Locum Tenens Articles
Articles For Physicians
Locum Tenens Process for Providers
Locum Tenens Provider Contracts
Articles for Employers (facilities)
Why Utilize Locum Tenens Agencies
Locum Tenens: A Reliable Solution
Locum Tenens: The Process for Providers
Physicians and mid-level medical professionals are turning to locum tenens assignments as a way of expanding their incomes as well as gaining valuable clinical experience in a variety of settings. But how does one new to locum tenens get started? What is the process? The good news is it is much easier than you might imagine.
A few things to keep in mind as you begin your search for the right locum tenens agency and, ultimately, assignment:
The process that locum tenens agency use will vary from one company to the next, but all of them have some commonalities. This article examines those common process requirements and offers some tips on how to get through them as easily and quickly as possible.
The first step in selecting a locum tenens agency is research. One of the most useful places to begin is at The National Association of Locum Tenens Organizations (www.nalto.org). This one resource can provide you with a wealth of information as well as a listing of member agencies that you can contact. One thing to keep in mind is that most locum tenens agencies are centralized in one location, but truly serve nationally. Just because you are in New York or California you don’t have to work locum tenens with a New York or California based agency. Find an agency by conducting phone interviews and make sure the agency is not too big, otherwise you may get lost in their system.
As you call agencies and narrow down your list, be sure to ask for a copy of the Provider Agreement. This is the contract between you and the agency. Every provider agreement is different, but common pitfalls may include language that would prevent you from receiving and accepting a permanent job offer at facilities introduced to you by the agency while working as a locum provider. Another major problem with some agency agreements is the practice of charging you a fee of up to $20,000 for accepting a permanent job at a facility that was “affiliated” with another facility where you worked as a locum provider. Make sure your agreement allows you to transition to other locum agencies or permanent opportunities with no possibility for you to incur a fee of any type. Also, make sure your notice period is 30 days or less should the right permanent opportunity arise while you are working a locum assignment. An exception to this may be if you have accepted an assignment for a government facility as notice periods tend to be much longer for government work.
Other factors to communicate to your potential agency include your objectives. Are you working locum tenens to earn more money? Gain experience in a variety of settings? Work in different geographic areas? The more the recruiter knows about your desires, the better able he or she will be able to help make them a reality.
During this interview process, and this often takes place over the phone, make sure you ask about the services they offer. Ask about malpractice insurance, who the carrier is, and make sure you receive a certificate of insurance and a letter that explains the tail policy.
Once you have selected an agency to work with, the paperwork follows. Generally, the recruiter you are working with will send you an application packet that you need to complete and return.
This would be an excellent time for you to put together a file that contains your important documents. Having copies of this file on hand will make future locum tenens work much easier and faster to obtain. This file should contain copies of your licenses and any certificates you have, your most recent CV, copies of your diplomas, an updated reference list, and a detailed accounting of where you have practiced during the last decade or so.
Once you have completed the agency application, you will be credentialed and ready to work. At this point your recruiter will begin contacting you with possible opportunities. Some agencies may bring in one or several scheduling director at this point, but that depends on the agency. Keep a detailed log of who is offering what, along with the pertinent information for each offering. If an offer comes up for a two-month assignment and you know you cannot be away for that long, tell the recruiter. Do not take the assignment and then bail out half-way through unexpectedly. Building trust with your locum tenens agency is a two-way street, and once earned on both sides, strong relationships are formed.
Once you give your agency the go ahead on a job, a phone interview and presentation of your CV is usually the first step. Be sure to inquire about patient loads, hours of operation and on call duty. Usually you will want to speak with both a business administrator and a medical director to get all your questions answered about the assignment.
Now that you have an assignment, your recruiter (or the scheduling director) will help you make travel and lodging arrangements. It is important to double check which of your expenses can be billed directly to the locum tenens agency, which expenses you will be reimbursed for later, and which expenses are not covered at all. Knowing this in advance will help you budget your trip and have enough cash on hand.
When you arrive at your assignment location, you may or may not get an orientation. To be perfectly frank about this, some facilities offer very good orientations to in-coming personnel, while others do not. If you find your facility does not offer much in the way of getting you up to speed, try to find the key personnel on your first day and get with them. More often than not, they are more than happy to help.
The last step in the process is getting paid. Make sure you keep good records and that you turn in your time sheets with an authorized signature and on time. Get to know who must sign your pay records early on so there is no delay in getting authorizations. If you have questions concerning pay do not be afraid to ask. Any issues that cannot be resolved at the facility should be referred to your locum tenens agency for resolution.
Locum Tenens Contracts and Agreements
Medical professionals who are thinking of working as locum tenens may often base their decision on the benefits this type of work has to offer. To be sure, there are many positives associated with this type of working arrangement. But it should always be kept in mind that locum tenens is a contract arrangement, and the more you know about basic contracting, the more informed your decisions will be.
This article examines some of the more common issues you find in locum tenens contracts. This article is not a substitute for professional legal advice, and it does not cover every possible situation you may encounter. It will, however, give you a basic understanding of what to expect when you sign on with a locum tenens recruiting agency.
Virtually all locum tenens agencies require some form of contract between their firm and the physician. The terms and conditions of the contracts will vary from one agency to the next, so it important to take the time to read each one that you are considering. While many agency contracts will contain a certain amount of standard language, it is possible for a firm to add its own clauses which you may not find with other agency contracts. Therefore, always read and understand before you sign.
Here are a few of the more important elements you want to look for and understand in locum tenens staffing contracts:
Carte blanche authority: It is always best to know in advance if the locum tenens agency that you sign with is contractually allowed to present your employment information to all interested parties, with or without your permission. For some medical professionals, prior consent is not that important; for others it is. The important issue is that you know what the agency is allowed to do.
Exclusive versus Non-Exclusive Clauses: You will want to know, in advance of signing, if you are allowed to work with other hiring agencies or if you are prohibited from doing so. Some locum tenens agencies will allow you to work with as many hiring agencies as you wish, while others will not. It is important that you know which option you signing on for.
Cancelation clause: You want to know if an employment opportunity can be cancelled for no reason or if notification required? The general industry standard is 30 days, starting from the signing of the contract. Some companies, like Mint Physician Staffing require only 14 days notice
Non-compete: Another clause you see at times with some firms is the 2-year non-compete clause. The time can vary on these clauses but in general they bar physician from directly competing with the locum tenens agency for permanent or temporary employment once the provider has been introduced to a facility/practice location for a set period of time. Some of the “worst” agency contracts include language regarding fees and penalties to be paid by the physician, sometimes up to $20,000.
Similar restrictions include prohibiting physicians and mid-level providers from accepting contracts with other agencies. For example, if a provider learns about an opportunity—whether it is accepted or not—and that same contract comes up later, the provider can only sign on with the agency that introduced the opportunity.
Compensation and Insurance: Providers should ask about the locum tenens agency payment schedules before accepting a contract. You should also inquire about payment services such as direct deposit and tax withholding.
Also, since locum tenens providers are usually considered as independent contractors, they will receive 1099 tax forms. For those that fall into this category, they should research the tax rules carefully and, if needed, seek advice from tax experts. When problems tax problems arise, they are often based on confusion between being an independent contractor and being an employee. A locum tenens agency will normally not deduct any taxes, unless specifically directed to do so by the physician. Locum tenens agencies also do not normally offer healthcare benefits or insurance, other than medical malpractice insurance. Make sure your medical malpractice insurance is “A” rated, get a certificate, and if the insurance is “claims based” make sure you receive a tail letter describing the tail coverage for the work you expect to conduct through the agency.
Transportation and housing: You will normally find that larger locum tenens agencies will have in place certain arrangements with travel and housing vendors. Wise providers will understand the accommodations provided prior to agreeing to any assignment. It is normal for airfare, rental car and housing to be paid directly by the agency and not the provider. Be sure to have the agency billed so you don’t have to fill out additional expense reports nor add complexity to your personal accounting.
Generally, housing is most often determined by the contract length. For instance, if the job is for two weeks or less, locum tenens will probably be housed at a hotel or an extended-stay motel suite. For longer contracts, many agencies prefer to use an apartment or condo in the area. Apartments are often more comfortable for the physician and more economical for the agency.
Addendums and schedules: Most locum tenens agencies will use a general contract, followed by additional schedules or exhibits that outline additional important details. Make sure you understand your pay rate, pay date(s), work environment, role and responsibilities including any on-call hours. This should all be documented and is often done in a schedule or exhibit that is additional to the contract.
Government Contracts: In general, there is usually little difference between traditional contracts and government contracts for locum tenens. The one exception to this is paperwork. The government contract will usually require more input from the provider in form of paperwork. In real-life terms this often means it takes a bit longer to get into the government system. For this reason, the sooner a provider gets started, the better.
Locum tenens providers should keep in mind that most federally run facilities require primary source verification. Having to provide this will require time on your part, and the process may take a few months to complete.
You should also know that most government contracts are based on 90-day blocks of time. This can be good news in that it allows the provider a guaranteed 3-month job, often with the option to extend. Providers who have worked in a VA facility, for example, will have the opportunity to accept future work at similar institutions. In addition, a physician can work at any VA in the USA with one active license from any of the fifty states.
In regard to military locum tenens; some assignments still require state-specific licenses for locum tenens physicians, although this is the exception and not the rule. Also, working with the military often requires getting a thorough background check.
In closing: Always read the contract before signing, use a lawyer and remember; not all locum tenens agency contracts are the same.
Why Utilize Locum Tenens Agencies?
The decision to hire a locum tenens physician or mid-level provider is not always an easy one. Hospital administrators, department chiefs, and private practice doctors often face the dilemma of whether or not to invest in temporary help. So, in essence, how does a health care facility decide if locum tenens is a good option when they face a staffing shortage?
To be fair, hiring locum tenens can be expensive. Not only do facilities have to pay for the physician, but they must also pay the fees generated by the locum tenens agency. In addition, they normally pay for travel costs and housing for the professional while he or she is on the job. Then there are the added costs of malpractice insurance, license and privilege fees, credential verification, and the cost of simply getting everything in place for the locum tenens prior to and upon arrival. All in all, it can be expensive.
However, trying to run the facility short-handed can be even more expensive. For many facilities, the loss of even one physician can cause huge revenue shortfalls. These shortfalls are almost always immediate in nature, and they continue until something is done to remedy the situation. When this happens, hiring locum tenens to fill-in is a cost-effective way to maintain revenue and patient satisfaction.
In a recent study conducted by the California Health Care Foundation, it was discovered that an average of 20 percent of a hospital’s revenue and 50 percent of admissions came straight from the emergency department. It was also found that when an emergency department was short-handed, that department was more likely to go on divert status, thus sending patients, and the revenue they would generate, to the competition.
In another study that was conducted by the American Society of Anesthesiologists, 44 percent of hospital administrators reported that they did not have enough anesthesiologists on staff. Of those, nearly 60 percent went on to report that they were actively recruiting new physicians, and of those, 43 percent reported that it often takes more than a year to find a suitable replacement.
A full 30 percent of the administrators surveyed reported that waiting times for surgeries have increased while 47 percent reported that they are now forced to limit the number of operations. Over 50 percent went on to say that they are now using locum tenens anesthesiologists to supplement their staff.
The Medical Group Management Association found in a 2002 survey that full-time physicians generate between $500,000 and $700,000 in revenue per year, depending on the size of the group. When a physician is no longer practicing at a facility, all that revenue is lost.
As part of the decision process, those considering locum tenens should remember that all of the revenue that is generated by the physician is kept by the facility. For those medical facilities that work with many independent health plans, a good option to consider is credentialing the physician with the top two or three plans, and then to channel patients to the physician accordingly. The reason for this is that it may become too time consuming to credential locum tenens with each plan.
Those facilities that service patients under Medicare billing, should speak with the regional Medicare carrier as protocol for Medicare billing varies by region.
Bringing in locum tenens can do more than help maintain your revenue stream. For many facilities, utilizing locum tenens physicians is the best option for helping full-time physicians get the time off that they need in order to avoid burn-out. This is true with non-physician locum tenens as well. Whether your full-time professional is on family leave, military leave, or medical leave, locum tenens can fill those spots, thus leaving your facility at its optimum personnel level.
The American Medical Association is just the latest group to acknowledge the pending shortage of physicians. The association is projecting a deficit of up to 200,000 physicians by the year 2020.
For those facilities that are attempting to recruit physicians to rural areas, the problem becomes more challenging. Even though the total number of practicing physicians has increased, the General Accounting Office reports in a survey conducted in 2003 that nearly 17,000 physicians or about 12 percent, were willing to settle in rural areas. At the same time, 123,000 physicians ( or 88 percent of the increase in physicians from 1991 to 2001) settled in metropolitan areas. (www.gao.gov)
It is undeniable that searches that once took a few months from start to finish, now can take two to three years. Many facilities now recognize that having locum tenens physicians in place during this "search" period is the best option they have. Locum tenens physicians have proven that they can be an on-going and affordable solution to most staffing challenges, especially in hard-to-fill geographic locations.
In this highly competitive day and age, medical facilities of all sizes are turning to locum tenens when they have staffing issues that need to be resolved fast. An excellent place to learn more about locum tenens is www.nalto.org which is the National Association of Locum Tenens Organizations. This resource site has listings of members as well as good information on the topic of locum tenens.
Locum Tenens: A Reliable Solution
The use of locum tenens physicians has increased significantly over the last decade. Health care administrators, private practice physicians, and even government agencies are turning to locum tenens physicians and mid-level providers when they have vacancies that need to be filled quickly and professionally. There are some very good reasons for working with locum tenens providers, and this article examines some of those.
In many ways, this is a supply and demand issue. Physicians and mid-level providers (NPs, CRNAs and PAs) often have to leave their full-time, permanent job post at least once if not several times throughout a career. A few reasons for their absences would include retirement, sick leave, starting a family, military duty, continuing education requirements, or simply moving to another locale. It’s these real life situations combined with the positive return on investment of using locum tenens providers that have driven more and more facilities to include locum as part of the annual staffing strategy.
In a perfect world, the loss of a highly skilled professional would lead to hiring another highly skilled professional within a few weeks. In reality, though, finding a suitable full-time, permanent replacement can take 6 to 12 months, and sometimes longer. It is not at all uncommon for administrators to spend 12 to 24 months searching and recruiting new physicians. If the medical facility happens to be in a rural area the search can take even longer.
Aside from the fact that the facility will be working short-handed, which can lead to burnout and fatigue for those covering the duties of the now-absent professional, there is also the financial shortfall that takes place when a physician leaves. Depending on the specialty, these cuts in revenue can be substantial. Some medical facilities, especially smaller community-based facilities, may not be able to sustain these revenue cuts for long. Finding a suitable and qualified temporary replacement becomes a priority for these facilities.
Yet another solution that locum tenens providers can offer falls under the category of patient demand for certain specialties. It is no secret that patient demand for access to specialists has greatly contributed to the growing use and popularity of locum tenens firms. Locum tenens provide medical facilities with access to specialist that they might now otherwise have. Because the locum tenens specialist is only a temporary hire, the cost savings to the facility can be dramatic.
Hiring a Locum Tenens Agency: What to Look For
It is possible to contract with a physician directly, but almost all contracting for a locum tenens provider goes through an agency. Hiring through a reliable locum tenens agency has many benefits. First of all, working through an agency can make the process go smoothly for both the medical facility and the locum tenens physician. Larger agencies will be able to act as a middleman in gathering and sharing information on a variety of subjects to the potential locum tenens. This might include information on housing, car rentals, and general information about the facility and the community where it is located.
Licensing and hospital credentialing is normally taken care of by the staffing firm. Because this important task is handled by the firm, medical facilities have more time to spend with the locum tenens, familiarizing the professional with policies, procedures, and other aspects of the job. There are only four agencies that are JCAHO certified a key attribute to understand those who take credentialing seriously and understand your needs.
How Much Does It Cost?
It is impossible to give any accurate pay scales in this article. Each agency will have its own pay scale and this may vary a great deal from one agency to the next. Primary care physicians can range from $95 to $120 and more, depending on the geography, facility type, and skills required. Therefore, the amount of pay is often determined by many variables that relate to how difficult it is to find another physician. It is important as you do your search for the best locum tenens agency to get as much information on what they offer as possible. It is important for you to describe your facility, patient type and volume and any special skills required when you speak with your short list of locum tenens agencies. The more you can detail your needs, the better the agency will be able to serve you.
Most experts agree that the need for locum tenens will only increase as time goes by. A shortage in physicians, as well as the challenge of getting qualified people into rural areas, are just two of the many reasons locum tenens will continue to be used in the future. Some specialties are expected to be more in demand than others. Political initiatives to help the un-insured have better access to healthcare may also place a burden on the physician supply and drive the need and use of more locum tenens providers.
Facilities of all sizes can take advantage of this working arrangement, and will more often than not, see their revenues go up, even with the added cost of the locum tenens. The most important element to successfully working with locum tenens is to work through agencies that provide licensed, credentialed professionals, and who have the expertise and experience to move through the process smoothly.
An excellent resource for those new to locum tenens can be found at www.nalto.org where you can find listings of approved locum tenens agencies. You can also find links to information sources as well as general information that can help you make the best hiring decisions.