It is only natural to assume that a physician who is only temporarily taking the place of a permanent staffer would be less committed to a higher standard of care. After all, a locum tenens (temporary doctor) replacement has fewer ties to the community and only a limited time to cement relationships with patients. They are also new to the working environment, so they possess less experience massaging the system to the benefit of their patients. On top of that, they have no long-term commitment, so they might not be as interested in impressing their peers.
At least superficially, it would appear that temporary physicians are riskier than those in it for the long haul. However, common sense falters in the face of evidence. A new study published in the Journal of the American Medical Association found that there was virtually no difference in 30-day mortality rates between patient populations treated by permanent staff and those in the care of locum tenens physicians.
This parity in quality has been evolving over time as more physicians transition from permanent positions to locum tenens careers. The number of locum tenens or temporary physicians has skyrocketed in recent years. In 2002, there were 26,000 locum physicians working in the U.S., but in 2016, the number of locum tenens physicians almost doubled to 48,000 — nearly 5 percent of the profession.
As more physicians opt to devote at least some of their career to temporary assignments in an to avoid burnout, experience new locales or provide care to needy communities, the level of care among this population of providers has steadily risen to the point that locum doctors are indistinguishable from permanent staff.
No longer are locum tenens physicians the less qualified who were incapable of securing a permanent position. More than 65 percent of locum doctors have been in the profession for more than 21 years, and almost all locum physicians have worked in a permanent practice at some point. The most compelling reasons for this change to a less permanent career are new environments, higher compensation, shorter commitments and reduced workload.
The data suggests that locum tenens physicians are as or more committed to delivering a high level of care as their colleagues. The 30-day mortality rates among locum-treated patients was 8.83 percent, compared to 8.70 percent for permanent staff. The 30-day readmission rates for locum doctors was 22.80 percent, slightly better than the 23.83 percent for permanent clinicians.
Although there does seem to be almost identical care quality among the general populations of locum tenens and permanent staff, there is some disparity among more specialized groups. The study found that hospitals that rarely hired locum physicians did experience a higher mortality among patients treated by these replacements.
The authors of the study could not correlate this effect with any single or group of factors but did speculate that some organizations lacked the resources to hire top-notch substitutes. Administrative deficiencies like lack of introduction or efficient integration of locum professionals may also play a role in this statistical difference.
Written by:
Dr. Robert Moghim, CEO Moghim Medical Consulting Inc.