them that luxury. Physicians also may only want to work six months out of the year, thus being unable to make a long-term commitment to one institution.
Physicians who elect to use locum tenens services encompass a broad range of age groups and medical specialties. Physicians in between permanent positions, graduating residents and older physicians pursue locum tenens opportunities in order to travel and practice at their leisure.
Graduating residents are more often turning to locum tenens firms to fulfill their needs until they find the right practice opportunity. On average, it will take a graduating resident three to six months, and in some cases up to one year, to secure a permanent practice setting. These temporary opportunities also allow recent graduates to practice medicine and generate income while they are conducting their search.
Many physicians will also want to know what type of medical practice setting they are “getting into” before they accept a permanent position. Locum tenens gives them the opportunity to decide if that particular institution is suitable.
In addition, many graduating residents have a year off before starting their fellowship, and a temporary position allows them to practice medicine during the interim.
Other physicians work with locum tenens services because they simply enjoy taking temporary positions in various parts of the country. They enjoy the freedom of exploring different geographic areas, with the ability of practicing medicine at the same time.
When investigating locum tenens firms to work with there are a number of factors physicians should consider. It is important that the firm chosen has an extensive database of practice opportunities and a high placement rate. The firm should be able to locate opportunities in areas of the country interesting to the physician and meet all their personal and professional needs with the highest degree of discretion.
A physician should ask as many questions as possible in order to determine how a locum tenens firm compares with its competitors in the industry. For example, physicians should ask about compensation, malpractice insurance, length of a typical assignment and the process of credentialing.
Personal issues a physician should inquire about are reimbursements for travel expenses, licensing fees and available relocation services, as well as any other questions deemed important. The job of the locum tenens firm is to fulfill each obligation within its realm of responsibility.
Most locum tenens firms will cover travel expenses, licensing fees and provide relocation services. However, a firm typically will not cover taxes. Taxes and personal finances are issues in which a locum tenens firm should not be involved. The firm should be competitive and reasonable with compensation as well as take into consideration all current retirement and pension funds, but the organization of a physician’s personal finances, usually, is not offered by locum tenens firms.
It is also important to be aware of the malpractice insurance policies the locum tenens firm offers. Most firms offer a policy, but it is important to discuss the particular policy’s limits, as well as the types available, be it occurrence-based or claims-made. Occurrence-based is the preferred option as it does not require tail coverage.
Also, physicians should research the accuracy and dependability of the firm’s services. The best method of investigation is to ask the firm to supply references from both physicians and clients. Once the firm has secured a practice opportunity for the physician, representatives should be available throughout the period of placement to answer any questions or address any issues and concerns.
In addition to becoming more popular among physicians, an overwhelming number of health care institutions are also turning to locum tenens as a viable staffing solution. Institutions find that they save resources, time and money by having a professional locum tenens company fulfill their staffing needs. Institutions also secure a locum physician to staff busy periods in various hospital departments, group practices, etc.
Health care institutions contact locum tenens firms to fill temporary voids when the regular physicians are on vacation, at medical conferences or CME training. Typically, physicians are granted a minimum of one month’s vacation time, and financially, most institutions cannot afford to operate for an entire month with that decrease in service. Physician staffing voids are similar to any other industry. Illness, accidents, maternity leave or sudden departures can cause a staffing shortage.
Health care institutions also experience seasonal voids. For example, during the summer months, Cape Cod, Massachusetts, a busy tourist location, with an enormous population surge, needs more physicians at local hospitals. There is also a greater interest among physicians to fill these voids, as it allows them to spend the summer months on the Cape. This scenario is also evident during the winter season with locums positions in Florida.
As physician retention issues arise, locum tenens services have now become a successful “temp to perm” tool for hiring organizations allowing the opportunity to evaluate a physician before hiring permanently. A trend has emerged that more locum tenens doctors are securing permanent positions as a result of their temporary work.
Characteristics hiring organizations should look for in a locum tenens firm are dependability, resource capabilities and the firm’s reputation within the health care industry. Asking for references from current and past clients is one way to determine if the firm will become a partner with clients to develop staffing solutions.
Word-of-mouth referrals are also extremely important when choosing to retain a locum tenens firm. If possible, ask other health care institutions about their success rate with locums firms. Checking with a variety of institutions will create a list of firms that you can contact.
It is also important to ascertain the firm’s reputation within the medical arena by investigating its professional affiliations. For example, is the firm affiliated with any national medical organizations that your institution deems important, such as the American Academy of Pediatrics, the National Association of Managed Care Physicians or the National Rural Health Association?
This will allow the institution to gauge the firm’s professional standing within residency programs and medical assemblies, as well as ensure the highest quality of candidates were contacted for possible placement.
A locum tenens firm should also have superior research capabilities, allowing for a full and complete background check on all potential candidates. A extensive background check consists of verifying all licenses, residency programs and medical school records. In addition, a minimum of five verbal references and three written references from a previous supervisor or colleague should be obtained by the firm.
Additionally, the firm can cross-check information with the National Practitioner Databank as well as the Federation of State Medical Boards. A firm should also carefully investigate any previous malpractice cases as well as the physician’s history at other institutions.
It is also extremely important that the locum tenens firm, once selected, stay in contact and be available in the event of a conflict, or if a problem arises with the placement. Some firms offer a guarantee on placements, promptly providing an alternate candidate, should the first physician not work out.
As managed care continues to evolve in the health care industry, health care professionals are met with new, cutting-edge methods for practicing medicine and working with patients. Locum tenens is one such tool that has been sharpened by changes in health care, while witnessing increasing popularity as it allows more physicians and hiring organizations to benefit from the freedom and flexibility temporary staffing provides.
Frank Phillips is the senior vice president of Weatherby Locums, Inc., a locum tenens recruitment firm located in Ft. Lauderdale, Fla.