The rise of locum tenens among primary care physicians

Requests for locum tenens physicians are up, but increased use of temporary doctors might be a warning sign of impending shortages and greater turnover in the clinician workforce. Demand is up particularly for primary care physicians (PCPs)-the group predicted to face the worst shortages in coming years.

PCPs are physicians were the most requested locum tenens, followed by behavioral health, hospitalists, emergency medicine physicians, and surgeons, according to a new report from Staff Care, a temporary healthcare staffing firm and division of AMN Healthcare.

The number of hospitals using temporary physicians rose from 22% in 2009 to 55% in 2013, according to the report. Of the 230 healthcare facilities surveyed, 90% reported using temporary physicians in the last 12 months-a 16% increase from the prior year.

“When physicians were mostly small business owners, they had a high financial and emotional investment in their practices and tended to put down roots,” says Staff Care’s president Sean Ebner. “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.”

Healthcare facilities seek locum tenens while searching for permanent candidates, and to provide coverage during vacations or peak periods.

“As the traditional private practice model gives way to the employment model, physician turnover has become more prevalent,” the report states. “Turnover is likely to become a greater issue in primary care because primary care physicians are employed at a greater rate than specialists.”

Physician self-employment levels dropped from 72% in 1988 to 53% in 2012. Productivity is dropping, too. Physicians worked nearly 57 hours per week and saw 23.42 patients per day in 2008 compared with 53 hours per week and 20 patients in 2012, according to the report.

More physicians are placing greater emphasis on their work/life balance and flexibility. Most locum tenens are experienced and looking for a change of pace. A third of them want ways to supplement their retirement.

Most respondents ranked flexibility as the biggest draw to working locum tenens, compared with 50% who valued the absence of the “politics” found in a permanent position, and 47% who valued the opportunity to travel while they work. Nearly 70% say being away from friends and family was the biggest drawback, and 59% say uncertainty of assignments was the biggest problem.

“Temporary practice is an increasingly popular alternative for many doctors who are tired of the bureaucratic and other restrictions they face today,” Ebner says.

Growth in locum tenens positions is expected to continue, given that 31% of the managers polled say they plan to increase staff due to the requirements of the Affordable Care Act. Another 7% plan to increase temporary physician staffing to address patient increases.

In 2002, about 26,000 physicians were working in temporary assignments. Today, the number is  about 40,000. PCPs make up more than 17% of that total. The increasing demand for locum tenens physicians is also an “early warning sign” of a physician shortage, the report states.

The survey suggests that healthcare facilities may have to rely on temporary physicians because they may be unable to fill permanent positions in the future.