Locum tenens is a Latin phrase that means “place-holder”.  Locum tenens neurologist is a term used to describe a neurologist who works temporary positions in hospitals and neurology practices. A locum tenens neurology job may entail weekend coverage or may last for a few weeks, a few months, or up to a year or longer. Many hospitals are using locum tenens neurologists to provide coverage for their neurohospitalist programs as there is a shortage of neurologists who are willing to do all of the inpatient work.

Telestroke was one of the first uses of tele-neurology and remains one of the most requested neurologic services overall. A tele-neurology program provides the technological infrastructure to enable a neurologist-led team at a centralized location to electronically monitor patients around-the-clock, complementing the care plans of a hospital’s local inpatient care team. The team is available to deal with any changes in the patient’s condition. Tele-neurologists hold multiple state licenses and have clinical privileges at as many as 20 hospitals under contract with a tele-neurology service provider.

Mainly to adequately cover their ICUs but they are also needed to manage pulmonary patients on the floors. There has long been a national shortage of intensivists with nearly half of the country’s acute care hospitals that do not have any on staff.  Of the roughly 7,000 physicians who deliver critical care services, it has been reported that roughly 65% are pulmonologists, 19% are trained in both pulmonary medicine and critical care, 10% are internists and the remaining 6% are anesthesiologists and critical care surgeons.

Tele-ICU programs primarily use critical care trained pulmonologists to enable an intensivist-led team at a centralized location to electronically monitor patients around-the-clock, complementing the care plans of a hospital’s local critical care team. The team is available to deal with any changes in the patient’s condition. Tele-pulmonologist also provide care remotely to non-ICU patients in the hospital who wouldn’t ordinarily have access to a pulmonologist.

With an aging physician workforce in the specialty, the primary reason is for after-hours call coverage and to provide inpatient care. General, non-invasive cardiologists are the oldest (30% over 60), however that number could be skewed by interventional cardiologists who, toward the end of their careers, tend to leave the catheterization lab and move into general cardiology practice.

Telecardiology allows cardiologists to use electrocardiographic data, which is transmitted remotely, in real-time, for interpretation by a specialist to achieve the remote diagnosis and treatment of heart disease. This includes coronary heart disease, both chronic and acute, as well as arrhythmias, congestive cardiac failure, and sudden cardiac arrest.

Tele-cardiologists provide care remotely to patients in smaller hospitals who wouldn’t ordinarily have access to a cardiologist.

The primary reason is for inpatient care. While the incident rates of end stage kidney disease (ESKD) have stabilized, inpatient consults continue to grow.  While hospitalists are typically capable of managing most nephrology inpatients there is a need for hospitalist to collaborate with nephrologists in reconciling medications. The most frequently billed diagnoses in the inpatient setting are acute kidney injury (AKI) and end stage kidney disease(ESKD). Locum tenens nephrologists are primarily utilized to provide inpatient care on the floors and in the ICU.

Tele-nephrology bridges the distance between where patients with kidney disease and the nephrologists are located. Large health care systems, for which incentives are aligned to innovate and implement new platforms to deliver cost-effective care, have been at the forefront of tele-nephrology. These systems include synchronous, direct physician-patient care in the inpatient setting through HIPPA compliant clinical videoconferencing.  Tele-nephrologists provide care remotely to patients in smaller hospitals who wouldn’t ordinarily have access to a nephrologist. Growing patient demand for patient-centric health care will continue to expand the tele-nephrology space.

Infectious disease specialists focus on preventing and addressing infections. They concentrate on bacterial diseases like tuberculosis and viral conditions like HIV. A common misconception about ID specialists is that they only provide HIV care.

Tele-infectious disease consults effectively bridge the gap between patients in remote areas and ID specialists’ who typically practice in large academic medical centers. Implementing telemedicine to provide care to patients with mild to moderate infections has been shown to improve clinical outcomes and reduce health care costs. Tele-infectious disease care helps hospitals move patients through phases of the care plan. Tele-infectious disease specialists provide care remotely to patients in smaller hospitals who wouldn’t ordinarily have access to a nephrologist.

In the early 2000s, internal & family medicine physicians shifted from inpatient and outpatient medicine to primarily office-based practices creating a need for hospitalists. Hospitalists do the admissions, facilitate inpatient specialty consults, round on the floors and discharge patients thereby by allowing staff internists to focus on their office-based practices. Hospitalists are scheduled in shifts and generally work a 7 On & 7 Off schedule covering both day & night shifts. Since this is a 24-hour 7-day per week service, many hospitalist programs come up short when scheduling, so it becomes necessary to utilize a locum hospitalist to cover all the shifts.

Smaller acute care hospitals who don’t have sufficient volume to support having a hospitalist on-site 24 hours per day, but still have a need to lighten the load for their staff internist who have active practices in their community. A tele-hospitalist staffing option is also well-suited for a hospital that has on-site coverage during the day with a hospitalist on-call at night. In this model, the local hospitalist is relieved of night call responsibilities.

All hospitals no matter how small have an emergency department. It is the front door of the hospital, and emergent situations are immediately tended to by a qualified emergency medicine physician. Hospital EDs are open to all patients including the un-insured who use the emergency department in many cases as their primary physician. With growing patient volumes, and the mobility of physicians, the use of a locum tenens physician is key in maintaining staffing levels to achieve optimal throughput levels. Most emergency physicians are certified by the American Board of Emergency Medicine. Many physicians trained in family & internal medicine also provide care in community hospital EDs.

These physicians usually work in lower volumes of ER’s, with most of them holding certification in some other primary care specialty. Their years of experience qualify them for staff privileges. With roughly 7000 hospitals, urgent care centers and free-standing EDs, it is easy to see why a temporary locum physician would be needed.

The episodic nature of emergency medicine makes them very well suited for this kind of work. An ER doctor sees patients of all age groups from newborn to geriatric with a wide variety of conditions being treated. With an ER doctor’s abundance of knowledge from seeing all these different kinds of patients with many different problems, their fund of knowledge and skill sets in interviewing patients lends itself perfectly for telemedicine. Emergency physicians are accustomed to identifying the chief complaint quickly, making the diagnosis and prescribing an effective treatment plan. Emergency physicians do shift work which gives them several days off each month, freeing them up to work on a virtual platform when they are not in the ED.

When a family practitioner takes an extended vacation, goes on medical leave or decides to relocate, the other physicians in the practice usually do not have the capacity to cover all the patients in the practice. Also, as health systems expand their footprint in their primary and secondary service areas through practice acquisitions and de novo start-ups, they do not have enough physicians due to the shortage of family practitioners that is pervasive across the US

Family medicine physicians are ideally suited to see the patients that typically seek care for primary & urgent care needs via telemedicine. They can also effectively manage patients whose condition may be chronic requiring ongoing follow-up consultations. Today’s family practitioners are looking at other ways to engage in patient care activities outside the walls of brick and mortar practices and they are looking to supplement their current practice income with minimal disruptions to their work schedules.

Tele-psychiatry consults remove the geographical issues associated with providing mental health care services with rural areas the most likely to be underserved by psychiatry practices and to benefit from tele-psychiatry.  The patient and provider will connect using  telemedicine software that is easy to use on a laptop or mobile device. The tele-psychiatrist or psychiatric mental health nurse practitioner (PMHNP) will discuss the patient’s case in detail and make a treatment plan. Providers who are authorized to prescribe medications can do so using telepsychiatry. Follow-up appointments or necessary referrals can be conducted the same way.

Hybrid healthcare brings together the best of telehealth and in-person treatment. It relies heavily on technology for video conferencing, patient monitoring, appointment scheduling, follow-up and more.

Consumer-centric, technology enabled practices afford patients the opportunity to drive and manage their care. This entails in-person & virtual care, remote patient monitoring devices, integrated digital care across multiple specialties all in one place. Access to their health data across providers is essential in the patient-centric model.