Yes, the use of locum tenens, or temporary physicians, can cost a little more, but it's less expensive than watching patients go elsewhere, say those in charge of staffing hospitals and group practices.
"Revenue is lost without physicians in place, and it also results in a lack of service for the community," says Sharon Anderson, director of physician recruitment for St. Louis-based Partners First, the recruitment division of Ascension Health, which has hospitals in 16 states. "It's worth it to use locum tenens."
It has been hard work to overcome the misconception that temporary physicians can't hack it in traditional practice, say staffing firm executives. Dustin Koger, vice president of operations at Staff Care, a national locum tenens company based in Irving, Texas, says the use of locums is growing as the supply of doctors continues to decrease, particularly for specialties such as radiology, anesthesiology and psychiatry.
Staff Care spokesman Dave Faries reports that only 4% of hospitals or medical groups in nonacademic settings had tried locum tenens in 1987. He now estimates that 15% of medical employers have used locums, and he expects to see more doing so in the future.
In a short-term situation, such as when a doctor is absent due to illness, a hospital or group might not worry too much about losing patients. The problem is when a physician leaves and needs to be replaced, says Robert Kuramoto, M.D., former assistant medical director and interim medical director at the Christie Clinic Association in Champaign, Ill., an outpatient facility with 88 doctors.
"You're lucky to find someone in three months, and it takes still more time to take care of certification," he says. "Six months would be very good to have a new doctor in practice."
Patients won't wait that long, however, and that's when the real value of locum tenens comes to the surface.
Organizations budget for locum tenens in different ways. For Partners First, the cost is incurred by the practice or hospital involved and not included in its own recruitment budget, Anderson says.
Diannah Thomas is contract credentialing coordinator for Michael Pesce and Associates, a group of about 64 anesthesiologists in Pinedale, Calif. She says locums, who are essentially independent contractors, are accounted for as regular vendor expenses. Locums have been particularly useful in staffing new locations as the group continues to grow, she says.
"We start with (a temporary doctor) for at least three weeks to a month to be safe while finishing up paperwork for a permanent physician," Thomas says.
Robert Shipman, manager of physician recruiting at the University of Utah Health Network in Salt Lake City, says his managers always shudder when he suggests the need for temporary doctors. But he saves the system a considerable amount by using locums for those facilities or specialties that see seasonal changes in volume, he says.
For example, Shipman hires more hospitalists in winter when there are more inpatients. Since the university network is state-supported, the savings from employing fewer permanent physicians keeps taxpayers happy, too, Shipman says.
Gil Johnson, president of the National Association of Physician Recruiters and of the staffing firm Gil Johnson and Associates in Monroe, La., argues that the use of temporary doctors is growing because hospitals and physicians benefit from a try-before-you-buy model.
"It's like courting before you get married," Johnson says. "If you have a chance to get to know one another, you can build a better relationship."
Are employers still worried about poor quality from locum tenens doctors?
"Quality is certainly a concern," Kuramoto says. "Credentialing is key, especially when you get into the more procedural specialties, for the protection of your patients and your organization."
Locums firms can provide a service to small groups that don't have access to the credentialing infrastructure maintained by most large hospitals, he says. Dan Growth, president of the Locum Medical Group in Cleveland, says he checks the status of a doctor's medical licensure, often with data available on the Internet. Growth also looks into whether sanctions have been recorded on a doctor's Medicare and Medicaid identification numbers.
"Locum tenens companies are only as good as the physicians they place," says Staff Care Executive Vice President Joe Caldwell.