Physicians have been filling in for one another for years. Temporary physicians (known as locum tenens) have traditionally taken over for other physicians as a professional courtesy during vacations, illnesses or other events requiring time away. In recent years, the use of locum tenens physicians has become more prevalent. In a 2014 survey conducted by Staff Care, an AMN Healthcare staffing firm, 91% of the 259 healthcare facility managers surveyed indicated they had used a locum tenens physician at least once in the last 12 months, and 42% said they are currently looking for one or more locum tenens physicians. Of the respondents, 73% said they use at least one locum tenens physician in a typical month, and 18% said they use four or more. Primary care physicians are the specialists that are most in demand, followed by behavioral healthcare specialists and hospitalists.
According to the facility managers surveyed, the top two reasons for the use of locum tenens physicians were physician turnover and interim coverage. Between 2009 and 2014, the number of survey respondents who reported using locum tenens as a response to physician turnover rose from 22% to 55%, a finding that Staff Care believes reflects a recent shift from the traditional independent physician practice model to the employed physician model.
"When physicians were mostly small business owners, they had a high financial and emotional investment in their practices and tended to put down roots," Staff Care's president, Sean Ebner, told Medical Economics. "As employees, they are more likely to pull up stakes if compensation, schedules or other factors are not to their liking. When that happens, many facilities use locum tenens doctors to fill the gaps."
Locum Tenens as a Career Option
Today, a growing number of physicians are choosing locum tenens work as their primary career. Internal medicine specialist William S. Gruss, MD, told Medscape that he began accepting locum tenens assignments in 2009 and started working locum tenens full time in 2012. "I have a more defined work schedule," he said. "When I am on, I am on, and when I am off, I am off. This is a nice change from when I was in private practice, or even as an employed physician with an outpatient setting, where I was getting paged frequently by the answering service."
Neurosurgeon Duane Gainsburg, MD, told Medscape that locum tenens work appealed to him because it offered him the compensation he wanted without all of the paperwork. "The primary advantage is the ability to concentrate on patient care and not have the hassle of running an office, dealing with increasing hassle and time requirements and decreasing income; also, the ability to predict one's work hours and income," Gainsburg said.
According to the Association of American Medical Colleges, by 2025, physician demand is expected to exceed supply by a range of 46,000 to 90,000, due to an aging population and full implementation of the Affordable Care Act. Where the shortage falls within that range will depend on the aggressiveness of increased use of non-physician clinicians and whether or not there is widespread adoption of new payment and delivery models, such as patient-centered medical homes and accountable care organizations. As a result, more organizations may be turning to locum tenens physicians as it becomes increasingly difficult to find physicians to fill full-time positions.