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Attractive to early- and late-career physicians as well as those with nomadic streak
After more than a quarter of a century, internist Walter Mulchin, MD, retired in 2000 having led emergency departments in New Orleans and Bentonville, Arkansas.
With his daughter grown and out of the house 10 years later, he returned to practice as an internist and has been working mostly in state-supported living centers in Texas, Oklahoma and Arkansas.
Mulchin is among an estimated 44,000 locum tenens physicians who are working in temporary positions for hospitals and other healthcare facilities, says Melissa Byington, president of the National Association of Locum Tenens Organizations and president of Salt Lake City-based CompHealth.
For Mulchin, the lure is that he can work where he wants, when he wants-and to say no if he doesn’t want the assignment. He prefers jobs that last a couple of months so he can take time off and return to his wife, Sandra, in Arkansas, although sometimes she travels with him.
“The biggest fun I have is that I don’t have to do it 100% of the time,” he says. “If you don’t like something, you can always refuse in the future.”
The estimate of 44,000 locum tenens physician dates to 2014 and is up from 26,000 in 2002, according to an annual survey conducted by Staff Care, a locum tenens agency, which estimates the number “based on the number of locum tenens physicians who work through us and our knowledge of the temporary physician staffing industry.”
The dramatic increase has come about partly because doctors appreciate the autonomy that comes from not being tied to a specific position, and the internal politics and administrative responsibilities that often comes with it, Byington says. The desire for autonomy has increased as a result of the Affordable Care Act (ACA) and the growing number of mergers and acquisitions of healthcare practices, she adds.
“Physicians have gone from being their own boss to becoming employees of a health system,” Byington says. She also cites a
CompHealth study of physicians conducted earlier this year showing that more than 40% of physicians are taking secondary jobs such as locum tenens to help combat declining incomes, maintain their lifestyles and pay off debt.
The 2015 Staff Care survey shows that 91% of hospitals use locum tenens, up from 73.6% in 2012, and that 36% of respondents worked at hospitals, 17% at medical groups and 12% at Federally Qualified Health Centers.
The quickening pace of locum tenens growth has occurred for several reasons, but the major one from facilities’ standpoint is physician shortages, especially in rural communities, Byington says.
Other reasons healthcare facilities use locums include as fill-ins for doctors on vacation or pursuing continuing medical education, meeting the surge in patients due to the ACA, staffing up during peak usage times, and maintaining the flexibility to increase or reduce staff numbers as needed, according to the Staff Care survey.
From physicians’ standpoint, the main reason is often lifestyle-related. “Doctors want to get their lives back,” she says. “You get to drop in, practice medicine and see patients, and then when you leave, you’re off.’”
Other benefits for doctors include higher hourly pay than salaried positions or additional pay when used as a second, part-time job.
Beginning physicians, those easing into retirement and even some who are mid-career appreciate the ability to work for a period of time and then take time off without having to answer to anyone, Byington says.
Locumtenens.com provides temporary physician and other healthcare practitioner staffing in all 50 states. Like other agencies, it provides benefits to physicians such as the ability to choose their own schedules, the desired work-life balance, higher hourly pay, a lack of bureaucracy as compared with a permanent position.
It also offers the ability to try different settings, such as larger versus smaller hospitals, or urban versus rural care, says Amelia Vietri, vice president of primary care recruiting for Locumtenens.com.
In some cases, physicians try a particular employer and decide to stay permanently once the contract ends, Vietri says. For hospitals, she adds, “It does give them a great opportunity to try out a physician.”
Val Jones, MD, took that path. She is now medical director of admissions at St. Luke’s Rehabilitation Institute in Spokane, Washington, after spending six years as a locum, the last two for various periods of time at St. Luke’s.
Jones got into locum tenens work as a way to keep her clinical skills fresh while working full-time in an administrative job, but she found locum tenens extremely appealing because it allowed her to get away from work completely.
“The treadmill of clinical work these days is set to 12, and you can’t dial it down,” she says. “I realized I was a happier person, a better doctor and enjoyed my work more when I could do it in chunks of two, three, four weeks. When I took time off, it was truly off. It allowed me to focus all my attention on patient care.”
The “try before you buy” aspect is especially appealing to physicians who have just finished residency and aren’t quite sure what kind of work setting they want, Jones says. “A lot of young physicians are pressured into making contractual commitments to hospitals” before they know what they’re getting into, she says.
There are other benefits to locum tenens, she adds. “It expands your horizons. It can offer you great job satisfaction in a place you never thought you wanted to be. A lot of people like the traveling aspect,” Jones says.
Michal Gross, MD, a New York-area native, wanted to see other places and other types of medical systems and experience how they managed diseases based on their resources and cultures. She also wanted a two-year bridge from residency to fellowship without tying herself down in one place with one organization.
Working through locumtenens.com, the internist has spent time at a 25-bed facility in Wolfeboro, New Hampshire, with only one other doctor, no subspecialties and limited imaging capability. In September, she was working as a temporary hospitalist at Doctors Medical Center in Modesto, California, an academic trauma center with multiple specialties and residency training.
Gross suggests balancing new experiences with some stability, because staying in one place allows doctors to deepen their knowledge of a given system, consult more effectively with nurses and fellow physicians, and learn the electronic health record (EHR) system more thoroughly.
Locums work requires flexibility to learn different cultures and different EHR systems, adds fellow internist Mulchin. The benefit, though, is “You’re less stressed because you don’t have that connection with the higher-ups, the administrators. You can stay in the background.”
Staffing agencies and doctors who practice as locums offer some cautions to those considering the arrangement. For starters, locums need to arrange their own health insurance and retirement savings. Those who do not work through locum tenens agencies also need to handle their own credentialing, state licensing, hospital privileges and malpractice insurance, as well as housing and travel arrangements.
Second, to work steadily, you must be willing to live a nomadic lifestyle, Byington says. “You have to be really adaptable and have great communications skills,” she says. “You can add your expertise, but you have to adapt to what works for them.”
Another challenge, especially at the outset of a new placement, is that hospitals and healthcare facilities sometimes don’t do enough orientation for locums. They don’t stop to think that new person doesn’t know where supplies are, how referrals work or how the EHR system is set up, Byington says.
Be sure you know why a hospital or healthcare facility needs locums help, Jones advises. Usually it’s for perfectly understandable reasons. But in some cases it’s because a hospital is under investigation by its state health department.
“Local people don’t want to touch them with a 10-foot pole,” she says. “I ran into a situation like that once and found out the hard way that I needed to do a close inspection.”
Gross suggests vetting your agency closely. The first one with which she worked kept promising positions that didn’t come. Then they told her that not having a license in advance wouldn’t matter, but a potential employer rejected her because she didn’t have one.
Locum tenens positions also can be unpredictable, given that most contracts allow facilities to cancel with 30 days’ notice. Jones says. “I was in a situation where a hospital canceled on me in two weeks,” she says. “I complained to the agency that that wasn’t fair, we should be able to recoup two more weeks’ pay. The agency said, ‘Our policy is to pay you those two weeks when we recoup, but we rarely recoup.’ Caveat emptor.”
John Thieszen, MD, was serving in the Air Force and decided in 2008 that he needed extra income, so he took on weekend assignments as a hospitalist. Since then, he has left the military and worked in eight hospitals across Colorado, Wyoming and Montana.
Echoing Gross’s experience, Thieszen advises those considering locums work to vet their contracts. Although he’s had nothing but good experiences with CompHealth, Thieszen says he’s heard about locums agencies that don’t vet their clients, so that doctors find situations very different from what they had expected-seeing 10 times as many patients, or with no housing lined up, for example.
That said, Thieszen agrees that locums need to be flexible. “You don’t want to show up and say, ‘This is how I do things.’ ”