September 16, 2015
As the nomads of health care, locum tenens doctors have a bad reputation. Some physicians consider them itinerant misfits who can’t hold a “real” job.
Far from being outcasts, however, locum doctors are generally peripatetic by choice. And judging from the growing number of firms that specialize in recruiting them, the demand for their services is spreading. According to Michael R. Weinholtz, CEO of CompHealth in Salt Lake City, one of the largest locum recruiters, the industry has been growing at 5 to 10 percent a year for the past five years, with no sign of letting up.
That’s because groups, hospitals, nursing homes, surgi-centers, HMOs, physician practice management companies, and other employers-not to mention solo practitioners-need locum doctors. Maybe a regular physician is unavailable because he’s sick, on extended vacation, or experiencing a personal crisis. Or maybe a peak work period or health emergency temporarily requires more doctors than are on staff. Or maybe an employer is interviewing candidates for a permanent position but won’t hire for a while.
Locum doctors are often so competent and well-liked that they’re invited to remain as full-time employees. Yet many decline, for being on the move offers benefits that being settled can’t match.
Three types of doctors choose a nomadic lifestyle. About 20 percent are going through a life transition and will be locums only temporarily. They may have lost their jobs or are in the midst of a personal crisis, like a divorce, and are taking time off from permanent practice to decide what to do next.
Another 40 percent are young doctors-typically recent residency graduates-who don’t know what sort of career they want. Doing a locum stint enables them to sample a variety of practice opportunities before making a permanent commitment.
Such a doctor might work for a month in suburban San Diego in a large multispecialty group with mainly managed care patients, followed by two weeks in urban Houston in a small primary care group with mostly fee-for-service patients, followed by three weeks in rural West Virginia, covering for a soloist with a mixed practice. In the process, he can see which type of practice, patients, and locale suits him best.
The remaining 40 percent of locums are seasoned doctors who choose the work for lifestyle flexibility. Many are in their 40s and 50s and intend to keep working but are burned out from full-time practice. Others are in their 60s and nearing retirement, but aren’t ready to quit medicine entirely. By becoming locums, these doctors can better control how much they work. They might work for six to nine months, temporarily living in some of the most desirable parts of the country, and then take the rest of the year off.
Many locums, for instance, follow the snowbirds south in winter. As dual-residence retirees
from northern climes swell the population of states like Florida and Arizona, the need for seasonal physicians in those states grows proportionately. Then, from late spring too early fall. When retirees migrate north to vacation hot spots like Martha’s Vineyard or Bar Harbor, ME, locums do likewise. It can be a very pleasant way to live.
Locum doctors are needed in virtually every medical field. “We staff 42 physician specialties, ranging from dermatology to urology to neurosurgery,” says Weinholtz of CompHealth. But the doctors in highest demand at his and other firms are primary care physicians, specifically FPs and internists.
Weinholtz attributes the booming market for primaries to health care organizations that need them to serve as gatekeepers. In addition, these organizations are looking to save money by turning their high fixed personnel costs into less-expensive variable ones. Weinholtz also attributes the demand to the turmoil among PPMs. As PPMs go belly up or are forced to lay off staff, or as fed-up doctors quit, there are gaps in patient care. Temporary physicians are needed to fill in.
Locum doctors are generally paid by the hour-about $65 to $80 for FPs and internists. However, they typically get paid extra for each on-call shift and for weekends. It’s not unusual for locum primaries to earn in six to eight months what they would make in a year in permanent practice.
Most locum tenens recruiters also offer benefits: malpractice insurance, health insurance, participation in a 401(k) plan, and multiple-state licensing assistance. Locum firms strive to build loyalty among their doctors. So the more weeks you’re willing to work, the richer your benefits tend to be. Hard-working doctors may also get upgrades in housing and transportation on new assignments.
It works the other way, as well. If you let more than a month lapse between assignments, you might lose your health insurance.
Locum recruiters try to provide their loyal doctors with regular assignments, but that’s not always possible. That’s why locum doctors routinely sign up with more than one recruiter to ensure that they work as often as they want.
Naturally, as a locum tenens, you’d need to be licensed in each state where you plan to work. Some states turn the process into a paperwork nightmare. Even if you have a state license, getting clearance to practice can be an ordeal.
The more state licenses you hold, the more employment flexibility you’ll have. For that reason, a locum firm will work to get you licensed in as many states as possible.
Does that mean you’ll have to pass, say, 16 state licensing exams? Not necessarily. Some states grant reciprocity: If you hold that state’s license, you’re automatically granted a license in certain other states, as well. Some states issue a special locum tenens license that permits a doctor to work in that state temporarily. Getting one of these temporary licenses is quicker than getting a permanent one. But if you have a favorite state where you hope to be assigned repeatedly, it may be more practical in the long run to get a permanent license.
When you deal with a recruiter for a permanent job, you don’t need to accept the recruiter’s word for what the job will be like, because you go on an interview to see for yourself. As a locum, however, you simply show up for work. And the job might differ dramatically from how a client presented it to the recruiter.
You might, for example, be expected to see 35 patients a day, rather than the 20 that the client led the recruiter to believe. Or even though the majority of patients are young and healthy, as you were told, you’re expected to see all the time-consuming older patients who may want several appointments a week. Whether the practice setting and patient load are a pleasure or a pain, you get paid the same.
While it’s in the best interest of a locum firm not to alienate the doctors it represents, you assume a risk anytime you agree to work in a practice that you don’t get to check out first. That risk is a regular part of the locum lifestyle.
An even greater problem is the varying quality of housing you receive on assignment. One way locum firms profit is by negotiating volume discounts on housing for doctors. But the accommodations aren’t inspected first-either by the firm or by you-so you must take what you get, whether it’s a pleasant apartment or a room above a garage.
Then there’s culture shock. Many physicians underestimate how tough it can be to enter a new work environment, surrounded by unfamiliar doctors with different practice styles and expectations. They may regard a locum doctor as an inferior and make no attempt to integrate him into the practice or the community because, after all, he’s only a temp.
If “Have stethoscope, will travel” sounds like a career option worth investigating further, dozens of locum recruiters nationwide will be glad to get you temporary work. The most convenient place to find them is on the Internet. Search for ‘locum tenens” with your Web browser.