NEW YORK—Locum tenens, once used primarily by healthcare organizations to find permanent staff, has exploded into an industry of independent contracting as a way to address personnel shortages and physician burnout. This type of arrangement can be attractive to healthcare organizations and anesthesiologists alike.
But it’s not for everyone, and even practitioners whose needs and disposition may be well suited to a locum tenens career need to know what to consider and look out for, said Clifford Gevirtz, MD, an anesthesiologist and the medical director of Somnia Inc., in Harrison, N.Y.
“The first thing you want to consider is the reputation of the firm. Are they making weekly payments? Monthly payments? Does the hospital have to pay the agency before you get paid? Who’s providing the malpractice insurance? What happens if the agency goes out of business?”
You’ll also want to consider the culture of the hospital, ambulatory setting or medical office you’re considering—something that is not always transparent in the advertisements placed by locum tenens agencies, Dr. Gevirtz said.
“They’re offering a lot of money, which sounds great, but they don’t tell you that there are no bathroom or lunch breaks. Or that since you’re not proficient with their electronic medical record, your first day doesn’t count. Recruiters always paint the position in the best possible light, but sometimes the light at the end of the tunnel is the oncoming train.”
Over the course of her 18 years in practice, anesthesiologist Angela S. Camfield, MD, MS, FASA, has worked in private practice, solo practice, team practice and academia at various geographic locations throughout the United States. Like many physicians, she felt stretched especially thin during the COVID-19 pandemic.
“I was taking care of pediatric cancer patients; working full time and taking call while handling an immunocompromised population, I got tired. I had the financial freedom to go part time and have more control over my life. I think that is where a lot of physicians are heading,” said Dr. Camfield, who is now self-employed, a board member of the Florida Society of Anesthesiologists and based in Jupiter, Fla.
She can cite a number of reasons for the growing popularity of independent contracting: Remote locations may have trouble attracting full-time physicians, mergers and acquisitions may result in contractual changes imposed by the newly formed entity, and the fact that advanced practice providers are taking on a growing set of functions within their credentials.
“We’re seeing a shift toward a care team model with fewer physicians; there are a lot of reasons a physician might rethink their full-time position to consider becoming an independent contractor,” Dr. Camfield said.
She acknowledged that there are advantages to being an employee, in which ideally one’s needs are covered by the employer: schedules, benefits, paid vacation, short-term and long-term disability, malpractice insurance, life insurance, and matched retirement programs. “And the stability; if you’re employed this year, you can mostly count on being employed next year,” Dr. Camfield said.
Independent contracting, on the other hand, offers the individual an opportunity to take the reins, to decide how much they want to work and where, she said. “We have excellent control over life balance: to work full time if your monetary demands are high, or part-time if you’re raising a young family; to take call or not take call. You can also use work as an independent contract position to explore new positions.”
Dr. Camfield wouldn’t recommend independent contracting to anesthesiologists early in their career when, although they may be adequately skilled, they may not yet have what it takes to quickly—and repeatedly—fill new roles. “You wouldn’t have enough experience to adapt and make those modifications easily, and you would want to have confidence in your skill set to be able to adjust to a new perioperative environment, a new surgeon, a new medical record—everything that comes with a new position.”
Having worked both as an employed physician and independent contractor, Dr. Camfield finds that the latter is the better choice for her at this point in her career. She is financially independent, she likes having control over her life balance, and she has felt very welcomed in the locum positions she’s taken. Dr. Camfield finds positions primarily through locum tenens agencies.
“I like using an agency because they serve as an intermediary between myself and the client; trying to develop your own contracts and making sure they are fair to both parties is a lot more difficult without an intermediary,” she said.
Reputable agencies usually include detailed descriptions of the location of the assignment and what they expect from the provider—what happens if you work overtime, how much call is involved, etc. If you get an email from someone you’ve never contacted, or an agent doesn’t answer questions clearly and directly, think twice about taking the job, Dr. Gevirtz cautioned; he advises carrying out a fair amount of due diligence before signing on with an agency.
“Make sure someone you know doing locum tenens has worked with that agency. It helps to have a community, such as Doximity, where you can pose the questions: Has anyone worked with this firm? What did you think? Before you go into the middle of nowhere and start doing anesthesia, it’s worth spending a few minutes reading these boards to find out what people think.”
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