Making the Transition to Locum Tenens in 2016: What to Expect

staffing surgeonsThe New Year is rapidly approaching and maybe you’ve decided it’s time to take control of your work schedule instead of somebody else controlling it. Like most of us, you want more free time to pursue other interests. As a locum tenens physician, here is what to expect:

Availability of Jobs

Recent studies have estimated that roughly $2.5 billion dollars is spent annually on locum tenens, and there are roughly 150 agencies of various sizes scattered across the country covering all specialties. Depending on your specialty, availability, state licenses and particular situation, chances are that you will not have any difficulty finding as much locum work as you want. Be mindful that, since most locum needs are urgent, hospitals, clinics and contract groups generally use multiple agencies to fill their needs. It is not uncommon for physicians doing locum work to get calls from as many as 10 agencies/recruiters about the very same job.

Consequently, most hospitals have implemented a system where the recruiter has to “name clear” you as a candidate before being considered. This helps to avoid what is referred to as a “double presentation”.  This is particularly true in the case where a hospital or hospital system is using a Managed Service Provider(MSP). The MSPs utilize as many as 20 different agencies and they typically own one themselves. It is very important for you to keep a log of who contacted you about each job. You must be very specific with the agencies to ensure they don’t submit you as a possible candidate by way of the name clearing process or by submission of your CV without your specific approval. You should not move forward with the agency if they will not identify which hospital or group is in need of locum tenens coverage. If you don’t manage this part of the process, you could likely end up in an adversarial position with one or more agencies, and it may appear that you are a desperate for work

Scope of the Practice & Expectations

Before accepting an assignment it’s important to understand what is expected of you in terms of seeing office or clinic patients, performing procedures, taking call, etc. For example, if you are a surgeon and you don’t do endoscopy work, you would want to be sure that the hospital or practice does not have this requirement. The agency recruiter should provide you with a description of the position that clearly lays out everything, and you should not hesitate to pose questions about the job specific to your specialty. You should be evaluating the locum job carefully, as they will be looking at you and your background to be sure you are not getting yourself into a situation that is not a good fit for you, or worse yet, potentially litigious.

Getting Paid

There are plenty of surveys out there that will tell you what other physicians in your specialty are making annually—median compensation, 75th percentile, etc.  You can take those numbers and come up with a daily rate, or you can even look at your own practice and what you bill for your professional services, but this is not reflective of market rates for locum tenens, which can be different. To get a sense of what physicians are being paid as independent contractors around the country please follow this link. Rates are either straight hourly or a daily fee with a specified number of “gratis” hours with additional per diems paid for taking call at night or on a Saturday/Sunday. For example, four (4) gratis hours means that every hour you actually provide patient care after the first four are paid to you at agreed upon hourly rate, in addition to the daily fee.

This brings us to an important issue. No matter who you work through, you’ll be working as an independent contractor and the agency will not withhold any taxes, social security, medicare , workers compensation, etc. You will need to pay estimated quarterly taxes to the IRS and the state in which you currently reside (if applicable) and you will also need to purchase your own health, life and disability insurance. At the end of each year you will receive a 1099 and the income should be reported on schedule C of your 1040 form or however you are advised by your accountant. You can also contract your services through an existing medical corporation, or if you don’t have one, you can easily form one. Check with both your lawyer and accountant as to what is best for you and your particular situation. Regardless of which option you choose, agencies make payments either electronically or by check upon submission of timesheets, which the agencies provide to you at the start of each assignment. The good news is that payment is usually quicker than how the payers reimburse for physician services.

Liability Insurance & Other Details

Most agencies both large and small have liability insurance policies in place to cover you while you are under contract for each locum job, and they also have the ability to add and delete physicians from their policies as they come and go and still cover you whenever a claim arises. The cost is wrapped into their client bill rate and is provided to you at no cost.  There are a handful of malpractice insurance companies with about 4-6 carriers that write locum tenens policies. You may want to check the rating of the policy that the agency provides and you should be wary of any under an A-. Each agency has a different underwriting process, so be prepared to provide them with full details of your liability claims history, if any. Once approved, by the agency, you will still need to provide this same information for hospital credentialing.

Using your own liability insurance may or may not be an option and it doesn’t necessarily mean that you can increase your pay rate by using your own liability insurance. The agency can still be subject to vicarious liability and still may need coverage in place on your behalf to account for this.  

Typical agency support includes travel, lodging and local transportation (auto rental) at no cost to you. The agency will also handle all of the credentialing details. The Devil is in the Details adage is very true when it comes to this part of being a locum tenens physician. Don’t expect any shortcuts. Hospitals have become almost merciless when it comes to fulfilling the credential requirements of the medical staff due to JCAOH.