With the well-documented shortage of physicians and advanced practitioners coupled with the increased demand for healthcare services, it is not surprising that workforce continuity is the top concern of hospital leadership. Old perceptions regarding the use of locum tenens no longer apply. A big shift is occurring in the market, and the increased use of locum tenens makes the difference for struggling healthcare systems.
Healthcare leaders are seeking solutions to address labor shortages(1) brought on in large part by physician burnout exacerbated by the pandemic, unprecedented number of retiring physicians,(2) and insufficient residency slots to meet the demands of a rapidly aging population.
This challenge is only made worse as healthcare systems’ profits decline and operating costs rise.
Predictions of the future are full of challenges, and locums is one solution that can help minimize these market dynamics while giving healthcare systems an opportunity to change how they manage their workforce.
More healthcare systems are implementing a locum tenens workforce plan that supports existing staff, extends patient care opportunities, and grows profit.
The Value of Locums
There are several long-held misconceptions(3) about locum physicians. Many outmoded concerns center on the quality of the physicians who work locum assignments.(4) However, 88% of healthcare facilities employed locum physicians during the pandemic(5) and are discovering the benefits that align to the pillars of value-based care and strengthen healthcare systems’ outcomes. These include:
Consistent patient care by a licensed physician.
Expanded opportunities to offer specialized patient care.
Healthcare systems empowered to be fiscally agile and responsive to patient needs.
Reduction in turnover.
Decreased physician burnout through reduced shift hours.
Organizations can use locums to extend their circle of care to offer a complete suite of services patients have come to expect, even if it is not available within a given system or geographic region.
Additionally, locum tenens has been instrumental in meeting the needs of disadvantaged(6) and rural areas where physician placement is difficult.(7)
The U.S. Department of Health and Human Services invested $60 million to grow Indian Health Services and rural healthcare’s workforce in the fall of 2022.(8) The agency cited access to care as their top concern for people living in rural areas of the country.
If a physician is not in place to offer care, the vacancy can result in some services being suspended until it is filled. No matter the location, lost opportunity comes with a cost, and this cost can be decreased by leveraging temporary or temporary-to-permanent locums to fill the gap.
Deploying locums in remote areas and at Indian Health Services(9) has increased the quality and consistency of care because of the increasing availability of these “just-in-time” physicians. This model can work for any healthcare system.
Historical healthcare workforce trends show seasons of predictable need within facilities,(10) including holidays, staff relief, and seasonal illness such as flu.(11) Many facilities have been able to meet the pent-up demand for postponed surgeries during the pandemic by supplementing full-time surgeons with specialized locum physicians. Anticipated seasons of increased needs are prime opportunities to incorporate locums into a staff coverage plan.
Locums also position healthcare organizations to deliver value-based care in an agile manner. They ensure new specialties and enhanced patient services are deployed at the right time, place, and cost without full-time employment commitments. Emergent patient needs are met by locum physicians while the service’s sustainability is tested. This reduces overall risk and increases bandwidth for the healthcare system to focus on improved health outcomes.
It is essential to note that locum tenens has many advantages for physicians and healthcare organizations, and industry rules are enforced as with any medical workforce scenario. Just like their peers, locum physicians must meet all clinical standards, healthcare system credentialling criteria, and be trained to deliver care within the system’s operations. Physicians placed on locum assignments do not come with medical oversight, as they function as an extension of the healthcare organization’s existing care team. A healthcare organization is responsible for ensuring their facility complies with all applicable laws and regulations when working with locum physicians.
Another important aspect of engaging locum physicians is reviewing the staffing company’s medical malpractice insurance certificate to ensure that the limits meet the facility’s minimums and the company is insured for the specific specialties they are being asked to staff. Not all medical malpractice insurances are the same.
There are many locum tenens firms from which to choose, and those who are members of the National Association of Locum Tenens Organization (NALTO) maintain exacting standards. NALTO members have codified and abide by a locums’ code of ethics(12) and best practice guidelines,(13) which ensures the fair treatment of physicians and facilities. These guidelines also require physicians to meet specific qualifications, such as education, licensing, and ongoing training. NALTO will even assist in arbitration services if there is an inter-agency dispute over physician contractual obligations.
Locums and Your Workforce
According to a report by Optum,(14) 65% of healthcare leaders identified finding qualified talent as one of the biggest obstacles to success. Not surprisingly, workforce investment, including wages, benefits, and employee training, are ranked as the largest budget investments for 2023.(14) Partnerships built with locum staffing services can help meet and mitigate the systems workforce capacity challenges.
Timelines for permanent recruiting and staffing of physicians and advanced practitioners are lengthy and can lead to a loss in revenue.(15) According to the Association for Advancing Physician and Provider Recruitment (AAPPR), it took more than an average of 150 days to recruit a new full-time physician in 2021.
More specifically, it takes approximately 77 days to recruit a full-time surgeon to an average of 253 days for a neurologist.(16) It is important to consider revenue lost as opposed to the cost of a full-time employed physician when evaluating locums.
Managing the Administration of Locum Tenens
Larger, more experienced locum tenens agencies can provide workforce management solutions to a facility with limited physician recruiting resources. They have the expertise to minimize time spent on talent searches while streamlining complicated processes such as licensing, privileging, scheduling, timekeeping, and invoicing.
For locum physicians, workforce teams often reduce time spent on administrative credentialing processes, time reporting, and EMR orientation. The result? Increased quality of patient care, improved outcomes, reduced loss of revenue, and balanced workloads for the healthcare facility’s teams. Well-oriented physicians are immediately more productive; this is no different when onboarding locum physicians.
Summation: Locums and the Future
In summary, companies that are not availing themselves of the competitive advantage that locum tenens can provide will be disadvantaged in the healthcare marketplace. Like many industries before — technology, industrial, call center, and many more — the use of “just-in-time” labor is a proven model for meeting your system’s productivity needs. However, like any other core business strategy, it requires good planning, strong operational oversight, and smart execution.
A widely accepted business principle is that if something is not part of a business’s core competency it should be outsourced. The business process outsourcing (BPO) model should be considered even in healthcare to non-core functions.
If locum tenens is going to be a large part of your manpower plan, let experts find you the right talent, at the right time, for the right cost. Let your facility focus on what it does best, delivery of care. Locum tenens is a valuable solution for the healthcare industry’s current workforce challenges. It provides:
Support to weary staff.
Increased profitability and agility.
An opportunity to optimize impact of value-based care.
A NALTO member locum tenens staffing service can be a critical strategic partner in elevating workforce and patient experiences while delivering positive results within the rapidly evolving state of healthcare.
American Association of Medical Colleges. AAMC Report Reinforces Mounting Physician Shortage. AAMC News Release. June 11, 2021. https://www.aamc.org/news-insights/press-releases/aamc-report-reinforces-mounting-physician-shortage .
Boyle P, Writer SS. Aging Patients and Doctors Drive Nation’s Physician Shortage. AAMC News. June 11, 2021. https://www.aamc.org/news-insights/aging-patients-and-doctors-drive-nation-s-physician-shortage .
Ferguson J, Walshe K. The Quality and Safety of Locum Doctors: A Narrative Review. Journal of the Royal Society of Medicine. 2019;112(11):462–471. doi:10.1177/0141076819877539
Mustafa Ali MK, Sabha MM, Mustafa SK, et al. Hospitalization and Post-Hospitalization Outcomes Among Teaching Internal Medicine, Employed Hospitalist, and Locum Tenens Hospitalist Services in a Tertiary Center: A Prospective Cohort Study. J Gen Intern Med. 2021;36(10):3040–3051. doi:10.1007/s11606-020-06578-4
Bailey V. 88% of Healthcare Facilities Employed Locum Tenens Providers. RevCycleIntelligence. RevCycle Practice Management News. June 2022. https://revcycleintelligence.com/news/88-of-healthcare-facilities-employed-locum-tenens-providers .
Health Resources and Services Administration. Health Equity for Diverse Populations. HRSA Office of Health Equity. https://www.hrsa.gov/about/organization/bureaus/ohe/populations/diverse-populations .
Rural Health Information Hub. Recruitment and Retention for Rural Health Facilities Overview. https://www.ruralhealthinfo.org/topics/rural-health-recruitment-retention#barriers .
HHS Invests Nearly $60 Million to Strengthen Health Care Workforce and Improve Access to Care in Rural Communities. HHSgov. August 2022. https://www.hhs.gov/about/news/2022/08/08/hhs-invests-nearly-60-million-to-strengthen-health-care-workforce-and-improve-access-to-care-in-rural-communities.html . Accessed February 6, 2023.
Tobey M, Ott A, Owen M. The Indian Health Service and the Need for Resources to Implement Graduate Medical Education Programs. JAMA. 2022;328(4):327. doi:10.1001/jama.2022.10359
Walker NJ, Van Woerden HC, Kiparoglou V, Yang Y. Identifying Seasonal and Temporal Trends In The Pressures Experienced By Hospitals Related To Unscheduled Care. BMC Health Services Research. 2016;16(1). doi:10.1186/s12913-016-1555-7
Centers for Disease Control and Prevention. Coverage by Season. CDC. Flu VaxView https://www.cdc.gov/flu/fluvaxview/coverage-by-season.htm . October 21, 2022.
NALTO Code of Ethics. NALTO. https://www.nalto.org/code-of-ethics/ . November 29, 2022.
NALTO Best Practice Guidelines. NALTO. https://www.nalto.org/best-practice-guidelines/ . November 29, 2022.
Optum. C-suite Check-in: The Health Care Workforce Crisis. Optum Research Report. https://www.optum.com/business/insights/c-suite.html .
Increase Healthcare Revenue with Locums. Jackson + Coker. https://jacksoncoker.com/increase-healthcare-revenue-locum-tenens-staffing/ . Published January 31, 2023.
AAPPR. 2022 Days to Fill Calculator. https://www.secureii.com/AAPPR/Reports/Benchmarking/CalcDTFpub.aspx .
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