The Executive Suite: Temporary vs. permanent: Is it time to restructure physician work?

Clinician burnout and staffing shortages have been taxing our healthcare system for years. The COVID-19 pandemic certainly exacerbated things; however, these issues loomed long before. While there is no silver bullet solution, we can agree that what’s really important is patients having access to quality, credentialed providers. If providers aren’t available, then we have a problem.

The phrase “locum tenens” means “placeholder” in Latin. In healthcare, a locum tenens fills the gap for a provider who is absent. It’s essentially a substitute. I practiced as a locum tenens surgeon for 10 years — I needed flexibility when I was launching my technology company, but I also genuinely enjoyed not being tied down to a brick-and-mortar practice.

Looking at our current provider crisis, it’s becoming increasingly clear that locum tenens is a key solution that healthcare organizations tap into to help solve some of our staffing and burnout issues. An increasing number of healthcare facilities are already doing so to address physician shortages in order to maintain services for patients while seeking to fill permanent positions. So if locum tenens can serve as a solution, why don’t more doctors pursue this kind of work?

Roadblocks to filling more provider gaps with temporary providers

To start, many people don’t know what a locum tenens is. According to internal research conducted by CHG Healthcare, most current locum tenens first heard about it through friends or colleagues (which is how I heard about it myself), and one-third of physicians said they would have liked more information on locum tenens from their residency/fellowship program. Another barrier is the stigma surrounding locum tenens. Many falsely assume a temporary or “fill-in” provider isn’t as skilled. However, I would argue a locum tenens provider is more frequently and thoroughly vetted than a sample family medicine doctor who has been at the same practice for 45 years.

There are many different reasons a doctor would choose this direction. Freedom and flexibility of where and when you practice are two big benefits as is the compensation. The fact is there is always a critical need to fill somewhere. We need more resources out the gate for medical students and residents that locum tenens is a viable, impactful path to take.

Better flexibility for clinicians who want to practice in other states and facilities

Whether you’re a locum tenens already or that late-career family medicine doctor, the credentialing process is never easy, especially when many healthcare organizations still credential manually. The shift to telemedicine spurred by the pandemic definitely helped relieve some of the pain points of credentialing but certainly not all and not permanently. The bottom line is safety first; no one is arguing for skipping steps to ensure quality providers are thoroughly vetted. Antiquated credentialing processes that involve Post-it Notes on file cabinets and Excel spreadsheets will not cut it. It simply delays physicians and nurses being able to work (at times up to 120 days) and see patients when and where they are needed. Modernized credentialing solutions greatly reduce the time providers can start working and ensure data is updated and easily accessible and sourced in real time.

Paperwork continues to hinder healthcare

Paperwork has always been a massive pain point and energy waster across our sector, and unsurprisingly, it’s a large barrier preventing physicians from pursuing employment as a locum tenens. Internal data from CHG conducted in May 2021 that included 997 physician respondents found administrative tasks were actually the most frustrating part of the process. The data showed 42% of physicians polled felt that collecting all the necessary paperwork and documentation was the top barrier, followed by getting credentialed and privileged at the facility (41%), finding jobs that are a good fit (38%), and obtaining new state licenses (33%).

Provider credentialing is a massive headache for any provider, permanent or temporary, but for a locum tenens, it can be a massive deterrent. It’s frustrating for the hospital in Maine that needs to fill a position quickly — and for the provider in California ready to fill that need but waiting on the credentialing process. If you’re on the locum tenens path, partnering with a reputable staffing agency that can take on the credentialing burden for you reduces a lot of the pain points here.

Misunderstood regulations in reimbursement waste millions

Although hospitals work with locum tenens often to cover for doctors who are out for shorter work stints, many times healthcare organizations won’t go through the payer enrollment processes to get reimbursed because the process is so arduous. They need the doctor urgently, so they will bring the provider on to fill that gap but then eat the costs.

“Lengthy payer enrollment times can also disrupt cash flow. Practitioners who are credentialed and privileged, but not enrolled, can technically begin seeing patients and earning reimbursement. However, the facility and physician cannot receive payment for claims until the practitioner is enrolled with the payers connected to the patients he or she sees,” writes Brooke Murphy for Becker’s Hospital CFO report. “When this happens, hospitals may end up holding onto claims for weeks, resulting in delayed or decreased payments. Claim write offs from commercial payers occur when enrollment takes longer than the allowable claim period from the date of service delivery.”

Healthcare organizations and providers should familiarize themselves with processes such as the Q6 Modifier if they haven’t already, which will ensure payment for locum tenens who are employed by the facility for up to 60 days.

Opening up the path for more locum tenens

The pandemic has forced us all to rethink the traditional parameters of how we deliver medicine as providers and healthcare organizations. What once was uncharted territory is now the “new normal,” and niche sectors of medicine that were coined over 40 years ago — locum tenens — are proving a valid ally as we navigate provider burnout and staffing crises.

Locum tenens are talented, credentialed providers practicing at the top of their license who are opening up access to care so that physicians and nurses can take vacation, go on maternity leave, stay home when they are sick, and take time off when they need it. We can make this path easier and more impactful through modernized credentialing practices, reducing unnecessary paperwork and administrative tasks, and making sure healthcare organizations and providers can safely and easily work where they are needed when they are needed.

We also need to start educating medical students and residents that locum tenens work is indeed an option and that it can be uniquely helpful. Not just in putting more physicians to work, but also helping to create a more balanced, healthy work environment for providers. We know there is a need, and we know there is value — so let’s start talking more about the potential for locum tenens to share the workload.