The tradition of one doctor stepping in for another—referred to as locum tenens, Latin for "to take the place of"—has been a respected practice in the medical field for over two centuries. Doctors have historically covered for each other during illness, travel, or other absences as a mark of professional respect. It wasn't until the 1970s, however, that employing locum tenens doctors shifted from being a casual, impromptu arrangement to a more structured and essential aspect of medical staffing

The turning point came when government funding was introduced to address the shortage of physicians in underserved regions, heralding the contemporary age of locum tenens staffing. Agencies specializing in locum tenens emerged to cater to the needs of healthcare facilities that required temporary professionals to bolster their teams. These agencies now provide not only physicians but also Advanced Practice Providers (APPs) and other healthcare professionals.

Nowadays, nearly 90% of hospitals, medical groups, and various healthcare institutions rely on locum tenens physicians and APPs. This widespread adoption is primarily to ensure continuous service while they search for permanent staff members, according to a 2022 survey by AMN Healthcare on locum tenens staffing trends.

In this article, we explore the persistent challenges of securing permanent healthcare positions and discuss how locum tenens serve as a viable solution, reflecting a growing preference for flexible staffing options.

7 Drivers Shaping Modern Medical Practice

The healthcare sector is currently at a critical juncture, shaped by profound demographic transitions and deep-seated systemic shifts. These elements challenge our conventional approaches and call for an anticipatory strategy to manage emerging complexities effectively. The following seven drivers are critical, as they are redefining the contours of medical practice management:

1. Population Growth

The U.S. is on track to expand from 332 million residents today to 423 million by 2050. This significant increase will inevitably escalate the demand for medical services across the board.

2. Aging Population

Marking a historic shift, the number of Americans aged 65 and older will surpass those under 18 by 2034. Older individuals tend to require more frequent medical attention, significantly influencing healthcare demand dynamics.

3. Aging Providers

Currently, 30% of physicians engaged in patient care are 60 or older. This demographic trend points toward a potential "retirement cliff," threatening to deplete the ranks of experienced medical professionals.

4. Provider Burnout

Recognized as a public health crisis by the Harvard T.H. Chan School of Public Health even before the pandemic, physician burnout has worsened, compounding challenges in workforce stability and healthcare delivery. About three in 10 medical groups had a physician leave or retire early in 2023 due to burnout.

5. Widespread Chronic Illness

Chronic conditions such as diabetes and lung disease afflict 60% of U.S. adults, with 40% managing multiple health issues. This pervasive ill-health is placing continuous pressure on healthcare systems to provide ongoing, complex care.

6. Training Bottlenecks

The capping of federal funding for physician training in 1997 has stifled the growth of the physician workforce, leading to a bottleneck that restricts the flow of new talent into the healthcare system.

7. Evolving Practice Styles

44% of physicians reported changing jobs to work locums assignments either full or part time, compared with 28% in the 2022 survey. This evolution is leading to a decrease in the available full-time equivalent workforce, further complicating the staffing equation.

These trends are shaping a future that requires careful planning and innovative strategies to ensure that healthcare delivery continues to meet the evolving needs of the population. As leaders in healthcare, your role in navigating this shifting terrain will be crucial in shaping the future of healthcare delivery.

Physician Burnout: Navigating a Growing Public Health Challenge

The scarcity of physicians deeply relates to physicians' sentiments towards their careers. The issue of professional burnout has been a long-standing problem and remains widespread. A 2022 study by the Mayo Clinic revealed a significant 38.6% increase in emotional exhaustion scores among physicians annually. In 2021, nearly 63% of physicians experienced signs of burnout, a sharp rise from 38.6% the previous year, highlighting a concerning trend during the first two years of the COVID-19 pandemic.

U.S. physicians saw a dramatic rise in burnout and a drop in satisfaction with their work-life balance between 2020 and 2021. Although changes in depression scores were minimal, the spike in distress was primarily linked to work-related factors. This surge in physician burnout correlates directly with the quality of care, increased turnover, and reduced work effort, posing significant challenges for the U.S. healthcare system.

Another consequence of widespread burnout is the increasing rate of physician turnover. From 2010 to 2018, physician attrition rates jumped 43%, from 5.3% to 7.6%, indicating a growing trend of physicians leaving their practices.

Amid these challenges, an increasing number of healthcare professionals are opting for temporary positions over permanent, full-time engagements. This includes "travel" nurses and allied health professionals, as well as physicians and APPs taking up locum tenens roles. In 2019, AMN Healthcare Physician Solutions reported that 52,000 physicians were working as locum tenens annually, a significant increase from 26,000 in 2002. Today, that number is at least 15% higher, although precise data remain elusive.

Top 5 Benefits for Locum Tenens Providers

The 2024 Survey of Locum Tenens Physicians and Advanced Practitioners sheds light on why more physicians and APPs are embracing the "locums life" amid the ongoing turbulence in the healthcare workforce.

Flexibility in Scheduling

In today's healthcare environment, many physicians are seeking a better balance between work and life, desiring the flexibility to engage in personal pursuits, attend family events, and maintain their well-being. The survey revealed that many are turning to locum tenens for more accommodating schedules, with 86% of respondents stating that "achieving a better schedule" was a crucial or significant factor in their decision.

This quest for balance can be challenging in high-volume practices where physicians face strict schedules and the pressure to see numerous patients within constrained timeframes. Locum tenens work offers physicians and APPs the freedom to choose their practice locations and schedules, ranging from occasional weekends to full-time hours with overtime. This autonomy in scheduling is a powerful attraction for those looking to improve their work-life balance compared to their experiences in permanent settings.

A significant 80% of those surveyed pointed out that "addressing feelings of burnout" was a key or moderate factor in their choice to pursue locum tenens. Burnout can be exacerbated not only by rigid schedules but also by the overwhelming amount of non-clinical, bureaucratic tasks required in many healthcare settings.

Streamlined Compensation

Three-quarters of the physicians and APPs surveyed (75%) indicated that "declining compensation" played a crucial or significant role in their decision to pursue locum tenens work. Although physician salaries haven’t necessarily dropped recently, many doctors feel that their earnings haven't kept pace with inflation.

Beyond the issue of stagnating pay, physicians often grapple with the complexities of getting reimbursed. The survey reflects this, with 68% of locum tenens physicians and APPs citing "reimbursement challenges" as a pivotal or moderate factor in their decision to opt for locum tenens.

They struggle with the intricate, sometimes opaque methods used to calculate their payments. Medicare and private insurers frequently deny claims, leading to drawn-out disputes that add to doctors' frustrations. Often, the dissatisfaction stems not as much from the amount they receive but from the convoluted processes involved in determining and receiving their pay.

Freedom from Traditional Employment Constraints

Close to three-quarters of the physicians and APPs surveyed (71%) expressed that "dissatisfaction with being an employee" significantly influenced their decision to pursue locum tenens work. Today's landscape shows a stark shift, with private practices becoming increasingly rare. Many physicians, faced with financial and other challenges, have in recent years transitioned from small practices to employment within larger organizations—a trend that intensified post-COVID, with over 100,000 physicians becoming employees since January 2019. 74% of physicians are now employed by hospitals, large medical groups often owned by investors, insurance companies, or other corporate bodies.

According to Medscape's 2023 Employed Physicians Report, 56% of employed physicians cited reduced autonomy as a major drawback of their roles. With the challenges inherent in both the private practice and employment models, it's no wonder some are turning to locum tenens as a viable alternative. This path offers them detachment from the corporate culture and management dictates of permanent facilities, granting them the freedom to exercise their clinical judgment more independently. If dissatisfied with the care standards at a particular assignment, they can simply move on to another.

Balancing Earnings, Paperwork, and Travel Opportunities

A vast majority of those surveyed (92%) highlighted the "pay rate" as a highly rewarding or moderately rewarding aspect of locum tenens work. Locum tenens providers are compensated on a per diem basis, and this can match what they might earn in a private practice if they choose to work full-time or even overtime. However, those who opt for less than a full-time schedule might find that their earnings don't quite reach what they would achieve in a permanent position. Nonetheless, the simplicity of the locum tenens payment model is a clear advantage, offering straightforward compensation without the complexities often found in permanent settings.

Additionally, 86% of physicians and APPs found the "reduced bureaucracy/paperwork" associated with locum tenens to be a major or moderate benefit. While paperwork is still a part of locum tenens roles, it tends to be far less burdensome than in permanent positions, providing a sense of freedom that many locum tenens providers find refreshing.

According to a national survey by AMN Healthcare Physicians Solutions for The Physicians Foundation, physicians spend about 23% of their time on such paperwork, citing inefficient EHR systems and burdensome regulatory and insurance documentation as major sources of frustration.

While locum tenens physicians and APPs still handle necessary administrative tasks like tracking patient conditions and documenting services, the extent of bureaucratic duties is generally less than that demanded of their counterparts in permanent positions. In permanent roles, providers might also be involved in practice management, attending department meetings, and participating in compliance programs—activities that can pull them away from direct patient care. By contrast, locum tenens professionals enjoy a relatively greater focus on patient care, which many physicians regard as the most fulfilling aspect of their profession.

Enhancing Career Opportunities

The survey probed physicians and APPs about the impacts of working locum tenens, revealing diverse experiences and benefits. Seventy percent reported that locum tenens work has broadened their understanding of various healthcare delivery systems. By working in different regions and facilities, locum tenens providers experience firsthand the nuances of care delivery that vary by location.

Additionally, 56% of respondents appreciated the expanded networking opportunities that locum tenens offers, while an equal 55% valued the personal relationships they've established during their assignments. Another 55% enjoyed the travel opportunities that come with locum tenens, although the appeal might be greater if more assignments were in popular tourist destinations. However, many locum tenens roles are in less-traveled, remote areas.

Choosing Between Locum Tenens and Permanent Employment

The survey posed a direct comparison between locum tenens and permanent practice to physicians and APPs, asking them to evaluate the benefits and challenges of each. Notably, 47% of the respondents felt that locum tenens provided a more satisfying work experience than permanent positions. In contrast, only 12% preferred the stability of permanent roles, while 30% found both styles equally satisfying.

Although locum tenens comes with its set of challenges, it appears to offer a refuge from many of the dissatisfying aspects of permanent practice. The data suggests that the decision for some physicians and APPs to switch to locum tenens is not solely driven by its appealing aspects but also by a desire to escape the less favorable conditions of permanent roles. Supporting this, many locum tenens providers indicated they would consider returning to permanent practice if the conditions improved, highlighting a readiness to embrace more traditional roles under better circumstances.

Physicians and APPs were queried about their willingness to return to permanent practice if conditions such as scheduling, compensation, and other practice aspects were more favorable. Almost half of those surveyed (45%) indicated they would consider a return, while a slightly smaller group (43%) preferred to continue working in locum tenens. The remaining 12% were unsure. This division highlights a critical point: nearly half of the locum tenens physicians and APPs might switch back to permanent roles if the conditions improved, pointing to a significant level of dissatisfaction with some aspects of traditional practice models.

Insights from Locum Tenens Professionals

The 2024 Survey of Locum Tenens Physicians and Advanced Practitioners, conducted by AMN Healthcare, provided a platform for these professionals to voice what they wish their peers and the public understood about their roles. The survey garnered over 300 responses, reflecting a wide array of personal and professional experiences.

Representative comments highlighted their dedication to patient care, which matches that of permanent staff, despite the transient nature of their positions.

"We are just as committed to our patients as the permanent staff; we simply choose to steer clear of hospital politics."

Many respondents spoke about the benefits of locum tenens, such as achieving a satisfying work-life balance, albeit sometimes at the cost of temporary separation from family. Others appreciated the control over their work frequency, location, and compensation.

"You can find exactly what frequency you want to work, where you want to work, and the salary you want to work for," shared one APP.

A significant advantage mentioned was the ability to explore various practice settings without long-term commitments, reducing the time spent in less than ideal work environments, adding that this flexibility allows for a focus on patient care over management and administrative politics.

"You can try on numerous practices without long-term obligation and frustration until you find an excellent match"

The respondents also highlighted the professional neutrality required in locum roles, advising newcomers to remain uninvolved in ongoing administrative or provider disputes to maintain professionalism. Additionally, the locum tenens path is seen as an excellent way to enhance clinical skills, learn new software, and test different clinical settings, which can be pivotal in deciding if a certain work environment is a good fit.

Expanding on these reflections, the survey underscored that locum tenens is not just a job but a unique approach to medical practice that offers substantial professional growth, learning opportunities, and personal flexibility. This path allows many physicians and APPs to rediscover their passion for healthcare, free from the burdens of practice management and administrative obligations.

Exploring the Challenges Faced by Locum Tenens Providers

Every practice style has its challenges, and locum tenens is no exception. A significant 71% of survey respondents identified the "lack of benefits" as a major or moderate challenge, as locum tenens providers, working as independent contractors, must secure their own health insurance and retirement plans, though malpractice insurance is typically provided through staffing agencies.

Another noted challenge is "being away from home," which can complicate life for those with families. While locum tenens work allows for visits with relatives and friends when logistics align, sometimes separation is unavoidable. Additionally, "uncertainty of assignments" was marked as a challenging factor, with the demand for providers varying by specialty. Those in high-demand specialties usually find it easier to secure assignments, while those in less demanded fields may struggle to fill their schedules.

Credentialing emerged as another significant hurdle, as the time required to get credentialed at new hospitals and facilities can disrupt the continuity of assignments.

Optimizing the Credentialing Process for Locum Tenens

Credentialing stands out as a notable challenge for locum tenens providers, as the process can often disrupt the continuity of assignments due to its lengthy duration. There are two primary types of credentialing they must navigate: internal and external.

  • Internal Credentialing

Handled by the locum tenens agency, internal credentialing involves a thorough vetting of the provider's identity, education, training, certifications, licenses, and references. This comprehensive process also includes background checks, with credentials generally validated for two years, allowing providers to undertake multiple assignments with the same agency. Despite its thoroughness, this process can typically be completed within 2 to 4 weeks, although delays can occur depending on document availability and the responsiveness of references.

  • External Credentialing

This is performed by the healthcare facility where the locum tenens will work. It involves not just verifying credentials but also granting the necessary privileges to practice within the facility and access to systems and equipment. Being assignment-specific, this process ties directly to each location and can take anywhere from 4 to 8 weeks. The duration often depends on the facility’s internal credentialing policies, the volume of applications they are processing, and the urgency of their staffing needs.

Both types of credentialing are essential, and the variability in their duration can impact the start of new assignments. Factors influencing the timeline include:

  • Document Requirements: Necessary paperwork such as proof of training, medical diplomas, board certifications, DEA certifications, and life support certifications.
  • State Regulations: Differences in state laws and medical licensure requirements can affect the credentialing time.
  • Facility Policies: Each facility's specific credentialing and privileging procedures can alter the expected duration.

Key Documents Required for Locum Tenens Credentialing

A fundamental component of the credentialing process for locum tenens involves gathering and verifying essential documents that affirm the provider's identity and professional qualifications:

  • Proof of Training: This encompasses copies of certificates or diplomas that validate the completion of residency and fellowship programs, tailored to the provider’s specialty.
  • Medical School Diploma: A copy of the diploma must be provided which details the graduation date and the degree obtained.
  • Board Certifications: These documents should show the specialty, along with the certification's expiration date.
  • DEA Certification: A copy of the DEA (Drug Enforcement Administration) certification is necessary, displaying the registration number and its validity period.
  • Life Support Certifications (e.g., ACLS or BLS): These certifications must include the dates of completion and when they expire.
  • Medical Licenses: Documents should include the license number, the state of issuance, and the expiration date.

Given that locum tenens may take assignments in various states, it's crucial to have licenses specific to each state of practice.

Additional Documents:

  • Change-of-Name Documentation: If applicable, such as marriage certificates or court orders, to confirm any changes in the provider's name.
  • ECFMG Certification: For international medical graduates (IMGs), this certification verifies their foreign medical education and their eligibility for U.S. medical licensure.
  • Proof of Legal Work Status: For IMGs, documentation like a permanent resident card or H-1B visa is required, proving their legal status and work authorization in the U.S.

Role of Professional References:

Professional references are critical in verifying a locum tenens provider's qualifications and past performance. Ideally, references should provide a thorough assessment of the provider’s clinical abilities, covering the past two years and especially related to the procedures expected in upcoming assignments. They should confirm the provider's clinical skills, communication capabilities, teamwork, ethical conduct, and other professional traits.

At least three references are needed, with two being clinicians from the provider’s specialty. These references could be former employers, peers, supervisors, or mentors who have directly observed the provider's clinical practice. If possible, including a program director as a reference is beneficial for additional insights into the provider’s education and training. If a reference does not respond or is unavailable, the credentialing process might need to source alternative references, which could extend the timeline.

Streamlining Credential Management with Credsy

For healthcare organizations employing locum tenens, managing the administrative burden of tracking, renewing, and acquiring new licenses for multiple providers can be daunting. Credsy offers a transformative solution by automating and streamlining these processes, significantly saving time and resources. With features like real-time tracking and alert systems, Credsy ensures that credentials are maintained up to date, a crucial advantage for locum tenens working across different states and needing to keep various licenses active.

Wrapping Up

In conclusion, the increasing shift towards locum tenens among physicians and APPs underscores a crucial response to the evolving landscape of healthcare. Driven by a combination of demographic changes, systemic challenges, and personal burnout, many healthcare professionals are finding solace and satisfaction in the flexibility and autonomy that locum tenens roles offer.

As we have seen, 86% of providers in the survey cited improved scheduling as a significant factor in their decision to switch to locum tenens, closely followed by 80% who sought to alleviate burnout. Moreover, declining compensation and dissatisfaction with traditional employment contribute to this trend, with a notable 75% and 71% respectively highlighting these issues. This move towards locum tenens not only reflects a desire for better work-life balance but also indicates a broader shift in medical practice management in response to the sector's current pressures.

Credentialing emerges as a critical factor in this transition, impacting the efficiency with which locum tenens can start new assignments and move between different healthcare facilities. Efficient and streamlined credentialing processes are vital to accommodate the dynamic nature of locum tenens roles, ensuring that providers can swiftly adapt to new environments without administrative delays. For healthcare organizations, investing in robust credentialing software like Credsy can significantly reduce the administrative burden, enhance operational efficiency, and support the seamless integration of locum tenens providers into their systems.

To adapt to these changes, healthcare organizations should consider how they can offer more flexible, physician-friendly work environments that address these concerns. Implementing more transparent and fair compensation structures, reducing bureaucratic burdens, and offering schedules that accommodate a better work-life balance may help retain existing staff and attract new talent.

Furthermore, the healthcare sector must remain proactive in navigating these shifts. Organizations should engage with current trends and feedback from medical professionals to continuously refine their practices, ensuring they meet the evolving needs of both their patients and their employees.

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