Survey Shows Rising Role of Locum Tenens
Jan.–Feb. 2006
Physician recruitment typically is thought of as the effort to attract and retain permanent, full-time medical practitioners. However, medical staff plans also frequently embrace the use of temporary, locum tenens physicians. For a variety of reasons, these physicians are playing a larger role in hospital and medical group staffing plans today.
This is reflected in the “2005 Review of Temporary Physician Staffing Trends” survey conducted by Staff Care, Inc., and tracks supply, demand, and other developments in locum tenens. The survey includes interviews with physicians who work as locum tenens and interviews with hospital and medical group administrators who use the services of locum tenens physicians. The survey also includes a review of the temporary physician staffing assignments Staff Care conducts in the course of a calendar year.
Growing Numbers
There is no precise way of determining exactly how many physicians are working locum tenens. However, by reviewing our own records and extrapolating from our knowledge of the locum tenens staffing industry, we are able to compile estimates, which are included in the survey. We estimate that the number of physicians working locum tenens on either an occasional or full-time basis has increased from more than 26,750 in 2001 to approximately 34,000 in 2004. Estimated total annual spending on locum tenens services increased from $1.25 billion in 2001 to $2.9 billion in 2004.
There are a number of reasons for the increases cited above. Primary among them is the acute shortage of physicians, which is being experienced virtually nationwide. In May 2005, the Association of American Medical Colleges (AAMC) convened to address the shortage of physician manpower. Edward Salsberg, director of the AAMC’s Center for Workforce Studies, projected at the conference that the United States could have a deficit of 200,000 physicians by the year 2020, even if enrollment in U.S. medical schools increases 15% by the year 2020.
The pattern of shortages driving recruitment toward a temporary model should be a familiar one. A similar trend occurred and persists in nurse staffing today. Lacking an adequate number of permanent candidates, many hospitals and medical groups now are reliant upon a growing number of nurses who work temporary assignments. The same trend is emerging in physician recruitment. Increasingly, hospitals and medical groups are using locum tenens physicians to fill gaps in their staffs while permanent candidates are being sought.
Thirty-six percent of administrators surveyed indicated they use locum tenens to hold a place until permanent staff is recruited. In the past, locum tenens physicians were used primarily to cover for physicians who were temporarily absent from the staff due to sickness, vacation, or CME. Now they also are being used for a variety of other reasons that are more proactive, such as supplementing staff during peak usage seasons or to test new market service lines.
Changing Practice Styles
The way physicians practice today is also impacting the use of locum tenens. Physicians coming out of training are increasingly concerned about lifestyle, which, in essence, means set hours and regular vacations. While locum tenens physicians have traditionally been used to cover for vacationing physicians, the volume of vacation coverage required today keeps expanding. “Time off” has become an important recruiting and retention tool, and locum tenens physicians often are used to ensure that full-time physicians get the time off they expect.
Partly as a result of these trends, the number of “physician days” Staff Care was asked to fill with locum tenens physicians increased from 182,370 in 2003 to a projected 287,068 in 2005.
Just as in a permanent search, some medical specialists are more in demand as locum tenens than are others. In 2005, we received the most requests for anesthesiologists/CRNAs, followed by psychiatrists, radiologists, family practitioners, general internists, pediatricians, orthopedic surgeons, and general surgeons. As the survey results show, hospital-based specialists are in particular demand as locum tenens, as are primary care physicians and some surgical specialists.
Quality is another factor behind the increased use of locum tenens physicians. In the past, a presumption existed that physicians working locum tenens were deficient in training or experience, or were unsatisfactory in some other way.
In recent years, however, perceptions about locum tenens physicians have changed. This is in part because the malpractice crisis has compelled health care staffing firms and those who use locum tenens services to be more thorough in their review of physician candidates. As a result, hospital and medical group administrators generally regard locum tenens physicians as on par with their own staff physicians. When asked how they viewed locum tenens physicians working at their facility or group, 56% of those surveyed responded that they are equal or superior to existing staff, 39% indicated they are average compared to existing staff, and 5% said they were below average compared to existing staff.
Finally, locum tenens physicians have become a greater resource for recruiters and medical staff planners simply because there are more of them. While the net number of permanent physician candidates declines due to retirement and changing practice styles, the net number of locum tenens physicians continues to grow.
Like nurses, physicians find temporary work attractive — mainly because of the flexibility and travel opportunities. When asked why they practice locum tenens, 48% of physicians surveyed cited a flexible schedule, 38% cited travel, 35% additional income, 34% clinical experience, and 15% indicated they work locum tenens assignments as a way to find permanent positions.
Locum tenens traditionally has appealed to older physicians who wish to work part-time and travel. However, locum tenens has growing appeal to younger physicians seeking a controllable lifestyle and the ability to “test drive” various practice settings before they commit to a permanent job.
The majority of experts now concur that the physician shortage is a long-term problem. As the shortage persists, and as the number of locum tenens physicians grows, temporary doctors will continue to be an important part of the medical staffing mix.
Source: Joseph Caldwell is executive vice president of Staff Care, Inc., a national temporary physician staffing firm based in Irving, Texas. He can be reached at jcaldwell@staffcare.com. To receive a copy of the “2005 Review of Temporary Physician Staffing Trends,” visit www.staffcare.com.
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