Locum Tenens Surge Due to Doc Shortage, Turnover

A big increase in the percentage of healthcare facilities seeking locum tenens physicians reflects both the physician shortage in the United States and the growing turnover among employed doctors, according to a Staff Care report based on its 2019 survey of healthcare facility managers.

Staff Care, a national staffing firm and subsidiary of Merritt Hawkins, surveyed more than 200 healthcare executives and managers at hospitals, medical groups, federally qualified health centers, and other facilities in the fall of 2019.

At the time of the poll, 72% of the respondents were actively seeking locum tenens clinicians, compared to 47% in 2016 and 39% in 2012. This was the highest percentage in the 14 surveys Staff Care has conducted over the years.

The physician shortage has contributed to this surge in locum tenens utilization, according to the report. In addition, the huge rise in physician employment in recent years has led to an increase in turnover, because employed doctors are more likely to relocate than are those in private practice. Consequently, Staff Care noted, hospitals and other facilities are seeking more locum tenens than in the past.

During the 12 months prior to the poll, 85% of facilities had used locum tenens physicians, down slightly from 94% in 2016. But the percentage of respondents who used seven or more locum tenens (and/or nurse practitioners/physician assistants) per month almost doubled ― from 10% in 2016 to 19% in 2019. Moreover, in 2019, 28% of facility managers used locum tenens physicians 26 to 30 days a month, compared to 9% who did so in 2016.

According to Staff Care, about 52,000 physicians were working locum tenens in 2019, a slight rise from the 48,000 locum tenens doctors in 2016. But, in a 2018 Physicians Foundation survey, the report stated, 8.4% of responding doctors said they planned to work as locum tenens in the next 1 to 3 years. Staff Care estimated this could add up to 70,000 physicians to the locum tenens total.

"Locum tenens is an increasingly popular practice style among physicians because it allows them to focus on what they like to do best, which is treat patients, while minimizing the administrative duties they like least," said Jeff Decker, president of Staff Care, in a news release.

PCPs Down, Specialists Up

In the 2019 survey, locum tenens primary care physicians (PCPs) were the most in-demand type of doctor, but just 30% of facility managers had recruited PCP locums, down steeply from 43.6% in 2016.

The report offered two possible reasons for this downturn. First, many hospitals have already hired enough PCPs and may be looking to recruit more specialists from the locum tenens ranks.

Second, office visits to PCPs are declining, partly because a growing number of young people are instead visiting urgent care centers or are using telemedicine.

The use of specialist locums is on the rise. Twenty-one percent of healthcare managers reported using locum tenens surgeons in 2019, compared to 10.8% in 2016. Seventeen percent of the respondents said they were using locum tenens internal medicine subspecialists, up from 9% in 2016. And 22% of the managers reported using locum tenens anesthesiologists, compared to 10.8% in 2016.

Rise of Telemedicine

The percentage of facility managers using locum tenens behavioral health professionals dropped to 18% in 2019; it was 23.1% in 2016 and 29.9% in 2014. Nevertheless, the shortage of psychiatrists in much of the United States has produced strong demand for locum tenens psychiatrists, according to the report.

Some of the decline in demand for locum tenens mental health therapists may have been related to the rise of telemedicine. In 2019, the report said, 64% of facility managers reported that they had integrated telemedicine into at least one of their departments, compared to 47% who said that in 2016. Fifty-one percent of respondents said they used telemedicine primarily to provide behavioral health services, up from 36.8% in 2016.

Thirty-five percent of respondents used telemedicine for radiology, compared to 16.1% in 2016; 33% used telemedicine to provide neurology services, up from 9.2% in 2016. Twenty-one percent of the managers used telemedicine in primary care, compared to 12.6% of them in 2016.

Reasons for Using Locums

The top reason for using locum tenens doctors, cited by 71% of the respondents, was to fill in while the facility sought a permanent physician. "In instances where healthcare facilities do not have enough doctors and are seeking more, they often use locum tenens providers to maintain services and revenues," Staff Care pointed out.

Seventy percent of the respondents said they used locum tenens physicians to replace those who had left a facility — most of whom had relocated elsewhere. Other facility managers said they used locum tenens to fill in for vacationing physicians, to meet rising patient demand, and to supplement the workforce during peak periods, such as flu season.

Sixty-three percent of the respondents viewed locum tenens' skills as good or excellent; a third regarded them as adequate; and just 4% said these doctors were unsatisfactory. These percentages haven't changed much over the years.

A major advantage of using locum tenens physicians, said 73% of respondents, is that they allow continual treatment of patients. The second biggest benefit, 52% of the managers averred, is that they're immediately available. The biggest drawback is cost.

The percentage of managers who believed that locums tenens doctors were worth the cost declined to 73% from nearly 80% in 2016. Yet as the Staff Care survey shows, facilities are seeking locum tenens help more than ever.

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