Working with Locum Tenens 101
How can you make the most of utilizing a locum tenens physician in your practice?
Read about keys to success from someone who’s worked both sides
I’ve been on both sides of this equation, both on the managing of locum tenens physicians as well as working temp jobs myself. Though locum tenens physicians are certainly costly, they serve an important role to meet immediate patient needs and relieve what would otherwise be a tremendous burden on colleagues. Creating a good match is important for the success of both parties. The relationship can be tenuous, as both organization and physician can typically cancel the assignment within 30 days (a gap that is difficult to fill quickly due to credentialing). Although it may seem lucrative to the locums, the physician only takes home about 60% of the fee that is charged by the locums company. Before embarking, consider the availability of local per-diem physicians to fill short-term gaps instead. Per-diem workers can be paid as a contractor (and potentially work at a more competitive rate) while avoiding paying for housing and travel.
If you do need to go the locums route, how can you make the most of utilizing a locum tenens physician in your practice? Here are some keys to success:
Hire the right person. It’s tempting to want to fill the position immediately and get the task off your plate. Locums companies pressure both physician and organization to make a decision quickly to avoid ‘losing’ the opportunity. However, the work you put in to consider your options and make a good hire up front does pay off. You may earn someone willing to come back multiple times; this is a win because less onboarding input is needed each time, they build trust with staff and the patients, and they feel more confident in navigating your system. Are you delegating the hiring of locums to someone else? Before interviewing, decide what the key ‘must haves’ are and what qualifications are flexible. These may be different than for your employed hires. One example of a ‘must have’ could be previous experience with your EMR. An example of flexibility in hiring is in specialty; when we were looking for family medicine locums, we were able to find additional candidates by including internists with a plan to shift some pediatric patients to other panels if hired. Likewise, as a family physician who previously managed a geriatric panel, I was able to serve as a locum in an internal medicine practice with just a few modifications to my work duties.
Although culture may seem less important when hiring a temporary worker, it doesn’t take much for a sour grape to ruin the bunch. Patients are often already nervous about seeing a new physician, and poor experiences with locums can easily break trust with a practice. In the interview, ask at least one cultural or behavioral question that is key to working in your environment. Also set clear expectations on volume, role, call requirements, controlled substance prescribing, inbox management, and supervision expectations of APCs or learners. Know the contract, and be in contact with the locums agency if the locum is not meeting expectations so they help rectify the issue.
A thorough orientation sets the stage. There is wide variability in this arena. I’ve designed orientations for locums which were extremely thorough but costly from a time standpoint. When I started doing locums myself, I had only few hours with an EMR person but no information regarding workflows and was given a brand-new assistant who also didn’t know the flows either. Later I realized the risk in such a very brief orientation and aggressive I needed to be with asking questions to both protect patients and myself from errors resulting from lack of ‘tribal knowledge.’ I remember trying to do a shave biopsy with a scalpel after realizing the clinic didn’t have the dermablade I was used to and though we receive the information I needed, it wasn’t the prettiest biopsy I’ve done.
Think about, who are the key staff for the locum doctor to know? Is there too much or not enough work to accomplish in their allotted hours? What equipment is available for procedures? How is X test or referral accomplished? When clinic managers answer these questions with, “however you want to do it,” although leaders may feel like they are preserving autonomy, it is sometimes far less helpful than having standardized processes which staff can support with confidence. Patients need consistency as well; they need processes that are reliable and going to endure beyond the time that the locum physician is present. Building a team approach to care can really help with this.
With regards to the EMR orientation, ask whether the person has experience in that EMR vs being brand new? Elbow support is helpful but often the person giving that support doesn’t know the clinic-specific workflows. Empower the elbow-support person by making them familiar with key workflows that are tied to the EMR. For example, the typical support will be to show the person all the ways they can route a message in the inbox. Better support is helping the physician route specific types of messages to the right personnel.
Consider the locums role in panel management. Will they be assigned a panel or see overflow needs? Will they see established or new patients? Typically, seeing new patients to the practice isn’t a problem because they’re all new patients to the locum physician. The locum physician wants to make sure that once they are seen, the patient gets the follow-up they need even when the locums moves onto the next assignment. When it comes to inbox management, clear directions on whether locums will cover results from others in the practice and who will manage their own results and messages upon departure is very important for patient safety.
Communicate early and often. This applies with the patients and staff, as well as the locum directly. Communication can improve trust; although it is only for a short duration, patients need to know that their locum physician is dedicated to them as an individual and cares about their outcome. Often the physician who is leaving does not know the person taking their place and cannot speak to their skills or capability (not exactly inspiring to the patient!). Providing a bit of information about the locum physician, notifying patients of the transition, and who’s still a constant on their care team can be helpful. Checking in with the locum can help identify issues and questions before they generate real problems. Their fresh perspective on the workflows may make them more acutely able to identify safety and quality issues. Although it can be hard to hear feedback as a leader, having humility to listen can provide important insights even if you cannot act upon them right away.
Working as a locum tenens physician can be enjoyable, but it’s even better when joining a practice that is intentional and prepared. As a healthcare leader, no one really likes to have to use locums. However, investing in a process for working with locums can make the most of the situation and serve the practice and patients well in your time of need.
