Locum tenens are shifting from predominantly a role for some physicians to fill near the end of their careers, says one analyst.

Jan. 20—Almost 94 percent of healthcare facility managers responding to a newly released survey said they used locum tenens physicians in the past year, up from 91 percent in 2014 and 74 percent in 2012.

That Staff Care survey and other recent studies point to growing demand in the locum tenens practice niche. (Locum tenens is a Latin term describing a practice model in which doctors accept temporary work assignments for short or long periods.)

In addition to surveying hospital and other healthcare executives, Staff Care, a staffing management firm, also polled nearly 900 physicians who performed locum tenens work.

While that growth is significant, physician participation in locum tenens remains relatively small, with only 48,000 doctors—less than 10 percent of the country’s 700,000 physicians—performing locum tenens work in the past year. Still, that is nearly double the number of physicians who worked locum tenens in 2002. About 47 percent of healthcare facility managers surveyed said they were currently seeking locum tenens doctors, up from 42 percent in 2014 and 39 percent in 2012.

The survey found that primary care physicians (43.5 percent) are in the highest demand, followed by hospitalists, behavioral health physicians and emergency physicians. About 26 percent of managers said they hired nurse practitioners and physician assistants for locum tenens work in 2016, up from 9.5 percent in 2012. One-third of health facility managers in the study said they worked for hospitals, 23 percent for medical groups, and 14 percent for federally qualified community health centers.

David Francis, a senior research analyst for the journal Staffing Industry Analysts, said 2014 through 2016 were strong years for healthcare staffing overall, since implementation of the Affordable Care Act (ACA) increased demand for healthcare professionals by integrating millions of newly insured into the system. This benefited nurse staffing and locum tenens, since both are supply-constrained occupations. Locum tenens annual growth peaked in 2015 at 17 percent, with 10 percent growth in 2016 and 5 percent projected for this year, according to Staffing Industry Analysts studies.

 “U.S. locum tenens revenue was $1.4 billion in 2006 and grew to $3.4 billion in 2016, and we project that will continue growing through 2018,” Francis said in an interview.

The three largest locum tenens firms, CHG Healthcare (Weatherby Healthcare), Jackson Healthcare (LocumTenens.com) and AMN Healthcare (Staff Care) dominated the sector in 2015 with a collective 58 percent market share. 

Physician staffing firms and other industry experts cited the growing national shortage of physicians as the primary driver of locum tenens growth. A 2015 study by the American Association of Medical Colleges (AAMC) projected U.S. physician shortages of 65,500 by 2020 and 90,400 by 2025.

Physician Interest

Russell Libby, a pediatrician and board member of the Physicians Foundation, said as physicians become more aware of their practice options in different stages of their careers, they consider trying different practice styles. Ten years ago most physicians worked in traditional practice settings and were constrained from experimenting, Libby said. Today greater numbers are employed by hospitals and large independent practice associations. 

“Many feel that they’ve lost control of their own destiny and are thinking about other options,” Libby said in an interview. “Some see locum tenens as a better opportunity to enjoy freedom, take more time off, and work fewer days.”

Sometimes locum tenens physicians stay longer on assignments to try out the practice or location and may even join the practice later, he said.

“This option wasn’t as readily acceptable years ago,” Libby said. “Now staffing companies are making attractive options to these doctors, and more companies are seeking physicians for locum tenens work.”

The Physicians Foundation found in its 2016 health staffing survey that 11.5 percent of physicians planned to work locum tenens that year, up from 9.1 percent in 2014.

Ani Turner, co-director of the Altarum Institute’s Center for Sustainable Health Spending, said locum tenens used to be something some physicians did near the end of their careers.

“But it’s growing more common for younger doctors to step into this role, a part of an overall trend in the physician work force away from the classic private practice model,” Turner said in an interview.

Temporary physicians may play a particular role in business cycles, Turner explained.

“We often see a reduction in temporary health workers prior to a recession or period of greater unemployment, and when labor markets tighten and employment grows, we see increases in locum tenens because healthcare organizations are looking to fill permanent positions and fill those slots temporarily with locum tenens as they are looking to hire,” Turner said.

“With the uncertainty over healthcare reform, the repeal of the ACA, and looming changes in the number of uninsured, it would seem to be a reasonable strategy to continue to use locum tenens until it’s clear what’s going to happen,” Turner said.

Julie Ramos, senior managing director of the locum tenens division for The Execu|Search Group, said locum tenens work offers a wide range of practice settings that allow physicians to choose a geographic location or practice that fits their needs.

“We place doctors in rural and urban settings, with government programs like the Indian Health Services, Veterans Health Administration, and public hospitals,” Ramos said in an interview. “We place them on cruise ships and in schools and in CVS/Caremark clinics, federally qualified health centers, and urgent care facilities. Many corporations have locum tenens come in to do employee screenings. Some locums are working in the comfort of their homes doing telemedicine. We even are placing them in McDonald’s walk-in clinics.”

Hospital Impact

Jeff Waddill, divisional vice president of Staff Care, said the lost revenue to a hospital-based practice from unfilled physician positions can reach $124,000 per month. And those vacancies can last six to nine months.

“More and more facilities are using locums to bridge that gap and staunch those revenue losses,” Waddill said in an interview.

He said there is some seasonality directed by geography. For instance, Florida hospitals face demand surges as snowbirds converge there annually.

“But demand is strong nationally,” said Waddill.

Chris Franklin, president of Locumtenens.com, said hospitals are using locum tenens more strategically than in the past.  

“When locum tenens first began, it was more of a choice of last resort, something used when an organization was in a dire situation facing troubling consequences,” Franklin said in an interview. “What we’re seeing now is that healthcare organizations are viewing locum tenens as a very strategic component of their overall workforce management strategy.”

When used appropriately, Franklin said, locum tenens offers hospitals greater control over costs.

He said physician openings don’t always require full-time equivalents (FTEs).

“Sometimes the need in a hospital-owned practice is roughly half or two-thirds of an FTE to handle that load, so an FTE is underutilized,” Franklin said. “With a locum tenens, you can dial that in to address exactly the amount of coverage you need. Locum tenens aren’t just for emergencies anymore.”

Mark Taylor is a freelance writer based in Chicago.

Publication Date: Friday, January 20, 2017