When the US Economy went into a recession from about December 2007 to June of 2009 (it actually lasted longer), the usage of locum tenens in hospitals and medical practices also dropped precipitously. With fewer insured patients, Hospitals felt the squeeze and began laying off employees, something unheard of in years past. For elective procedures, patient volumes dropped across multiple specialties and physicians in previously successful small and large practices rushed to become hospital employees. Specialists who had avoided taking ED call and those who had become hospital-employed began taking call with little dissent, particularly where hospitals were paying per diems for taking call or requiring call as a part of the employment agreement.
Larger not-for-profit systems took advantage of the economic downturn and became much more proactive in acquiring hospitals. While in the process of consolidating systems and integrating medical staffs, there was a big push to reduce or eliminate the “spend” on locum tenens.
There never really was a slowdown in hospital & emergency medicine. Any hospitals not already outsourcing this to one of several big contract groups began moving in that direction for economic reasons, and partly because they also couldn’t staff the programs themselves. The supply and demand was, and still is, such that even these contract groups rely on locum tenens physicians to keep their programs staffed.
In preparation for the upcoming Affordable Care Act, the demand for outpatient primary care physicians and physician extenders increased dramatically. Population shifts, hospitals taking over and expanding networks of outpatient practices and urgent care centers, and an additional 2 million health-insured people created an influx of patients to physician offices and outpatient clinics as well as already over-crowded emergency departments.
After the dust settled
Recent post-recession studies indicate that the use of locum tenens is back on the rise with the “spend” estimated at $2.5 billion dollars. This is true for physicians as well as NPs & PAs. In the recent past, it was reported that 90% of hospitals are using locum tenens. Today, however, they are using them in a much more cost conscious way. A growing number of hospital systems and national contract groups have turned to Managed Service Providers (MSPs) with hopes of reducing costs and increasing fill rates. It remains to be seen if either of these two goals will be realized.
Some online staffing platforms are beginning to emerge as well, who also purport to reduce cost and streamline the process. However, the use of technology does not change the supply/demand equation. What’s more, the physicians doing the actual work have become accustomed to the traditional agency model that’s been around for 30 years where they have a recruiter who handles all of the details that they can actually speak with by phone when necessary.
The demand for physicians to provide inpatient care in neurology and pulmonary-critical care medicine is following that of inpatient care for general medicine. In neurology, with every third patient presented to the ED needing a neurology consult, practicing neurologists’ office hours are interrupted constantly. Many neurologists have opted to drop out of the call rotation thereby leaving the hospitals without inpatient care to include stroke alerts. This signaled the popularity of employing a neurohospitalist; however, there is a shortage of neurologist who want to do this type of clinical work. For economic and lifestyle reasons, the pulmonologist who have critical care training and have this area as their domain, are opting to limit their practice to inpatient and outpatient pulmonary medicine and sleep medicine. So, many of the hospitals are going to more of a straight critical care model where their ICUs are covered in 12-hour shifts by intensivists or intensivist contract groups. But, guess what? They are experiencing the same shortages as everyone else.
The demand for surgeons is also picking up steam. General surgeons are retiring at a quicker rate than they are entering into practice. Neurosurgeons and orthopedic surgeons have become less willing to take ED or trauma call as they have more confidence in their ability to sustain elective practices. All the while there has been a movement to upgrade trauma center designation from Level III, or no designation at all, to Level II status. But, guess what? You can’t have a trauma center without neurosurgeons taking call and orthopedic surgeons who are willing to treat patients with acetabular/high energy pelvic fractures in the middle of the night.
So, if you are an in-house recruiter, service line manager, Director or VP having difficulty recruiting or keeping a particular service staffed, you should not feel defeated by having to put your physician staffing needs out to an agency. Just be sure to pick two or three really good ones who know the specialty and have a track record of success.