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A comprehensive look at the locum tenens industry
Locum tenens plays an integral role in providing healthcare to patients around the country. Locum tenens, or locums as it is often referred, is the practice of physicians, PAs, and NPs, taking temporary jobs in healthcare facilities with staffing needs. Locums allows permanent staff to take vacations or leaves, fills gaps in coverage, or provides care in areas unable to recruit permanent staff.
The healthcare industry has faced a clinician shortage for many years. However, the COVID-19 pandemic has created even greater need for healthcare workers while at the same time driving many away from the industry. That, combined with the factors below, helps explain why the healthcare industry is turning to locum tenens at historic high levels.
Healthcare has always been an evolving industry. From clinical breakthroughs to the buying up of private practices, things are always changing. Healthcare staffing is no different. The pandemic brought its changes, and the future is sure to bring even more.
As I look to the future, I see three primary issues. The first is the ongoing healthcare workforce shortage. We’re seeing a growing imbalance between the supply and demand, and I think it’s only going to get worse, especially in rural and other underserved areas. I also think physicians are expecting more work/life balance and flexibility from their jobs. At the same time, the pandemic made a lot of people postpone needed care. They are now coming back in droves.
So, what role does locum tenens play in all of this? Locums physicians help solve two critical problems healthcare currently faces. They come into those underserved areas and provide patients the care they desperately need. They also alleviate some of the burden being put on staff physicians, allowing them to take a vacation, a leave of absence, or just have some additional help. And it’s not just traditional locums; we’re also seeing growing demand for tele-locums, with physicians working online, never having to leave the comfort of their homes.
Working locums is also a great way for physicians to find better work/life balance for themselves by working where and when they want. Often physicians, especially later in their careers, contemplate early retirement as a way to escape the burnout and stress of the job. Locums allows them to extend their medical practice and allow them to continue to serve patients. Locums lets physicians bend their work around their life, in contrast to the years they spent bending their lives to fit around their education, training, and careers.
While locum tenens can be a great solution for both facilities and physicians, it’s far from being the solution to everything healthcare is facing today. Unfortunately, very little is being done to systematically address physician burnout. Health systems have been so used to using physicians in a certain way that breaking the cycle of excessively long hours and high-stress situations is proving to be very difficult. There also needs to be more focus on better patient-to-provider ratios and more focus on the wellness of all staff.
For our part, both for our staff and the physicians and other healthcare professionals we work with, we are dedicated to providing a working environment that supports health and wellness, strong work/life balance, and building a community that meets the needs of the health systems we serve.
In my role, I interact with physician and APP recruiters every day. As I look at the future of healthcare staffing, a few things jump to mind. The first is the agility we are seeing with recruitment professionals. After being faced with a pandemic and workforce shortages and burnout in every level of the organization, they still found ways to find qualified clinicians and other staff to fill needed roles. This often meant facilities shifting their focus to hire more PAs and NPs when needed to support diminishing ranks of physicians, improving their compensation packages, streamlining their hiring process, or finding ways for telehealth or other technology solutions to allow existing providers to still see patients.
Secondly, as something to watch for, professionals working in staffing may be tempted to become more transactional in their candidate interactions. Savvy recruitment professionals know the value of building relationships with quality talent throughout a candidate’s career. The pressures from the pandemic have forced many professionals to do more with less, and less and less, and now do much of their work from behind a computer in any number of locations. The need to be more efficient and quick in our hiring timelines adds pressure to automate and process quickly. Recruiters will need to be mindful of these pressures so as not to lose sight of what makes their approach so organizational-centric and candidate-positive.
Physicians are also becoming a lot more proactive about their careers. The newest physicians entering the workforce are smarter than ever in looking for particular cultures or compensation models and are acting with greater savvy in their negotiation skills. Physicians at all levels want to be involved in decisions that impact them; they want to be supported to reduce administrative time and increase patient time; and they want career paths and opportunities for growth and mentoring. And unlike physicians of the past, if they don’t get these things, they will leave. Staying out of loyalty is not as high of a value as it once was. Unfortunately, organizational retention plans are still few and far between. To get ahead of this growing turnover trend, employers must address provider turnover with fresh, consistent, and measurable strategies with a sincere desire and willingness to make changes when the feedback directs it. Without this focus, staffing professionals will remain as busy as ever but with clear losses to organizations in productivity, profitability, and access to quality care.
Source: CHG Healthcare's Locum Tenens Awareness & Perception Survey 2022
Sixty-four percent of facilities report using locum tenens, with only 16% saying their utilization is rare, and 35% saying they use locum tenens often or very often.
Half the facilities anticipate they will continue to use about the same amount of locum tenens, and a third expect utilization to increase.
Our system is big enough that we are able to offer our patients a wide variety of services. However, we’re small enough that if one or two people leave, we can feel a significant strain on staffing. Locum tenens lets us cover those gaps and keep offering our patients the care they expect.
Amy Powell, CPRP
Director of Medical Staff Recruitment, Reid Health
Source: CHG Healthcare 2021 Client Awareness & Perceptions Survey
Locum tenens are used for a variety of reasons, with most used to fill in during the hiring process or to cover for a departing physician.
Source: CHG Healthcare 2021 Client Awareness & Perceptions Survey
We would love to be 100% employed with permanent staff, but it’s just not possible in the current state. We are growing faster than we can bring on new people, so locums support allows us to keep up with that growth while still offering great patient care.
Allison Spindle
MPS Director of Provider Recruitment, Inova
Facilities using locums for rising patient demand and during peak periods have increased dramatically from 2020, likely in response to COVID-19.
Source: CHG Healthcare 2021 Client Awareness & Perceptions Survey
While 44% of recruiters and hospital leaders have a neutral impression of the locum tenens physicians that have worked in their facilities, an equal amount reports a somewhat positive or very positive impression of the physicians. Only 12% have a negative impression, and no one reported having a very negative impression.
Source: CHG Healthcare 2021 Client Awareness & Perceptions Survey
Most staffing personnel report that locum tenens physicians are accepted, versus being embraced, at their facilities.
Source: CHG Healthcare 2021 Client Awareness & Perceptions Survey
Benefits of utilizing locums vary, led by continual treatment of patients. In 2022, we saw that 26% more respondents also reported reduction of staff burnout, a key indicator of increased burnout from the pandemic. However, using locum tenens also has some drawbacks.
The top three ways health systems can help themselves is by adopting a strategic approach to their locum tenens staffing. Simply cutting locums budgets may create a short-term savings but is potentially leaving three times the amount of revenue on the table by not offering the services those locums could be providing. Secondly, they need to better leverage telehealth and technology to streamline systems and make patient care more accessible. And finally, they need to find actual ways to address physician burnout. This means doing more than providing free lunches or meditation spaces. They need to look at work environment, hours, and other issues that directly impact physician well-being.
Melinda Giese
Senior Vice President, CHG Healthcare
Locum tenens are a need, not a want. The pandemic combined with the general workforce shortage has made finding permanent staff even more difficult. Locums are a good gap filler but not what our people or patients want long term.
Amy Powell, CPRP, CPRP
Director of Medical Staff Recruitment, Reid Health
Source: CHG Healthcare 2021 Client Awareness & Perceptions Survey
Source: CHG Healthcare 2021 Client Awareness & Perceptions Survey
Locum tenens should be seen as a profit center rather than a cost center. When locums physicians are used and, even more importantly, billed for correctly, they can bring in as much as three times the revenue compared to what they cost. Cutting locums to save money is in reality just costing you a lot more money.
Melinda Giese
Senior Vice President, CHG Healthcare
Premium labor costs, a constant challenge, are even more of a concern in a post-pandemic world. While hospitals can bill both private and public payers for locum tenens physicians, many of these revenue streams go unclaimed.
The exact number of physicians working locums is unknown, but it’s estimated to be almost 50,000, about 7% of the available physician population.
Foreign medical grads, about 24.7% of the total physician population, are not eligible to work locums
Removing this population from the AMA Masterfile of Active Physicians (940,254) and comparing it to the number that reported they currently worked locums in 2021, it would be 49,561 physicians
This represents an 88% increase in physicians working locums since 2015
Source: Utilizes data from the CHG Healthcare Locum Tenens Awareness research study and applying to "currently working locums" percentage to the AMA Masterfile of Active Physicians
33% of physicians are either currently working locums or have worked it in the past.
Source: CHG Healthcare 2021 Locum Tenens Awareness & Perception Survey
The AAMC Active Physicians by Sex and Specialty report states physicians across the country are 63.7% male and 36.3% female. For locums, the numbers trend higher for men (79%) than women (19%).
Current locums comes from all age groups but the largest segment are mid- to late-career physicians over 45.
Source: See AAMC report here.
Locums in the past were typically older, more tenured physicians looking for a way to ease into retirement. Today, we’re seeing more and more young physicians who want better work-life balance and flexibility in their lives. Being a physician used to be all about the work; now it’s about the work and the life outside of work.
Luke Woodyard
President, Weatherby Healthcare
While mid- and late-career segments make up a large part of the current locums workforce, most physicians with locums experience report taking their first locum tenens assignment earlier in their careers, with 59% reporting it was within 10 years of completing their training.
Source: CHG Healthcare's Locum Tenens Awareness & Perception Survey 2022
Most physicians report spending on average 4.6 years working locums.
Mean
4.61 years
Median
3 years
Source: CHG Healthcare's Locum Tenens Awareness & Perception Survey 2022
In 2019 (pre-COVID), more locums physicians worked part time, but in 2021 (post-COVID), that flipped to more working full time.
Source: CHG Healthcare's Locum Tenens Awareness & Perception Survey 2022
Source: CHG Healthcare's Locum Tenens Awareness & Perception Survey 2022
Fifty-one percent of physicians who’ve done locums report working locums assignments close to home, while 49% worked them in nearby cities or states.
Source: CHG Healthcare's Locum Tenens Awareness & Perception Survey 2022
In addition to the United States, the need for physicians working internationally has also continued to grow.
Like the U.S., many countries around the world are returning to pre-Covid norms and realizing they have huge needs for physicians. Demand remains strong in the traditional places that physicians have found international jobs like New Zealand and the Pacific Islands. However, we’re also seeing growing demand in places like China, the U.K., and the Caribbean.
Tyler Black
President, Global Medical Staffing
The most utilized specialties for locums have remained fairly consistent with family practice being the most in demand. Emergency medicine has seen a regular decline since before the pandemic as more patients utilize urgent care.
This past year we have seen tremendous growth in the need for both psychiatrists and oncologists. Both needs stem from the pandemic but for very different reasons. We’re seeing more patients wanting to address mental and behavior health issues, many that were overlooked or brought on during the pandemic. And oncology is unfortunately seeing an increase due to many people not seeking the cancer care they needed during the pandemic and are now faced with more serious diagnoses and medical needs.
Brooke Bowers
President, CompHealth
71% of physicians have reported to have had a very positive or somewhat positive impression of locum tenens.
Source: CHG Healthcare's Locum Tenens Awareness & Perception Survey 2022
Physicians overwhelmingly work locums as a way to supplement their income.
Source: CHG Healthcare's Locum Tenens Awareness & Perception Survey 2022
Source: CHG Healthcare's Locum Tenens Awareness & Perception Survey 2022
It may seem contrary to the desire for more work/life balance, but some physicians, especially those who were negatively impacted by the pandemic, are seeking out less balance in their lives because they are trying to make up for money they lost while furloughed or laid off. Whether it’s taking on more locums shifts in addition to a permanent job or just working as many locums assignments as they can, some doctors are taking advantage of the huge need that is out there for physicians right now.
Luke Woodyard
President, Weatherby Healthcare
Physicians today are expecting more from their employers, they want more flexibility and work-life balance. We’ve tried to address their concerns by reducing the call schedule and bringing on more advanced practice providers to alleviate some of their work stress. We have also improved compensation for physicians and APPs. In addition, we have changed our physician leadership structure, giving them more options for career paths into leadership.
Allison Spindle
MPS Director of Provider Recruitment, Inova
The majority of physicians who have worked locum tenens report having a positive experience.
Source: CHG Healthcare's Locum Tenens Awareness & Perception Survey 2022
Source: CHG Healthcare's Locum Tenens Awareness & Perception Survey 2022
Source: CHG Healthcare's Locum Tenens Awareness & Perception Survey 2022
Definitive Healthcare recently did an analysis of the facilities using the most locums. The top 20 list included a mix of rural and urban facilities. Interestingly, a 25-bed facility in Iowa used more locums than much larger hospitals in Washington, DC, and Pittsburgh.
As far as where the most locums jobs are being filled, these are the top 20 states for locums.
For jobs in relation to population, the list changes dramatically.
CHG Healthcare compiled these statistics from surveys issued to general physician audiences as well as internal data and resources.
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