Locum Labor

Staff shortages has always been a major problem of the US healthcare system, and with the economic crisis still looming, it looks unlikely that this is to be resolved anytime soon. Ruddy Polhill explains the life of a locum, and the need for greater compliance.

“Everybody wants higher quality healthcare but the real question is how to get there from where we are now and how to pay for it”
-Ruddy Polhill

A relatively new organization, the National Association of Locum Tenens Organizations (NALTO) came into existence in 2000 in a bid to standardize healthcare recruitment guidelines. A number of industry players concluded that a better understanding of the industry was needed with a formalized set of rules and procedures for both the recruiters and the employees to abide by.

“As far as our mission, we’re here to educate all of players in the industry – the physicians, the clients and the recruiters all wrapped into one,” explains Polhill, the association’s president. “We meet a couple of times a year, and the idea is to create a forum where we could exchange ideas, but anything it’s to educate and develop a positive image.

“We discuss best practices, industry standards more than and ethical guidelines. We have a whole process where if someone does have an ethical or standard of practice problem with another client or another member – the idea is to take the client out of the middle of the competitors in a fairly competitive market segment. For example, if two recruiting firms were claiming they were involved in placing a physician, the idea of NALTO is so that they can take the client out of the middle of that and talk it through another forum, and come up with a reasonable agreement.”

Staff retention
Staff retention is one of the major challenges currently facing the healthcare recruitment sector, in terms of the hospital environment. Polhill acknowledges the problem, and describes the industry as “having always been a revolving door.” During times of shortage, HR programs are rolled out within the hospital to keep employers onboard and happy.
   
“It’s no mystery there’s a shortage of physicians around the country. Locum tenens are coming alongside and helping our clients with that, creating an environment where as patient volume spikes obviously people work harder. We’ve seen this on the nursing side in particular.

“In the nursing sector, it is more likely to see job satisfaction than any other, but is often a little bit the same on the physician side. For example, if there’s a five-physician practice, and they don’t really have enough patient volume to bring in another physician as a partner, but maybe they’re all working a lot harder than they want to or they only have so much time to see patients, job satisfaction is likely to go down.

“At that point it might make sense to bring in a locum tenens doctor or physician a couple of days a week just to help with their busy days, so in that way it could help get the handle on it. As a strategy locum tenens are often viewed from a hospital perspective as a little bit of a high-cost alternative. I would challenge that – when dollar benefits are consideration, malpractice insurance and so on, what you pay for a locum tenens doctor, if you really study it, is not a high-cost alternative.

“Most hospitals, if they look at over their year statistics, there will be a lot of times where they’re not as busy, and so be overstaffed. We believe that the perspective of the locum tenens company focuses on the magic number of staffing being different for every hospital. For example, let’s assume that the magic number is 80 percent. The ideal would be to staff at 80 percent of maximum and then in those times when it slides to 85 or 100, due to a work overload, that’s when you bring in the locum tenens doctors to help the excess load and then when the patient load goes down, you don’t have them work those particular times,” explains Polhill.

By matching the doctor’s available hours with patient demand, an equilibrium of supply and demand can be achieved, and also result in a happier workforce who are more likely to retain their employment positions. The situation is also favorable for seasonality.

Compliance
To ensure that all locum workers uphold to a standardized set of practices during any given time of work, however, is often a laborious task. Polhill advises that one of NALTO’s primary objectives is to hold each of its members accountable to each other, which is done via an ethics committee. “We have an arbitration committee and an ethics committee,” he says. “So, for example, if two companies can’t come to an agreement, instead of involving the physician and involving the client, what we agreed to the membership was to involve NALTO – a company can bring a complaint, whether it be a standard of practice or an ethics complaint, against another company and it’ll be reviewed by a board.

“It’s nonbinding but it is helpful, and it’s unbiased because it’s done in a Company A, Company B format. We just get the facts. We don’t know who the personalities are involved in it, but the net effect is we get five or six peers that are in the industry to weigh in on what they think about the situation. Again it’s unbinding, so it’s not done in the sense that you have to agree with what they say, but what we’ve found is that most people tend to understand. Occasionally there may be a situation where for business reasons the other company says, “Well, we just don’t agree with that.” And that happens as well, but it’s a positive outcome more often than not. What’s important is the fact that we use that mechanism to keep the clients and the physicians out of the middle of the dispute between the companies.

“Prior to NALTO one thing that’s common, is that due to it being a very competitive industry, you see a lot of companies backbiting, being very aggressive and involving the clients, and that’s a very uncomfortable position for a client and, quite frankly, they just wanted a physician. And you have two companies who are saying that they presented this physician first, so that’s where the standards of practice come in to help us line up and give a peer review to the member companies and say, “Hey, really under our standards of practice this particular company is the company that really was the cause for the physician placement.”

Challenges
The challenges facing locum workers are far greater than those of permanent. Polhill advises that the biggest challenge for locum tenens physicians is at the beginning of each placement is in acclimating and getting comfortable with the staff and the enviuronment. After a period of returning to the placement numerous times, it more often than not works out well as physicians assimilate into their culture.

“The first time they go to a new environment they are an outsider looking in. Over time they assimilate great, but that probably would be the biggest challenge, similar to a person starting their first day on a permanent job. It takes a little while for people to get comfortable and to understand how things flow. Another challenge is that it’s very easy for a client if there’s one little hiccup to ask for a temporary physician to be replaced, whereas if it’s a permanent physician they might work harder to work through the communication issues. There’s also a higher standard out there for the temporary physicians because it’s easy to request to have them replaced,” says Polhill.

He also explains that a difference in patient population also presents cultural challenges for the locum physician. But despite the problems that can occur, the volatility of the environment is what draws physicians to temporary staffing  positions, because they get the variety and they like seeing different geographical locations and meeting people from different parts of the country.

The recent financial crisis has also impacted the physician locum sphere. Fortunately, physicians are viewed by hospitals as revenue generators, so there’s still a demand for physicians. The economic crisis has result in a decrease in elective surgeries – if patients are having the choice of waiting for surgery, they more often than not are postponing it, so it has actually decreased patient volume.

“Being a revenue producer, physicians are not impacted anywhere nearly as severe as the nursing side where they’re considered to be more of an expense from a hospital perspective,” says Polhill. “Hospitals are one of the largest, if not the largest, purchaser of healthcare next to government. The government’s growing; what goes on with the hospitals ultimately affects the demand for our services.

For example, in 2008 healthcare staffing brought around $11.4 billion in revenue. The good news for NALTO members is that the physicians are still being projected to be growing about five percent. Now just to put it in perspective, last year of the 11 billion generated, about 1.8 billion was actually the fees attributed to locum tenens physicians. The analysts that watch our industry are expecting the physician fees to grow to around 1.9 billion. As physicians, we are growing, but will be growing slower than expected as an industry.”

As Obama’s healthcare package begins to unfold, Polhill still remains undecided as to how this will affect the sphere of locum workers. “Everybody wants higher quality healthcare but the real questions is how to get there from where are now and how to pay for it. I’m not sure how it’s going to affect our industry, but I’m hopeful. Anything that increases patient access to care creates more demand for what we do, so from that perspective it will create more demand for healthcare services.”

Working within the locum sector certainly brings its share of challenges, both for physicians and the recruiters themselves, but as Polhill explains, 2009 could be the year of governmental change and with an increasing patient demand, the problems of staff retention are likely to work in favor of locum tenens.

Rutherford ‘Ruddy’ Polhill is the President of the National Association of Locum Tenens Organizations.

NALTO’s mission

The purpose of the National Association of Locum Tenens Organizations (NALTO) is to provide a foundation of industry standards and ethical guidelines for companies offering locum tenens recruitment services. These guidelines provide the building blocks for relationships between NALTO members and their clients.

NALTO is also committed to continuous education for locum tenens physicians, recruiters and clients. It provides a forum for the exchange of ideas about standards of the industry, changes in the locum tenens marketplace, and ethical treatment of physicians and clients alike.

Its other aims include taking a leadership role in developing a positive image of our industry, developing an increased market share for its members, and instituting a peer review process based on excellence, honesty and fairness.
[Source: www.nalto.org]

The meaning of locum tenens

The term ‘locum tenens’ is taken from a Latin phrase meaning “to hold the place of,” and most commonly refers to temporary physicians. Locum tenens doctors contract with recruitment agencies to perform medical services for a healthcare organization over a certain period of time. The physician works as an independent contractor paid through the staffing agency, which is in turn paid by the healthcare facility.

The benefits of locum tenens
Locum tenens work benefits both physicians and healthcare organizations. Physicians can be contracted for any number of reasons, from compensating for physician shortage to covering a permanent doctor’s vacation leave. Healthcare facilities benefit from locum tenens contracts by covering gaps in patient care during periods of growth or physician shortage. The industry continues to grow as more physicians choose this way of practicing medicine and healthcare organizations discover the value of locum tenens staffing.

Locums physicians often enjoy higher pay scales, more variety in medical cases, a broad array of work locations from which to choose, and the flexibility to build their own schedules. However, working as a locum tenens physician also requires some patience, good organization skills, and the ability to adapt to different environments.
[Source: www.nalto.org]