COMMENTARY

Doctors for Hire -- The New Case for Locum Tenens

Nancy R. Terry

Disclosures

September 01, 2009

Plagued by issues of managed care, mounting paperwork, malpractice costs, and diminishing reimbursements, a percentage of physicians are stepping away from traditional practices to explore alternative career options. Some have chosen to hang out a new shingle: doctor for hire.

In previous years, locum tenens (a Latin phrase meaning "to stand in another's place") positions were typically filled by early career and semiretired physicians, but recently more midcareer physicians are choosing temporary assignments. A 2008 survey of 12,000 doctors, most of them primary care physicians, reported that 7.5% expected to work as locums in the next 3 years.[1] In 2009, the number of physicians working as locums is anticipated to increase by 16% over that of 2008, according to a report by the Braff Group, a healthcare merger and acquisitions company.[2]

For some physicians, working as a locum is a bridge between full-time assignments or a way to experience how medicine is practiced in various parts of the country before choosing to move to one area. For others, locum tenens work is a way to supplement retirement savings hit hard by the recession. Yet, for a growing number of physicians, locum tenens work is their preferred form of medical practice.

Contributors to Medscape's Physician Connect (MPC), an all-physician discussion board, talk about the pros and cons of temporary medical work and what to expect when doctors take their skills on the road.

One MPC contributor turned to locum tenens work because he became disenchanted with the medical politics he encountered in his hospital position. "As an independent, I'm attended a significantly greater degree of freedom to concentrate on patient care."

For an obstetrician/gynecologist, locum tenens work offers greater job satisfaction. "I've spent a lot of time in the Midwest, mostly at small hospitals. The assignments help me remember why I chose to be a physician."

Locum tenens provides a flexibility of schedule and an opportunity to travel that some physicians find appealing. One MPC contributor comments that 6 months out of the year he works a steady job and the other 6 months he travels the world. "The pay is far less for the latter, but the life experience outweighs it."

"The travel to and from your home town becomes a drag after a while," comments a critical care physician, "especially if you have a family or a significant other." The obstetrician/gynecologist agrees that being away from her husband can be trying, but adds, "The flip side is we continue to feel like newlyweds."

Pay rates vary according to specialty, geographic region, and whether one chooses to work independently or with an agency. General surgeons, for example, receive between $650 and $900 a day, according to Staff Care (www.staffcare.com), a temporary medical placement firm.[2] Subspecialists can command higher rates. In addition to daily rates and overtime pay, agencies cover travel, lodging, and insurance costs.

MPC contributors advise that even among reliable agencies, it pays to shop around. The obstetrician/gynecologist says that some agencies pay much better than others, and some are more consistent in finding physicians work. "Many agencies compete for the same assignments and clients," she says, "so be careful not to get the low-ball rate."

Other physicians prefer to work independently of agencies. "It is far better to do the contracting on your own," says an internist. "You will be paid better. Of course, you do a bit more work." She adds that she and her husband, a physician assistant, have run a locum tenens practice in nephrology for the last 13 years. They have compiled what they have learned about running a contract business in an ebook, Finding Private Locums, which is available for purchase on their Website (www.mdpalocums.com).

Another MPC contributor agrees that being an independent contractor is preferable to working with agencies. "I bill a competitive hourly rate with flat fees for procedures, and I cut out the middleman agency costs to make a deal more affordable and attractive to potential contractees." He typically works with partnerships and groups that have coverage gaps, and contracts for local on-call services. How does he like running his own show? "I love it."

Yet, locum tenens has its downside. "You lack a little security possibly," says an anesthesiologist, "but my experience with a large group didn't convince me there was much security in a partnership."

"The rug can be snatched out from under your feet," says an MPC contributor. "You commit to a certain assignment and turn down other offers, and the assignment you accepted decides they don't need you after all." To guard against last-minute cancellations, he requires that his contract provide him sufficient notice. "Most of the agencies demand a 30-day written notice from the doctor if he or she decides not to take an assignment. So, I like to make sure that the client is also held to a 30-day clause."

Sometimes, the client hospital or practice offers the temporary physician a full-time position. Before accepting such an offer, one MPC commentator recommends that the physician do a thorough background check. "Find out as much as you can about the reasons they required your locum services in the first place. Who was the previous doctor? Why did he or she leave? Does the administration support their staff?" A critical care physician agrees that it makes good sense to be wary. "There is usually some sort of political and social dysfunction inherent in the hospital that makes it impossible to either hire permanent staff or keep them."

One MPC contributor relates that on more than one assignment, he was asked to falsify medical records, alter laboratory data, charge for procedures not performed, bill for patients he had not seen, and prescribe narcotics illegally. Other contributors acknowledge that, although it is uncommon, locum tenens physicians are sometimes pressured by hospital staff to do things that may be unethical or even illegal. In such cases, the placement agency can intercede on behalf of the physician.

Yet, locum work is sufficiently attractive that doctors are hitting the road in greater numbers. One physician, who has been working as a locum for several years, notices that he now has more competition. "Locums work has become very popular." And that's not surprising to some. "We should all be independent," says the anesthesiologist. "Let the medical corporations and the insurance industry fight each other, and let me be a physician."

For more discussion of locum tenens as a career option, go to: http://boards.medscape.com/forums/.29f0ecce/49.

View this and other discussions in Physician Connect (physicians only; click here to learn more).

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