The answer is yes, the size of a locum tenens agency does matter. But not in the ways you may be thinking.
In today’s world size is important but the biggest may not always be the best. Whether to go with a big, medium or small firm can be very subjective from both a physician and client facility’s perspective. Big agencies are typically publicly-traded companies with teams organized by functions such as business development, recruiting, credentialing, travel and payroll. Medium sized firms are those with more than 10 and fewer than 80 employees where the recruiter(with the help of an assistant or two) is responsible for securing the contract with the client facility, finding the physician to do the work and overseeing the coordination of all the details. The small firms are usually comprised of less than 10 employees with the owner intimately involved in all aspects of the process. There are as many as 100 firms engaged in providing locum tenens physician coverage who fall into all of the above categories. So, how do you choose which ones to work with? Three equalizers of great importance are; experience and reputation of the agency, the quality of the malpractice insurance(should be at least an A rated policy), and the agency’s ability to cash flow the locum job. These attributes can be found just as easily in a medium to small firm as they can in a big firm. A well-run, small to medium sized company can be much more efficient and deliver a more personalized service to both the hospital and physician.
The locum tenens agency ownership landscape has changed tremendously in recent years. They have gone from being closely held private companies to becoming divisions of publicly traded nurse staffing companies. Two such companies report annual revenues of $440M and $1B annually with the physician locum tenens portion amounting to only about 30% of the total revenue. They have promoted Vendor Management Systems(VMS’s) and Managed Service Providers(MSPs) and in several cases acquired or developed their own, so that they can get all or most of what they call the “spend”.
While this type of transactional processing may work fine with placing a nurse to cover a shift or two on a PRN basis, it is a much different set of issues(often times quite complex) when it comes to putting a physician into the system. The physician has to meet the requirements of the medical staff, document clinical competence by way of a delineation of privileges and be deemed qualified to fulfill the duties and requirements of the job. This cannot be accomplished by shoving a physician through an online portal and hoping for a favorable outcome. Many times an agency has no contact with a representative from the facility or the vendor management company, just processing forms online. Not safe in the charged medico-legal legal climate of today.
If you are a neurosurgeon or a facility that is need of a neurosurgeon, do you want to work with an agency representative that has very limited knowledge of the specialty? Do you want to work with someone whose only interest is in jamming a deal together to hit a monthly goal?
Just because a big agency can staff 30-40 nursing positions at one facility at any given time, doesn’t necessarily mean that they can be effective at meeting a client facility and candidate’s needs when it comes to arranging neurosurgery coverage in a Level I trauma center. With an increase in demand for primary care providers and shift to transactional processing, the big agencies are decidedly going to go where they can do big volume with solid gross profit margins- family practice, internal medicine, low volume Emergency Department physician staffing and psychiatry. But what if you need a trauma surgeon, an intensivist or a neurologist? A smaller, niche oriented company will have the resources, specialty knowledge and expertise to find a more qualified candidate who will meet the credential requirements to get the job done. That’s not to say that large companies are not able to fill these kinds of positions, they are.
And now back office competence. If you are a locum tenens physician working with an agency and getting paid weekly, if the pay is wrong, what is the advantage? If you are on the client side and receiving incorrect invoices and having to spend all of your time talking with multiple agency personnel to resolve billing and travel issues, how does the big agency add value?
A smaller agency is going to be more focused on the details, know the rates, and other aspects of the locum such as scheduled work and call hours and be able to quickly resolve any pay or billing issues. What’s more, they have fewer clients and physicians working with them, so you are much more important to them than to a big agency.
There are advantages to working with each size firm mentioned above. Whether or not Size Really Matters, depends upon your needs. What really does matter are Relationships. If you are a physician choose an agency that supports your interests in providing the best patient care possible in a safe environment. The money is not substantively different from agency to agency, especially if they know the nuances of your specialty. If you are a facility administrator-choose an agency that can deliver the best candidate possible, be responsive and treat you fairly when it comes to the contract terms.