News & Views

Perspectives on the locum tenens industry

Prevent Healthcare-Reform Access Problems with Proactive Locum Tenens Staffing

By Tim Hand – President & CEO, Interim Physicians

As American business shakes off the lingering effects of the worst economic downturn we have seen since the 1930s, temporary staffing is more important than ever to the US economy.
If the recession has been a boon for temporary staffing generally, it’s difficult not to imagine that implementing federal healthcare reform in the midst of a well-documented physician shortage and as 75 million baby boomers begin to retire will create greater demand for locum tenens staffing, at least over the next decade.

Moreover, the doctor deficit is unlikely to diminish enough to prevent critical access problems in the wake of dramatic spikes in demand for healthcare services. Considering the long lead time required for training new physicians and the economic constraints likely to limit funding increases for medical education, simply producing more physicians faster will not resolve the disparity between clinician supply and demand.

With millions of previously uninsured people projected to be added to health insurance rolls through healthcare reform over the next several years, maintaining an optimal staffing mix will be critical to your facility’s continued success. While the Patient Protection and Affordable Care Act (PPACA) forces fundamental change in âthe business of healthcare, recruiting and retaining the best physicians and advance practitioners remains a top priority.

As demand for physicians and healthcare services increases, I think healthcare organizations that employ locum tenens providers proactively can both increase market share and improve clinician and consumer loyalty, even during what could be the time of greatest change the healthcare industry has ever seen.

Proactive Staffing
By using locum tenens providers proactively, I mean thinking beyond the typical situations that prompt healthcare staffing managers to call us:

  • To provide coverage while a permanent clinician hire is made
  • To cover for clinician vacations, maternity or military leave, or continuing medical education
  • To see patients left without a doctor following a staff physician’s departure

In the interest of physician retention, what about making supplemental clinicians available so that some of your staff-physician superstars can actually use some of the eight weeks of vacation you agreed to include in their contracts? How about providing backup coverage one day per week or per month to allow a staff physician to attend his or her child’s school activities? Or what if you built a locum tenens physician into your staffing plan at some regular interval to allow staff physicians to take turns volunteering in the community?

If you’re already thinking about how costly deploying locum tenens providers like this would be, consider the cost of losing an excellent clinician because he or she feels overworked and under-appreciated. Ponder the potential to lose patients who are waiting longer for appointments and getting less face time with their doctors once they finally arrive at your facility. Also, think about whether you might secure favorable pricing from a locum tenens company by committing to a steady rate of provider utilization.

Physician Extenders
Depending on the situation, inter-professional teams might offer the best possible healthcare-staffing solution. While some services can be provided only by physicians, others can be provided as effectively and generally more cost-effectively by other types of clinicians. Relying more heavily on so-called physician extenders, primarily nurse practitioners and physician assistants, can help you improve both patient access and your bottom line.

Currently more than 135,000 nurse practitioners and approximately 70,000 physician assistants practice in the US. Nurse practitioners tend to provide more preventive care, patient education and counseling, and to function fairly independently. In contrast, physician assistants tend to provide more acute and emergency care, but with greater physician supervision. Generally both hold medication-prescribing privileges.

Although physician assistants have their own medical licenses, their scope of practice generally is spelled out in a PA-physician practice agreement, which is interpreted by a supervising physician. The Association of American Medical Colleges (AAMC) reports that the number of new physician assistants entering practice annually has grown five-fold over the past couple of decades, and it continues to rise.

Ripe Conditions
Under the heading Everything Old is New Again, I recently came across a 1979 report requested by the 96th Congress about the role of physician extenders. Submitted by then-director of the Congressional Budget Office Alice Rivlin and entitled Physician Extenders: Their Current and Future Role in Medical Care Delivery, the report indicates that greater federal funding support for physician-extender education might be advisable âif fundamental changes in the financing or delivery of the existing medical care system were sought.

It turns out that we are now experiencing all three conditions the report listed as preliminary to promoting greater dependence on physician extenders:

  • Implementation of a comprehensive national health insurance plan that provided more extensive coverage for primary medical care than exists today
  • Greater development of health maintenance organizations (in other words, a greater focus on disease prevention rather than damage control)
  • A limitation on the future supply of physicians

Creative Thinking
Of course, the locum tenens industry was starting to develop at about this same time, so Ms. Rivlin and company did not address the possibility of inserting temporary physicians (or other fill-in providers) into the mix. Our industry’s growth and maturity offers you an additional tool for accommodating greater patient flow through your facility.

Yes, we now find ourselves adapting our operations to what many for decades thought would never actually happen with healthcare. This will be an interesting decade for the both the industry and healthcare consumers.

The organizations that approach these challenging times creatively are the ones most likely to thrive in the new healthcare economy. Proactively utilizing locum tenens providers can help you assure patient access to services while you build critical relationships with both clinicians and the community. Give us a call today and let us help you tackle the transitions of PPACA with confidence.

Tim Hand is the Chief Executive Officer of Interim Physicians and is a noted healthcare staffing thought leader. He has led three companies to Inc. 500 status over 30 years.