Locum tenens solve staffing problems.

Further Reading

The following additional sources of information on locum tenens as a staffing stratogy were obtained through a computerized search of databases. Copies of cited articles may be obtained from the College for a nominal charge. For further information on the citations, contact Gwen Zins, Director of information Services, at College headquarters, 813/287-2000.

Bergman, J., and Schneeweiss, R. "The Locum Tenens Experience: A Comparison with a University Faculty Practice." Family Modicine 17(3):103-5, May-June 1985.

Henneman, P., and others. "Attending Coverage in Academic Emergency Medicine: A National Survey." Annals of Emergency Medicine 18(l):3441, Jan. 1989.

Koska, M. "Locum Tenens: Just in Time for Summer Vacations." Hospitals 62(11):104, June 5,1988.

Kronhaus, A. An Organized Locum Tenens Service and the Cost of Free Time for Rural Physicians." Modical Care 19(12):1239-46, Dec. 1981.

Renaidy, C., and Jenkins, M. Locum Tenens." Journal of do Madical Association of Georgia 75(8):504-5, Aug. 1986.

The use of locum tenens physicians physicians who work temporary assignments) began decades ago when primary care physicians arranged coverage for their private practices while on vacation. Today, the placement of locum tenens physicians has evolved into a national business. The reason for the increase in the use of locum tenens physicians is because of the benefits they can offer. They can prevent a hospital, HMO, clinic, or physician practice from losing market share due to a gap in medical coverage.

Locum tenens phyicians fill temporary staffing assignments that range from one week to one year. They have worked for health care providers in 50 states in both major metropolitan medical centers and small, rural communities. Although there are some drawbacks to using locum tenens, the technique can produce real benefits. It can:

* Prevent loss of revenue from unattended physician practices.

* Increase admissions.

* Provide an immediate solution to a physician vacancy while a search is conducted.

* Allow both physician and organization to see how well they work together before a permanent commitment is made.

* Ensure continuity of high-quality care.

* Control staffing costs by reducing the number of FTEs during peak loads.

Drawbacks To Using Locum Tenens

On the other hand, problems can occasionally arise with the logistics of hiring locum tenens and with the quality of these physicians.

* There can be a delay in filling the assignment. For example, although a physician is available in the specialty requested, the physician must be licensed before he can practice. You might have to wait until the state licensing board meets again before getting licensing approval, and that might mean a month's delay.

* Problems can arise with the quality of the locum tenens. Clinical competency is not usually an issue, because it is easy to check professional references for suspended privileges, malpractice suits, etc. However, personality or addiction problems are more difficult to detect in the screening and reference process. (A professional locum tenens company should replace any problem physicians as soon as possible.)

*You might not get the "exact" candidate that you order. The more urgent the need, the less time there is to match the client with the precise specifications requested. For example, a hospital might want a board-certified physician and the physician immediately available in that specialty might be clinically competent but not board certified.

*It can occasionally be difficult for a medical staff to grant privileges in a short time, especially in an organization that does not grant temporary privileges. To avoid problems and delays, all the licensing and credentialing information should be in place before the credentialing committee meets. If a locum tenens firm is used to recruit physicians, it should be given a deadline for completing this information.

When To Use A Locumtenens

Locum tenens can be used in a variety of situations caused by planned or unexpected physician absences.

When a practice is unattended due to a physician's illness, continuing medical education, maternity leave, or vacation.

When extra coverage is needed during peak periods. (This alleviates stress on other physicians, reduces un - * All insulin-dependent diabetics and

*All insulin-dependent diabetics and also noninsulin-dependent diabetics with known renal disease or elevated serum creatinine or BUN.

* Significant cardiovascular disease, including history of ischemic or valvala heart disease, cardiac arrhythmias, or congestive heart failure.

* Previous allergic contrast reaction.

* History of significant allergies, including anaphylactic reaction or multiple allergies.

* Renal failure: serum creatinine greater than or equal to 2 mg/dl in nondiabetics.

* History of asthma requiring medication or hospitalization. Also significant respiratory compromise by severe pulmonary disease (e.g., ARDS, pulmonary hypertension).

*Patients on renal dialysis.

* Patients with dysproteinemia (e.g., hemoglobinopathy, gout, Waldenstrom's Macroglobulinemia). If the patient has multiple myeloma, the radiologist should be consulted on whether any intravenous contrast should be given.

*All children under one year of age.

* Unusually anxious patients.

* At the request of patient or referring physician.

* Arteriographic and venographic studies, at the discretion of the performing radiologist.

* Myelography, at the discretion of the performing radiologist.

* For all examinations, at the discretion of the radiologist supervising the study.

* For studies obtained when there is no nurse available in the department for monitoring the study, at the discretion of the performing radiologist.

T H E A U T H O R

David M. Bloom, MD, MBA, FACPE, is Vice President for Medical Affairs, Lourdes Hospital, Binghamton, N.Y., and a Distinguished Fellow of the American College of Physician Executives. The survey results were tabulated by James Lane of Lourdes Hospital's Research and Development Department. necessary overhead, and eliminates the need to hire a permanent physician.)

* When testing a new service so you do not have to expend money or time to recruit a permanent physician until you know the service is viable.

* When there are delays in relocating a physician to a permanent position.

*When a physician dies. (The practice can be staffed by a locum tenens physician to help maintain the value of the practice before it is sold.)

Who Works As A Locum Tenens

There are four primary groups of physicians who work as locum tenens.

* The new physician completing residency who is undecided about his permanent career goals or who just wants some time off before settling down.

*The middle-aged physician who is seeking a professional or personal change.

* The older physician who still wants to practice medicine but who no longer wants to practice full time or to worry about practice management.

*The growing number of physicians opting to be "permanent" locum tenens. Locum tenens has matured into a recognized alternative to the classical medical practice. Physicians who work as locum tenens are no longer viewed as doctors who can't get jobs elsewhere. They simply like the benefits of being locum tenens. These include the diversity of practice settings, travel opportunities, freedom from management headaches, steady competitive income, and malpractice coverage (especially important for expensive-to-insure specialists).

Using A Locum Tenens Physician

Locum tenens companies win check references, prescreen the physicians, arrange for licensing details, make travel arrangements, and provide malpractice insurance. However, the client is responsible for travel expenses and temporary housing. The client has the opportunity to interview the prospective candidate in person before hiring.

Although there are instances in which a locum tenens firm has provided a physician within 24 hours, at least six weeks should be allowed to complete the licensing and credentialing process, especially in the harder-to-find specialties.

The daily rates for a locum tenens vary according to the "market value" of the specialty. For example, a pediatrician costs approximately $450 a day, and a neurosurgeon costs approximately 1,300 per day. These fees are in direct proportion to the amount of revenue that the specialists usually can generate for a client.

Cautions

If you are planning to use a locum tenens, keep the following guidelines in mind to ensure the best results:

* Verify references to ensure they are current and that the physician is in good standing and has no past disciplinary action.

* Be sure licenses and DEA numbers are current and verified. Ask to see documentation that these have been checked.

* Be sure the physician is fully credentialed at the hospital where he win be working. This is a joint effort between the locum tenens firm and the client.

* Be clear on expectations for the physician, such as office hours, types of procedures to be performed, length of assignment, any extra responsibilities involved, etc. Problems can arise if a physician accepts an assignment that is different from the original job description.

* Be sure people with whom the physician will be interacting are aware he is coming. It really makes a difference if the physician feels welcome.

T H E A U T H O R

John D. Smith is President of Locum Tenens, Inc., Atlanta, Ga., a division of Jackson and Coker, a national physician search and health care consulting firm.

Some User Comments

Obviously, not all locum tenens stories will be positive, but in many instances, the use of these physicians can carry an organization over a rough spot. The following examples illustrate some of the benefits of locum tenens.

Ernest J. Henson, M.D., Vice President of Medical Services at Mercy Medical Center, Springfield, Ohio, first used a locum tenens in June 1988 when a primary admitter announced he would be retiring after 33 years in practice. He gave the hospital only seven weeks' notice. The hospital used locum tenens for 10 months until a permanent replacement was recruited. Today the locum tenens physician is still on staff. He purchased the practice and is a large admitter to the hospital.

"Using a locum tenens allowed the hospital to retain its market," Dr. Henson says. He adds, It's important to have the means to replace a physician and keep a practice going. " Dr. Henson also says that the physician must be suited for the practice. He cites the example of not hiring a candidate for a very active situation if the physician is working locum tenens to slow down his pace.

Eldon G. Hoachlander, M.D., Vice President of Medical Affairs for Washington County Hospital, Hagerstown, Md., first used locum tenens when three of the seven OB/GYNs on staff discontinued their obstetrical practice. He thought the cost of using a locum tenens was high, but, he says, "We would have gone out of existence if we had not used locums."

Wallace W. Duncan, M.D., Medical Advisor at Bluefield Community Hospital, Bluefield, W.V., used a locum tenens for the hospital's emergency department when a physician left suddenly. He cites the following advantages of using a locum tenens:"It takes the pressure off until you find the right person, and also you can get liablity insurance on a short-term basis, which is becoming ready impossible to obtain."

Unlike Dr. Hoachlander, Dr. Duncan describes locum tenens as "less expensive. You pay less than market price for a permanent physician, and you are not paying fringe benefits," he says.--j.d.s.