How can locum tenens help your practice (or you)?

The phrase “locum tenens” derives from the Latin, meaning “place holder” or “deputy,” someone who fulfills the duty of another. Most think of locum tenens applied to medicine as temporary physicians provided by an agency to fill a hospital-based position that is vacant due to illness, vacation, retirement, or other extended absence. However, almost all specialties-including urology-are represented in the burgeoning locum tenens industry. In this article, I explore locum tenens medicine, with an emphasis on the potential applications in an outpatient urology practice.

While some urologists have managed their own locum tenens business, the majority of placements are transacted through firms specializing in locum tenens placements. According to the National Association of Locum Tenens Organizations (NALTO, www.nalto.org), there are about 80 organizations specializing in recruitment of locum tenens physicians, and 90% are members of NALTO. These organizations typically sign a short- or long-term independent contractor agreement with the physician and then match physicians with “placements” (job opportunities). The agency charges the hospital or practice where the physician is placed a fixed rate, and in turn pays the physician a slightly lower rate-usually based upon a per diem amount.

According to one firm, the average rate billed to a hospital by a locum firm was $1,743/day for a physician in 2008 (www.healthleadersmedia.com/HOM-225721-4625/High-demand-increased-procedures-drive-compensation). In return for their commission, the agency may provide to the physician-in addition to the placement service itself-malpractice insurance, assistance with credentialing and licensing, travel arrangements, and prepayment of qualified expenses. Some organizations promise “turnkey” services, and may even offer a personal account manager for the physician.

Locum tenens arrangements can be short term, such as weekends, or long term, such as 6 months-and seem to be plentiful. A perceived shortage of urologists may have created a demand for locum physicians, especially with hospitals, according to one recruiter (www.healthleadersmedia.com/HOM-225721-4625/High-demand-increased-procedures-drive-compensation). In preparation for this article, the author searched a single NALTO member’s site for urology jobs and returned 1,154 postings (www.locumtenens.com/urology-jobs/).

Why hire locum tenens docs?

What type of urology practice might consider hiring a locum tenens physician? A significant portion of urologists in the United States still occupy solo or small group practices, often in very small communities. The absence of a physician due to an extended vacation, unexpected illness, or temporary disability could be devastating to such a practice, as well as to its patients. Locum tenens arrangements may sustain such a practice through its principals’ absence and allow continued revenue to help defray the overhead expenses that do not necessarily reflect the absence of the principal breadwinner. Urologists wishing to participate in domestic or international volunteer opportunities-often requiring weeks of commitment-might consider locum tenens services to maintain their practice.

Another potential use for a locum physician might be a larger practice that is considering expansion, but is hesitant to make the investment. For example, some larger practices are exploring hiring a urologic hospitalist to see consults, ER patients, and other unscheduled patients that can disrupt the office practice. Either on their own, or in collaboration with a large hospital, a practice might consider hiring a locum urologist to assess the viability of the business model and its benefits before making a long-term commitment.

What type of urologist might consider being a locum tenens physician? A common scenario is a physician who has retired, but still wants to practice without the responsibility that comes with operating a small business and perpetually being “on call” for patients. Amid declining reimbursements, changing payment models, increased expenses, increased regulation, and other pressures on the traditional practice, many urologists report they are contemplating retiring early. Locum tenens medicine offers physicians with years of contribution left a meaningful outlet for their skills and an opportunity to make a reasonable living.

Locum tenens urology also might be a rewarding way to spend a “gap year” for physicians who are between jobs. Some locum placements are advertised as “temporary with possibility of permanent employment” and serve as a no-strings-attached opportunity for interested urologists to “try before they buy.” Finally, locum tenens opportunities may offer a supplemental source of income to a urologist with free time.

Practicing locum tenens offers flexibility

The locum tenens lifestyle offers advantages, according to NALTO: Physicians have the flexibility to choose their own jobs and schedules, and to work as little or as much as they want. Freedom from the business and politics of medicine may energize the locum physician. Physicians who like variety, meeting new people, exploring new places, flexibility, and autonomy will enjoy what locum placements offer.

The locum approach does come with challenges, however. Stepping into new and different environments requires a different application of skills: communication, time management, adaptability (think about learning a new EMR in days instead of weeks), patience, and people skills. Like any business, there are key considerations. Independent urologist contractors are well advised to have their agreements reviewed by an attorney. Some agreements may have non-compete clauses regarding the placement or even the agency. The NALTO website is an excellent resource for the urologist contemplating locum tenens medicine.

Bottom line: There is demand for urologists to fill short-, intermediate-, and long-term placements with practices and hospitals in search of physicians. Locum tenens medicine may not be for everyone, but it could be an excellent opportunity for the right urologist at the right time.UT

Dr. Dowling is an independent consultant and the former medical director of a large metropolitan urology practice. He resides in Fort Worth, TX.