Home | 12/21/2000 Issue | Article

Don't misinterpret implementation of CMS' HIPAA contingency plan

Effective Dec 10, 2003
Published Dec 10, 2003

‘Temporary’ relief: Use locum tenens to fill vacancies

If a physician leaves your practice, whether for vacation or retirement, and you don’t find a replacement, you risk financial hardships. With fewer physicians, you’ll have trouble meeting the needs of the same volume of patients. But if you use a locum tenens physician to fill your vacancy, your practice can continue treating the same number of patients without hurting the quality of care.

“When you have a vacancy, your services can’t and shouldn’t stop,” says Pamela McKemie, senior vice president of Locumtenens.com, a physician placement and recruitment agency in Alpharetta, GA. “Locum tenens contractors come in and bill services just like the physicians in-house. So the revenue continues to generate.”

With a locum tenens physician, you name the specialty and the amount of time you need a replacement. “In Latin, the term means, ‘stand in the place of.’ In locum tenens, we bring in physicians to stand in place of other physicians, for a week or a month or a year.”

The idea of locum tenens started 20 years ago with a grant from the government aimed at offsetting a severe physician shortage in rural areas, says McKemie. Today, physician vacancies exist everywhere. “The country just cannot produce enough [physicians] to make up for those retiring full time.”
 
The locum tenens ‘crowd’
Locum tenens physicians generally fall into one of three categories, says McKenie:

Residents figuring out their career paths. “Residents are about a third of the [locum tenens] population. They often do locum tenens work to explore what’s out there. They don’t know what kind of practice or geographic location they want so they do locum tenens as a working interview,” McKemie says.

Settled-but-restless physicians looking for a transition. You’ll also find mid-career physicians who may have previously been in the same position for 20 years. They need something new, says McKemie. “They’ll do it to fill the interim gap before finding the next permanent position.”

Retired physicians interested in working part-time. The third group consists of retired physicians not ready to give up practicing altogether, she says. “They don’t want to work full-time, but they don’t want to not practice at all. [Locum tenens] gives them the option to continue practicing on a limited basis.”
 
Advantages
You can find a locum tenens physician on your own or work through an agency. If you’re working with physicians in your state, contract directly with them or use an agency, but if you need to cross state borders, use an agency, suggests McKemie.

“A practice would probably first look in its local network. If that doesn’t work, go to an agency. Then the agency can start looking to find a licensed, available physician in the specialty needed,” she says.

You can also use this type of physician to test a new area. If you want to move into a new market but don’t know whether you have the population to support it, bring in locum tenens physicians. After you’ve tested the market, decide whether it’s an investment your practice really wants to pursue.

Tip: Work with more than one agency, says McKemie. “Every agency has unique physicians. When you’re looking for a particular specialty with a particular license at a particular time, the odds of making a hit are sometimes low.” Using more than one agency increases your chances of finding a match.
 
Drawbacks
Make sure bringing on new physicians won’t interrupt patient care. Patients don’t like surprises, so tell them about a new doctor coming in as far in advance as you can, suggests McKemie.

“The more you communicate in advance, the better. It alleviates anxiety from patients walking in to a physician they’ve never seen before,” she says. Put a notice in the community newspaper or in an internal newsletter to let your patients know about the new doctor. Introduce a locum tenens physician the way you would any new physician.

“Typically, the physician will sit down with the group and try to be conscious and cognizant of how they currently run the practice,” says McKemie. “The astute person will come in and adopt the current philosophies, procedures, and structures.”

If the new physician tries to run the show, talk to him or her about the importance of consistency and continuity for your staff and patients.

On the flip side, ask staff to work with the doctor and listen to ideas. Experiences locum tenens doctors have had at other practices could allow them to offer objective analysis of situations at your practice.

Tip: Take time for orientation. Don’t expect a new doctor to treat patients without becoming familiar with your practice, says McKemie.

“Give everyone—the physician, the staff, the administration—the chance to get to know each other and the procedures.”
 
A growing trend
In the last seven years, the demand for locum tenens services increased by about 10%, says McKemie.

Physician shortages, particularly in high-end specialties such as radiology and surgery, account for some of the increase.

“The number of residents coming out of medical school training programs has dropped 20%–40%, depending on the specialty. Medical schools just can’t train them fast enough to meet the demand,” she says.

Plus, many physicians are moving out of states hit hard with medical malpractice suits because they don’t want to pay the high premiums. More and more practices in these communities now look to locum tenens physicians to fill their vacancies.

The more patients deal with these temporary physicians, the more they’ll get used to the idea, says McKemie. “In the consumer’s mind, the thought of having a physician come in as a temporary position is somewhat counterintuitive. It doesn’t work. But it is becoming more and more mainstream.”


 
Three tips to using locum tenens physicians
 
Pamela McKemie, senior vice president of Locumtenens.com in Alpharetta, GA, offers advice to consider when hiring a locum tenens physician:

Post your position on an Internet job board. Job boards are often free and can connect you directly with physicians. If you find a physician in the specialty you need, you save money by not going through an agency, says McKemie.

Use a variety of different agencies. “It’s a nonexclusive contracting business, meaning you can work with more than one agency at a time,” she says. “Any agency would prefer you work with just them, but you really should work with two or three.” Working with multiple agencies gives you more flexibility and options, and a better chance to find the right physician for your practice.

Check credibility of agencies you use. Make sure the agencies all belong to the National Association of Locum Tenens Organizations, suggests McKemie. Also, be wary of agencies that don’t provide credentialing and background documents about their physicians up-front.
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