There is no doubt about the importance of hospital medicine. It has become the second stop in the 
hospitalization process after the Emergency Department. Hospitalists interact with the patients, patient’s families, specialists and every level of nursing and administration. With two main shifts per day, double coverage and several hospitalists scheduled during the days, it is a staffing behemoth that has become the cornerstone of the hospital physician staff. The hospitalist also must order tests and must bear the burden of not over ordering, keeping in line with the new medical paradigm and balancing the need to not create a liability issue by under ordering. When bringing in a locum tenens to the hospitalist staff, this must be the base line concern before proceeding ahead.
With so many types of hospitalist practices, from local to hospital employed to national companies, it is important to create a strong practice profile to make sure the potential locum tenens qualifies for the position and matches the needs of the practice. Does the locum tenens admit to the ICU? If so, do they follow the patient in the ICU? Are they required to do ICU procedures and if so what? How any admissions are there in a 12 hour shift? Is this responsibility rotated between members of the group? For inpatient rounding, is there a cap on the number of patients such as not more than 17? Can a hospitalist safely see 20 inpatients? Are the hospitalists required to run the codes or do the emergency physicians? Do they need to intubate? You see where this is going. There are many details that must be factored into hiring a locum tenens with so many variables.
A strong practice profile will then make the sourcing of appropriate candidates much easier. What you don’t want to happen, is choose a physician candidate, start credentialing only to find out they won’t see more than 15 inpatients or can’t intubate or work in the ICU. Then you have to start the process over as those open shifts near.
What is a reasonable hourly rate to pay a locum hospitalist? According to a recent survey the highest salaries for hospitalists are in the South at $246,000 per year, including a bonus. RVU bonuses vary all over the country based on geography, population and payer mix. These can be as low as $40 per unit up to $57 per unit. Of course your particular mix and hospital subsidy will enter into the equation. Most hospital medicine locum tenens are from an agency, so you must factor in the agency fee, airfare, lodging and auto rental during the locum period. If you are figuring it on an hourly rate based on the $246,000 you are looking at $126.00 per hour including malpractice with agency a total of $168.00 per hour. Hold on! You get what you pay for. Chances are that a locum at $126.00 per hour won’t make it through credentialing. You don’t want to hear this, but a well-paid locum tenens will most likely have the procedure skills and motivation to see a lot of patients, admissions and personality to get the job done correctly. The best locum tenens Hospitalists get $150.00 to $170.00 per hour with the agency rates for that physician running in the $200 to $230 per hour range. Remember, if you have a stable locum holding down the position that is reliable, you will be able to recruit a permanent solution quicker than dealing with the hassles and expense of turnover.
Many hospitalists choose to do full-time locum tenens since they are working 7 on and 7 off shifts anyway. It is an attractive alternative to the grind of being in a group or at the mercy of a hospital employed position, or the wild uncertainty of a national hospitalist company. The independent contractor hospitalist is responsible for their own health insurance, taxes etc. So the $150.00 per hour does even out at a lower hourly rate all said and done. That doesn’t change the agency fee per se, but a good locum tenens agency can be a major asset if you have multiple positions open and if they take the credentialing monkey off your back and manage that part well.
If you are with an agency that creates problems rather than solve them-get rid of them. The agency should have one point person for you to deal with in regards to the scheduling, contract, concerns and logistics. The agency should meet the credentialing deadline without causing a last minute workout stressing your medical staff coordinators and calling attention to the open position. Malpractice should be included in your hourly charge. Beware of the agency that separates the malpractice charge out. You are being double charged for the insurance very likely adding to the agencies bottom line and not helping yours. The invoice you receive should be simple and understandable with the time sheets attached with a signature line for you to approve the work hours each week.
I could go on, but these are the most salient points to look out for. The use of the locum hospitalists is very common and for the most part successful. Don’t be afraid to engage a locum tenens hospitalist, it will help relieve the work load of your current hospitalist and help you build goodwill with your medical staff. It can be used as a good recruitment tool and not as much of a negative as you may have previously thought.
