Valerie Choy, M.D., may be the new face of locum tenens staffing. While locum
tenens assignments at one time generally were opportunities for semi-retired
physicians to continue their practices, medical staffing executives indicate
that physicians of various ages now take temporary assignments for diverse
reasons.
Locum tenens also is becoming an increasingly important tool for recruitment and
retention in rural and other areas without an adequate number of physicians.
Choy, a 35-year-old graduate of the medical school at Loyola University Chicago,
has completed four locum tenens or temporary internal medicine assignments since
she finished her residency at the University of New Mexico School of Medicine in
Albuquerque last year.
"When I finished up my residency, I wanted to explore what kind of practice I
would want," says Choy, who is currently working in Salinas, Calif.
So far, Choy has worked at assignments, averaging four months each, in New
Mexico and California and plans to decide by the end of the year how she wants
to proceed with her career.
Although physicians 50 and older continue to be a majority of those doing locum
tenens work, staffing executives interviewed say physicians 35 and younger are
the fastest growing segment of the staffing pool.
"For a lot of younger doctors it's a good way to explore what kind of practice
they might want to do," says Michael Weinholtz, CEO of CompHealth, a medical
staffing company headquartered in Salt Lake City.
Mark Brouse, president and CEO of VISTA Staffing Solutions, also headquartered
in Salt Lake City, says physicians who accept locum tenens assignments generally
are "individuals in some kind of transition." These include physicians who have
completed residencies, fellowships or military service and physicians who are
moving toward retirement, staffing executives say.
Weinholtz estimates that 30% to 35% of physicians now in locum tenens are coming
from residency programs.
As recently as five years ago, most of the physicians who took locum tenens
assignments were 50 and older, but Dustin Koger, vice president of operations
for Irving, Texas-based Staff Care, says physicians now use locum tenens as a
tryout at medical facilities where they may to go to work on a permanent basis.
"We're beginning to see locum tenens as a career determiner," says Brouse.
Locum tenens assignments include interim placement while hospitals and other
medical facilities are seeking permanent employees and temporary replacements
for doctors who are on vacation or on leave.
Although salaries for these assignments are competitive, staffing executives say
many of the jobs are transitional and physicians are looking for tradeoffs in
regard to their schedules, travel and paperwork requirements.
Length of assignments vary with the speciality of the physician, staffing
executives say, but average four to six weeks. They can be as short as one day
or continue for months.
Estimates of physicians who have worked in locum tenens posts have increased
from 3% in the late 1970s to 15% today, says Koger of Staff Care, but industry
executives say the nature of the field, with temporary assignments, makes it
difficult to estimate the number of physicians working in locum tenens at any
specified time.
One factor in the increase in locum staffing has been the rise of managed care,
and that increase has been both in supply and demand, staffing executives say.
Koger says managed care has been "the No. 1 motivation" for physicians to
consider locum tenens and avoid the paperwork of a full-time post.
Brouse says some physicians have shown a reluctance to become organizational
employees with managed care. "We have seen that trend over the past two years,"
he says.
Jonathan Erich, M.D., a graduate of the Loma Linda (Calif.) University Medical
Center, says he began taking locum tenen assignments in 1993 after his effort to
go into private practice with two partners failed.
Erich, 43, an OB/GYN, moved to Portland, Ore., to join the partnership in the
fall of 1992 and qualified for various insurance programs, but when the
physician directories came out, his name was either omitted or on loose-leaf
sheets easily detached from the directory.
"Nobody knew that I existed," Erich says, and he knew that new directories would
not be out for another year.
Erich discovered that three other OB/GYNs had started practices just prior to
his arrival in Portland and even his partners had begun to take new patients.
"I went broke and lost (more than) $100,000," he says. "I decided to cut my
losses."
Since Erich began taking locum tenens assignments, he has worked in nine states,
generally taking assignments for about nine months each year.
"I can pick and choose where I work," says Erich, who was on an assignment in
Puyallup, Wash.
A disadvantage of locum tenens is a lack of job security, Erich says, but he has
had only one real break in employment--"in one three-month stretch in 1993 where
I had one week of work."
The major advantage of locum tenens, Erich says, is that "I don't have to deal
with the petty politics of the location. You can float above it all."
He says locum tenens physicians also don't have to worry about billing, payment
and insurance issues.
Brouse says managed care initially brought increased needs for locum tenens
coverage, but with time the influence has waned.
Managed care had shifted the demand toward more generalists, says Weinholtz of
CompHealth, but now the demand has shifted back toward specialties.
High-demand specialties now include psychiatry and radiology, executives say.
"We've seen tremendous growth in radiology with growth in the number of imaging
centers," Weinholtz says.
Weinholtz says locum tenens also provides physicians with an opportunity to
consider "quality of life" issues.
Susan Nguyen, M.D., who has taken five locum tenens internal medicine
assignments since she completed her residency at the University of California,
San Diego, last year, has worked in California, Kansas, Texas and Maine.
"I'd always wanted to go to Maine," says Nguyen, 30, who soon will begin a
fellowship in nephrology at UCSD.
She says she chose locum tenens assignments "because I didn't want to work full
time."
"It's a good thing," Nguyen says. "You can pick your hours."
But both Nguyen and Choy acknowledged that locum tenens work with a lot of
travel requires some flexibility in regard to family and social relationships.
"It's not the kind of job you can have if you are married or have children,"
Nguyen says.
Erich is testing this theory: He was married in March. His wife, Susan, is a
nurse and a home-health agency manager. They are making their home in
Battleground, Wash., and he plans to continue taking locum tenens assignments.
"I'm waiting to see how this works out," he says. "It's still open-ended."
One
of the advantages of locum tenens work, Erich says, is that when he is at home
he doesn't have to worry about patients or what is happening at the office:
"When I am home, I am really home."
Staffing executives interviewed say the amount of travel involved in locum
tenens assignments can depend on the preference and credentials of the
physicians.
Erich now has medical licenses for six states and Guam, but he noted that locum
tenens assignments for federal agencies and departments do not require the
physician to have a medical license for the state that is the site of the
federal facility.
Medical staffing companies work both to identify medical facilities that need
temporary physician services and physicians who are interested in providing
those services.
"We see ourselves as trying to serve two masters," says Weinholtz of CompHealth.
For the medical facilities, locum tenens is a "viable staffing strategy."
CompHealth recently acquired Weatherby Health Care, a permanent staffing
company, headquartered in Norwalk, Conn., and Weinholtz says the company is
trying to present a total service for medical facilities with both permanent
staffing and interim staffing until positions are filled.
Medical staffing companies work with physicians to ensure that they meet
credentialing requirements and have necessary insurance coverage.
Staffing companies also work on providing accommodations and transportation for
locum tenens physicians, executives say.
Staffing company executives say they
are comfortable about future growth in the demand for locum tenens physicians.
Brouse says, "The demand for physicians far outstrips the supply."
"We've seen the market grow some in the last few years," says Weinholtz. "There
is tremendous opportunity for growth."
Weinholtz says locum tenens particularly
is important in retention and recruitment in rural areas that do not have
adequate numbers of physicians.
Koger says the need for better distribution of physicians is also present in
some urban areas.
"Seventy percent of cities in Texas are underserved," Koger says.
Several states have taken the initiative to provide locum tenens coverage for
physicians in underserved areas.
The state of New Mexico, for example, has contracted with the University of New
Mexico for locum tenens staffing to provide relief for rural physicians.
Diana Chavez, manager for the program, says New Mexico's effort is the largest
state program in the country and uses faculty and staff members from the
university's medical school.
Some 300 physicians have participated in the plan since it began in 1993, and 71
physicians now work in the program, she says. They receive additional
compensation for their locum tenens work.
Chavez says the locum tenens program also has provided opportunities for UNM
Medical School residents who haven't quite found the type of practice they are
looking for.
South Carolina also has initiated a locum tenens program through its Office of
Rural Health, and Amy Brock, associate director of the office, says the program
has been contracting with three physicians to provide locum tenens relief for
rural practices.
South Carolina also is one of eight states that is participating in the Southern
Rural Access Program, which the Robert Wood Johnson Foundation is funding
through a $13.9 million grant.
Brock says funding from this program may allow
her office to establish locum tenens programs with residents from the state's
medical schools.
"We're trying to give them rural exposure," she says.
Crystal Hull, a spokesperson for the Southern Rural Access Program, says all of
the state programs likely will have locum tenens components.
Also participating
in the program are Alabama, Arkansas, Georgia, Louisiana, Mississippi, Texas and
West Virginia.
The Health Resources and Services Administration reports that in 1998, the
latest statistics available, these states had an average of 53 primary care
physicians per 100,000 population in nonmetropolitan areas.
This compares to a
national average of 55.8 per 100,000 in nonmetropolitan areas, 100.4 per 100,000
in metropolitan areas and 91.7 per 100,000 overall.
Brock in South Carolina says the locum tenens programs for rural physicians
"help to prevent terrible burnout."