MedLink

Case Studies

Locum Tenens and Physician Staffing Case Studies.

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Emergency Medicine & Hospital Medicine

Problem

A local emergency physician group that treats 40,000 patients a year dissolves their group to become hospital employees. The hospital does not use a regional or national contract group to staff and manage their ED or Hospital Medicine services. The burden of guaranteeing optimal physician staffing is now on the hospital and its physician director of the ED. The hospital is located in a semi-rural area with the nearest metropolitan area being 2 ½ hours away. The practice is already short one or two physicians and they have another ED physician turnover. Current physicians are new employees, feeling overworked and the hospital is concerned about additional physicians leaving the practice. There is an immediate need for additional physicians who are capable of working in a high volume ED to maintain appropriate staffing levels to optimize patient care.

Meanwhile, the hospital is experiencing a similar physician shortage with its hospital medicine services. The need is for a hospitalist capable of working in a busy hospital, cover a full seven-day rotation, unopposed to working as a nocturnist, and who is not already tied to a permanent seven-on, seven-off job.

Solution:

The hospital secures the services of MedLink and several other contingency placement firms. MedLink ramps up recruitment efforts and secures five physicians over a period of 12 months to stabilize the ED physician schedule, as well as three experienced hospitalists who commit to covering all gaps in coverage for a 120 day period, allowing the hospital to stabilize its hospitalist scheduling while they recruit for the full-time positions.

Results:

MedLink assisted in licensing, credentialing and scheduling “work interviews” for the hospital’s own internal candidates which resulted in the hospital hiring a total of four full-time physicians to complete the group. Additionally, MedLink representatives work with the hospital’s physician recruiter and builds solid working relationship with the ED Director. Over time the ED Director feels like he has the resources and support to stabilize the group and sees light at the end of the tunnel. MedLink is available to him 24/7 and becomes his “go to” resource to assist in addressing any issues.

Pulmonary Medicine, Critical Care, and Neurosurgery

Problem

The hospital is one of three hospitals in the community and has a disproportionate share of indigent patients. Two pulmonologist who see office patients, manage inpatients, and provide ICU coverage leave to accept full-time employment with the other hospital in town as the hospital is trying to recruit a third. Client hospital has a busy ICU and now has a need for three full-time pulmonologist to handle the patient load.

The hospital was concurrently contracted with MedLink to provide support for their neurosurgical service. The community had an adequate number of neurosurgeons in town, so recruiting additional neurosurgeons who would have to garner referrals and build a practice was difficult –however, the current neurosurgeons were unwilling to share call two ways.

Solution:

The hospital secured the services of MedLink and several other locum agencies. MedLink ramped up recruitment efforts and secured four pulmonologist who covered all of the clinical areas, outpatient clinic, in-house patients, and the ICU. The hospital utilized other agencies to help staff the service with mixed results. They turn out to be more of a problem than a solution. Over a period of 4 years, the hospital hires two full-time pulmonologist who each stay for a period of 12-24 months, at different times, but coverage is still supplemented with MedLink contract physicians who have covered from day one.

Additionally, MedLink secured a neurosurgeon who provided neuro-trauma coverage every third week, for a period of six years. The neurosurgery supply side improved and the hospital was finally able to secure a third neurosurgeon for both elective general neurosurgery and trauma call.

Results:

Hospital was able to continue to provide ICU services without any gaps in coverage to meet the needs of its patients and medical staff members who admit patients to the hospital and ICU. With the day to day ICU physician staffing stabilized, the hospital was able to focus on recruiting permanent physicians which resulted in them establishing a complement of three full-time pulmonologists/intensivist.

Neurology/Neurohospitalist

Problem

A local multispecialty clinic with neurologist on staff felt overburdened by the high volume of hospital inpatient work and night call. Hospital administration’s initial request was for two weekends per month to give the neurologist some relief from call. As hospital negotiations progressed with the group, the neurologist had refused all call coverage and gave notice that they would be completely off the call roster in thirty days. The burden of guaranteeing the ED has adequate neurology coverage falls on the hospital to make sure the specialty is covered. The hospital was in need of a “neurohospitalist” program, but did not have time to consider that option let alone recruit neurologist and implement a program.

Solution:

With less than one month to implement a working neurohospitalist program, MedLink was contracted initially to provide one neurologist per day 7 days per week to see all ED consultations, round on unassigned neurology patients, and respond to all emergencies and stroke alerts on a 24/7 basis. Due to patient volume, the coverage requirement was moved to two neurologists per day working in-house and sharing call. MedLink was the sole agency assigned to the project. Within days of getting the contract, neurologists with adequate availability were identified, screened, credentialed, and secured to start providing coverage. MedLink assisted the hospital in establishing a working neurohospitalist program to meet the demands of its busy neurology service.

Results:

Hospital contracted with MedLink to provide 24/7 neurohospitalist coverage and within less than 30 days MedLink recruited, credentialed, and scheduled two neurologist who could provide long term coverage on a 7 on 7 off basis, with other supplemental neurologist to fill in any gaps. MedLink also recruited a Physician Assistant with neurology experience who was incorporated into the coverage model to optimize patient care. MedLink managed all scheduling, travel & housing, and operational issues that would arise. MedLink representatives were available to the physicians and hospital staff on a 24/7 basis to respond to any issues surrounding the coverage of the neurology service.

Trauma & Critical Surgery, Acute Care Surgery

Problem

The system’s anchor hospital experienced turnover in their panel of employed trauma surgeons to provide care for their growing trauma program.

Solution:

MedLink worked with the trauma services department to develop a contract model to adequately attract trauma surgeons to work in the program, taking into account the workload associated with primary call (first call) and back-up call. In the initial stages of MedLink’s engagement, they identified two experienced trauma surgeons to cover several weeks a month over a period of eight months.

Results:

The trauma service permanently hired one of the two surgeons provided by MedLink. After stabilizing the trauma service, the hospital developed an acute care surgery model and named the MedLink hire as Director of Acute Care Surgery who built the group to 5 full-time surgeons. On two subsequent occasions, MedLink has provided supplemental coverage to both the trauma and acute care surgery service as a result of leaves of absence and increased patient volume with the recent being for a 12-month period.

Neurosurgery

Problem

A level II trauma center serving patients in three states has one neurosurgeon. The services area is such that there is adequate volume to support one, but not two full-time neurosurgeons. In order to maintain a level II trauma designation, the facility must have a neurosurgeon on call 24/7. Having just one neurosurgeon to cover all of the call created staffing issues for the hospital. Without adequate neurosurgery coverage, the hospital would lose its trauma center designation. The hospital’s Director of Physician Services contacted MedLink seeking regular recurring relief vacation coverage for their sole neurosurgeon.

Solution:

MedLink has been providing the hospital with the needed half-time (.5 FTE) neurosurgeon to properly maintain the neurosurgical service. MedLink has licensed, credentialed and scheduled neurosurgeons to cover neurosurgical trauma who have provided services for 6-8 month periods, intermittently over the last 10 years.

Results:

MedLink’s neurosurgical candidate pool has allowed the hospital to stabilize the neurosurgical staffing with no gaps in coverage. In addition, MedLink’s coverage has allowed the hospital and their employed neurosurgeon to open an outreach clinic to shore-up its referral base. The Level II trauma center designation status remains intact with expanded coverage of neurosurgical services in the region.