Locum doctors carry a stigma. It was thought that doctors who worked locums could not keep a full-time job elsewhere due to personality issues, sub-par clinical skills, or a variety of other factors. They were B-team docs that filled in for real doctors who needed days off. Unfortunately, this has been the experience of the several dozen hospital executives, CMOs, and administrative staff I have spoken to across the country. In one conversation with a VP of a physician group, he said the locum docs they received were “hit or miss; more often than not, it is a miss.” The tide is starting to turn, however.
The demographics of locum doctors has changed significantly over the past few decades. In a recent survey from Staff Care, 15% of residents said they worked locum tenens right out of residency. This is up significantly from years before. Whereas previously, the image of a locum doctor was of a second-rate, semi-retired doctor, more new graduates are gravitating towards locum tenens right out of residency.
A recent study published on Harvard Business Review, found, “contracted general internists deliver inpatient care of similar quality to their non-locum tenens colleagues“. One can deduce from this that the tide is turning and the quality of locum physicians has drastically improved. But why is there still a negative perception among hospital leadership?
The truth of the matter is that bad locum doctors do exist and they give the rest of us a bad name. In my experience, without fail, within a few days of a new locums gig, I hear from various staff (NPs/PAs/Nursing staff, etc) of how relieved they are to work with someone normal and competent. Naturally, I ask the staff what their experience has been with other locum doctors. I hear stories of doctors who were disrespectful, regularly came into work late, didn’t show up for shifts, yelled at nurses, cursed at consultants, refused to see trauma patients (at a busy level II trauma center), and the list goes on.
The bar is set pretty low for locum doctors. Don’t be a jerk, be clinically competent and you pretty much guarantee they will offer to hire you. It really doesn’t take much. This is also the experience of hundreds of locum doctors I have spoken to around the country; after a few shifts, the hospital wants to hire them because they do go to work and kick ass. I would argue there are plenty of lazy, incompetent, and underperforming employed doctors as well, and that locum doctors just get a bad rap because the hospital is paying more for them.
The underlying reason why more competent and young doctors are gravitating towards locums is that they are fed up. They want to take control of their destiny. They are tired of being treated like children by the administration. They choose the independent contractor life because it frees them from the shackles of employment and allows them to live flexible, more fulfilling lives. They get a rude awakening shortly after graduating residency that healthcare is broken, perhaps beyond repair, and physicians have become pawns to fill the pockets of CEOs, administrators, and insurance companies. They refuse to be subjugated and told what tests they can or cannot order by those without clinical experience.
As the current healthcare system continues to reduce physician autonomy and further burden them with metrics and impossible standards, I suspect more physicians will choose to work as independent contractors. The truth is, as an independent contractor, doctors bypass almost all of the administrative B.S. Guess how many department meetings I have attended in the past two years since starting locums? Zero. I am able to practice medicine as I always imagined; I work hard, do what is best for my patients, and go home. My “bonus” isn’t attached to some arbitrary, nonsensical Press Ganey score. I am not obligated to work more shifts because the department is short-staffed and hospital leadership failed to plan for emergencies. I no longer feel burnt out since I create my own schedule and can take months off at will. Truth be told, I’m not sure why the vast majority of doctors aren’t practicing as independent contractors. It may only be that once a critical mass of doctors chooses this method of practice, we will finally gain the upper hand and win back the autonomy physicians once enjoyed.