Use of Locum Tenens Physicians Keeps Growing

Ken Terry

January 20, 2017

In a reflection of changing practice patterns, an increasing number of hospitals, medical groups, and other healthcare organizations are hiring locum tenens physicians to fill gaps in care, according to a new survey released by Staff Care, a firm that staffs healthcare facilities. The survey found that about 48,000 physicians work in locum tenens positions, up from 44,000 in 2014 and 26,000 in 2002.

Of the 206 managers of healthcare facilities who responded to the 2016 survey, 94% said they'd employed locum tenens physicians within the past 12 months, compared to 91% in 2014 and 74% in 2012. Forty-seven percent of the facilities were actively seeking locum tenens doctors, up from 42% in 2014 and 39% in 2012.

Primary care doctors were the most sought-after locum tenens practitioners. Almost 44% of the facility managers had hired temporary primary care doctors in the past year, compared to 35% in 2014 and 28% in 2012. Also in demand were hospitalists, behavioral healthcare providers, and emergency medicine physicians.

About three quarters of the managers had used at least one locum tenens physician in a typical month, and 24% had used four or more, up from 18% in 2014. Just more than a quarter of the managers had hired locum tenens nurse practitioners or physician assistants, compared to nearly 10% in 2012.

Locum tenens physicians were mainly used to fill in until permanent doctors were found in certain specialties or to address staff turnover. According to the survey report, the increased use of locum tenens doctors is being driven by the nationwide physician shortage and the employed physician model, "which for many healthcare facilities increases physician turnover."

Physicians have less attachment to a job in a healthcare system or large group than to a practice they own, the report said. It estimated that only about a third of US physicians remain in private practice.

Payment rates for locum tenens physicians — who are usually hired through staffing agencies — can range from several hundred dollars to more than $2000 per day, the report said. Yet 80% of facility managers said locum tenens doctors were worth it, mainly because they prevent the loss of patients and revenues to competitors.

Locum tenens work has become increasingly attractive to physicians in recent years. In a 2016 survey by Merritt Hawkins and the Physicians Foundation, 11.5% of physicians said they planned to take locum tenens assignments, compared to 9% who said that in 2014. Although physicians don't always follow through on their plans, that number of locum tenens doctors would be nearly double the 6% of doctors who now work in locum tenens positions.

The Staff Care survey, which included responses from nearly 900 locum tenens physicians, found that 75% them are 51 years of age or older, and 10% are 40 or younger. Sixty-five percent of locum tenens physicians have more than 2 decades of practice experience; 14% have had 10 years or less of this experience.

Although primary care doctors were most in demand for temporary assignments, these physicians represented only 21% of locum tenens practitioners in 2016. By comparison, primary care doctors make up 34% of the physician workforce, the study noted. Specialists represented a higher percentage of locum tenens doctors than their share of the physician population.

Sixty-three percent of locum tenens doctors said their work was as satisfying as a permanent position, although 22% were looking for permanent jobs. Sixteen percent of the respondents found locum tenens work more satisfying than being part of a regular practice; 21% found it less satisfying. Overall, locum tenens doctors prized the freedom and flexibility of their jobs the most, followed by pay rates that are often higher than those of doctors in permanent jobs.

Make "Market Work More Perfectly"

Geriatrician Dennie Bryant, MD, a Texas-based locum tenens physician, told Medscape Medical News that she appreciated the independence that locum tenens work offers. Today, she flies back and forth from home to a part-time assignment in Oklahoma at the expense of the healthcare system. She used to fly to another gig in central Pennsylvania from her home in New Jersey, where she lived at the time. Both assignments were procured by Staff Care, which also pays for her malpractice insurance.

Dr Bryant would like to join a private practice someday, she said. But for now, she likes the high pay rates and the ability to practice in and experience different areas of the country. She also likes not being under the thumb of an employer.

Jonathan Weiner, PhD, a professor of health policy and management and a workforce expert at Johns Hopkins' Bloomberg School of Public Health, said that he is skeptical that physician shortages are driving the growth in demand for locum tenens doctors. But physicians are maldistributed, he noted in an interview with Medscape Medical News, and locum tenens doctors may help correct those imbalances.

He agreed with the report's point that employed physicians are more likely than private practice doctors to move around, leaving gaps in the staffs of healthcare organizations that locum tenens physicians are called upon to fill.

Dr Weiner believes the locum tenens trend will continue, because "it's clearly a way to make the market work more perfectly." Also, he said, many older doctors will continue to do locum tenens work on their way to retirement. "Most of these physicians are financially secure, and they could probably use a little extra money, but they're doing it for the experience," he said.

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