Those of you who have reached a certain stage of maturity (and – why not say it? – wisdom and distinguished looks) no doubt remember the old television show, “Marcus Welby, M.D.” You may even remember that Dr. Welby had a partner, the young, impetuous, motorcycle driving Dr. Kiley. Dr. Kiley was always dashing here and there, getting involved in crises that the older and wiser Dr. Welby eventually would resolve.

While classic family physicians like Dr. Welby may be a dying breed, there are a growing number of Dr. Kileys out there – that is, physicians who like to move from place to place, taking their doctor bags with them. These doctors work temporary assignments that may last from a few days up to a year. In the healthcare staffing and recruiting world, physician temps are known as locum tenens, a Latin term meaning “holding a place.”

The recruitment of locum tenens physicians started in the 1970s. Initially, locum tenens doctors were intended to substitute for sick physicians, those on vacation, or those taking continuing medical education. Today, however, due to the national physician shortage, locum tenens doctors are also often used to fill in until hospitals and medical groups can find the permanent physician candidates they need.

Every year, Staff Care, a locum tenens staffing firm that, along with Merritt, Hawkins & Associates, is a division of AMN Healthcare, conducts a review of the temporary physician staffing market. The following stats indicate how the number of physicians working as locum tenens has increased in recent years.

Estimated number of physicians working locum tenens
Year 2005 2004 2003 Locum tenens physicians 36,000 34,000 29,639 Source: Staff Care, Inc. 2006 Review of Temporary Physician Staffing Trends

Savvy healthcare recruiters use locum tenens physicians in a variety of ways as part of a comprehensive medical staff plan.

Strategic uses for locum tenens doctors

1. Vacation and CME coverage. This traditional use of locum tenens has not diminished in recent years and has, in fact, increased. Many younger physicians are seeking groups that offer set vacations, regular hours, and favorable coverage schedules. In addition, the number of female physicians has increased dramatically in recent years, and female physicians may be more likely to require time off for maternity leave or family responsibilities. As a result, the number of locum tenens “physician days” needed to cover vacation time is running into the millions per year.
2. Physician retirement or disability. About one third of physicians in the U.S. today are 55 or older, and abrupt physician retirements are not uncommon. When an established physician suddenly turns in his stethoscope, hospitals and medical groups can use locum tenens physicians to maintain continuity of care until they can reorganize and adjust. The same is true in cases of physician disability.
3. Test marketing new service lines. Many hospitals and medical groups wish to experiment with new services, but hesitate to recruit new physicians full-time in case a viable market for their services does not exist. Some facilities use locum tenens physicians to gauge patient receptiveness to new services which then allows them to make a more informed decision regarding whether or not to add the service.
4. Expanding into new market areas. Health care providers seeking to establish satellite clinics may not wish to gamble by recruiting a permanent physician to set up practice in a new location. Instead, they staff the clinic with one or more locum tenens physicians to establish a foothold in the area. If the practice proves viable, they then can recruit a permanent doctor.
5. Permanent physician recruiting. Hospitals, medical groups, and other organizations can use locum tenens physicians to bolster their permanent physician recruiting efforts. A locum tenens physician can build a patient base so that when a permanent physician joins a practice she can hit the ground running. In addition, a locum tenens physician with a thriving patient load demonstrates clearly to permanent recruitment candidates that a sound practice really exists. In addition, it is not unusual for locum tenens physicians to see the advantages of working for a particular group and to join the group full-time.
6. Prevent patient defections. Health care today is becoming more consumer driven, and “customer service” has become a greater priority. During flu season or peak usage periods, some facilities use locum tenens physicians to see patient overflow and to forestall patients who are impatient with lengthy appointment times from seeking care elsewhere.
7. Secure larger managed care accounts. Medical groups or hospitals seeking large managed care accounts are often reluctant or unable to recruit a significant number of permanent physicians until the account has been secured. However, they cannot secure such accounts until they can demonstrate they have the staff to service the account. By working with a pool of locum tenens physicians, groups can demonstrate to the account that they have the necessary manpower and be sure of the account before they recruit permanent physicians.
8. Hospital expansion. As hospitals expand, they often allow groups to bid on hospital based services such as radiology or anesthesiology. Groups that may not have the current manpower to handle the hospital’s increased volumes can supplement their staffs with locum tenens physicians and remain competitive in the bidding process.
9. Maintain revenue. Health care providers considering locum tenens are obliged to take a close look at the potential return on investment. While locum tenens physicians are a cost, this cost must be weighed against the revenue locum tenens physicians allow facilities to maintain. In some cases, locum tenens physicians more than pay for themselves by generating revenue for the hospitals, groups and other facilities.
10. Continuity of care. Last, but not least, quality of care is largely dependent on continuity. Locum tenens physicians can maintain continuity of care for patients when, for whatever reasons, current levels of physician manpower are insufficient.

In today’s healthcare environment, recruiters have to use all the resources at their disposal. “Temp doctors” are an important piece of the puzzle.

Kurt Mosley is Vice President of Business Development for physician search firm Merritt, Hawkins & Associates, a division of AMN Healthcare (NYSE: AHS). He can be reached at kmosley@mhagroup.com.