Part-time Locum Tenens Surgeons Can Alleviate Staffing Shortage
Locum tenens surgeons offer a part-time solution to a full-time problem.
U.S. Surgeon Shortage
The United States faces a shortage of 91,000 physicians—including 46,000 surgeons and medical specialists—within the next 10 years because not enough physicians are being trained to keep pace with population growth and practitioners’ retirements, according to a report by the Association of American Medical Colleges (AAMC).
Quality of care could decline as a result, particularly for the 20 percent of Americans who live in rural or inner-city locations designated as health professional shortage areas, according to the AAMC. The association urges Congress to lift the freeze on Medicare-supported residency positions as a means of preparing more physicians each year without short-cutting their education or training.
Part-time surgeons also can alleviate the shortage by helping hospitals fill gaps in coverage, and they offer a quicker way to do so than waiting years for new surgeons to be trained. Swift action is imperative given that nationwide the number of active general surgeons declined 7 percent from 2000 to 2010, dropping from 23,725 to 22,061, according to the AAMC’s 2012 Physician Specialty Data Book. Furthermore, as of 2010, 43.4 percent of general surgeons were age 55 or older as of 2010, compared to the national average for all physicians of 40.3 percent, according to the AAMC.
Benefits of Locum Tenens Surgeons
General surgery is among the fastest-growing specialties of the locum tenens industry because younger surgeons are pursuing part-time positions to balance life and work, while older surgeons are seeking such opportunities as preludes to retirement. In both cases, hospitals can get well-qualified, experienced locum tenens general surgeons.
Benefits of hiring part-time surgeons include:
They are a cost-effective means to meet demand that does not yet justify hiring a full-time surgeon.
Hospitals gain flexibility in covering vacations, holidays and sick days for other surgeons.
Experienced surgeons can mentor younger peers.
Employers can spread the costs of one full-time-equivalent (FTE) surgeon, including pay and benefits, over two or even three part-time surgeons.
The responsibilities of a single FTE surgeon can be divided among multiple part-time surgeons based on their individual strengths.
They can use otherwise unused office space for revenue-producing activities.
Locum tenens surgeons and their employers have found hospitalist positions in particular to be mutually beneficial, according to the authors of an article on the impact of part-time surgeons on the expected surgeon shortage published in the Journal of the American College of Surgeons in September 2011. The authors wrote:
“Rather than paying for on-call stipends, hospitals are looking for better value in providing acute care and in-hospital round the-clock care. For the hospital, the advantages are 24-hour coverage, a predictable budget, ability to treat the uninsured, faster initiation of diagnostic and therapeutic measures, and a reduced length of stay. For the acute care surgeon or surgical hospitalist, this model provides a flexible and controllable lifestyle, keeps surgical and procedural skills current and maintains direct patient contact, eliminates management responsibilities and liability concerns, and ensures a predictable income in an era of declining reimbursement.” (Click here to read the full article by Bhagwan Satiani, MD, MBA, FACS, Thomas E. Williams, MD, PhD, FACS, E Christopher Ellison, MD, FACS.)
How to Staff for Locum Tenens Surgeons
Staffing plans for part-time surgeons should address flexible work schedules, malpractice premium adjustments, academic promotion, maintenance of certification and licensure, and employment benefits, according to the authors of the Journal of the American College of Surgeons article.
Call coverage. Unlike in primary care, in which call coverage is typically prorated based on percentage of FTE equivalency, part-time surgeons usually take equal call. Resolve the terms of a part-time surgeon’s call coverage upfront, while being mindful of its impact on the hospital as a whole. Allow part-time surgeons to “buy” on-call coverage, the authors of the Journal of the American College of Surgeons article suggest. This way, older surgeons can pay younger ones to take call as a means of mitigating any resentments over discrepancies in pay, whether real or perceived.
Malpractice premiums. Prorate professional liability insurance policies in terms of FTE equivalency so that part-time surgeons add up to a full-time position.
Credentialing and certification. Part-time positions may allow surgeons to maintain full hospital privileges and their clinical skills, but if you use too many collectively one or more may not be able to perform enough of the procedures required to be recredentialed or board-recertified. Know the requirements and staff accordingly.
Managing numerous part-time surgeons can be complicated at times, but it can be done. Look for surgeons who will work well with their colleagues and clarify expectations for everyone early. Communicating clearly and dividing workloads fairly among part-time surgeons and their full-time counterparts will go a long way in solving the surgeon shortage.