Balancing personal and family time with your responsibilities as a physician may be one of your biggest challenges, especially if you are a self-employed physician in a solo or small practice since time off can mean no income for you and your staff. If you have wrestled with striking a balance between running your practice and having time for yourself and your family, there’s hope. Hiring a locum tenens during your absence may provide a solution that will allow you to take time off work to re-energize both body and mind and return to work with a renewed focus and sense of purpose without a negative financial impact.
Common practice for independent physicians is to have a network of colleagues who are willing to cover for one another for routine evening and weekend on-call coverage. These arrangements enable physicians in smaller practices to enjoy their evening and weekend time while still providing patients access to care at all hours. Though this type of arrangement works well in areas where physicians are willing and able to provide short-term coverage for each other, extended absence from the practice may require a longer-term solution.
A locum tenens physician can provide coverage during extended periods of absence such as maternity leave, caring for elderly parents or sick family members, taking a special — and longer — vacation, or even being called to active military service.
Advantages of Hiring a Locum Tenens Physician
Locum tenens is a Latin phrase that means “hold the place” or “hold the position.” In its purest form, it refers to physicians hired to take the place of another physician during an absence, though the term now generally refers to any physician (and other medical staff) hired as temporary contractors. The main reason physicians may want to hire a locum tenens is that it reduces the financial impact of taking time off.
Since a locum tenens takes the place of the physician, billing can continue as usual. In fact, the Centers for Medicare and Medicaid Services (CMS) even has published guidelines for billing under a locum tenens arrangement. According to CMS regulations, the regular physician may receive payment for the substitute physician’s services as long as the following conditions are met: 1
- The patient desires to see the regular physician, but the regular physician is unavailable
- The regular physician pays the substitute physician on a per diem or fee-for-service basis
- The substitute physician doesn’t see Medicare patients for a continuous time frame longer than 60 days (an allowable exception to this rule is if the regular physician has been called to active duty in the Armed Forces)
- Claims are submitted using the appropriate HCPCS modifier when billing for physician services rendered
In addition to keeping revenue flowing during an absence, a locum tenens physician also ensures continuity of care for your patients. Despite your absence, office staff can still meet patient needs within the practice setting without interruption. Patients will have increased trust in and goodwill toward you and your practice when they know you have made adequate plans for their care even when you are away from the office, and they will be less likely to seek the care of another physician in your absence.
Plan Ahead to Ensure a Positive Experience
While a locum tenens physician is a good option under some circumstances, like any other business owner, physicians should plan carefully when making the decision to let someone else represent their business. After all, the locum tenens provider will be a reflection on you and your practice as well as your reputation. With that in mind, following a few simple steps and taking precautions will help you plan ahead and make the best choice.
1. Research locum tenens organizations.
A good place to start is the National Association of Locum Tenens Organizations (NALTO). NALTO lists member organizations that provide locum tenens services, and all NALTO members are subject to the association’s code of ethics.
2. Interview locum tenens organizations.
Contact organizations that seem to be a good match for practice needs. Ask how they vet their physicians. Find out how quickly a locum tenens can be placed if needed. Request information on the firm’s malpractice coverage. Ask them for a sample contract to review.
3. Check your existing malpractice coverage and any specific state requirements.
Since liability coverage options for locum tenens physicians may vary by state and by the underwriting policies of individual carriers, contact your medical professional liability insurance carrier to discuss coverage options before hiring a locum tenens physician. Let your carrier know what coverages the locum tenens firm offers or carries on its physicians.
4. Be clear about your expectations for a locum tenens provider.
You may work 10-hour days. You may be responsible for taking call on certain days. While your work schedule and work habits are the norm for you, a locum tenens provider may have different expectations. As you interview candidates, make certain that your expectations are spelled out and that there is agreement from both parties regarding specific work requirements.
5. Consider a trial run.
If possible, consider a short trial in advance of your planned time off. Hiring a locum tenens for a shorter time frame will give you experience in working with a locum tenens firm and give your staff experience in working with a locum tenens physician. It’s an opportunity to ensure that the locum tenens firm and their services meet your needs before making a commitment for a longer coverage period.
Cultivate Staff Buy-In and Support
As you work with a locum tenens organization, you’ll have an opportunity to determine the best match for your practice’s specific needs based on your specialty, your patient population and other factors. When vetting locum tenens physicians, remember that it’s not only your patients who will interact with this substitute provider, but also your staff members. Just as you would do if hiring a full-time staff member, you will want to look for the candidate who is the most qualified as well as the best personality match for your practice’s work culture.
You’ll want buy-in from your staff as well. Your staff will need to show the locum tenens physician how the practice operates and get them up to speed quickly. The substitute physician, though, isn’t you and will, of course, do some things differently from you. If your staff are reluctant to support the locum tenens physician during your absence, the practice won’t run as smoothly as you want. Educate your staff on the locum tenens process and the reasoning behind hiring someone to continue practice operations.
Get to Know the Locum Tenens Candidates
If you’ve never hired a locum tenens physician, you may be at least a little apprehensive about letting another physician represent you and care for your patients. Researching locum tenens firms and getting as much information as possible can help allay those concerns.
At the same time, stories from locum tenens physicians reveal scenarios of unreasonable expectations and issues with contractual arrangements. For instance, one family physician tells of his experience as a locum tenens in a remote Alaskan village where he felt he was “virtually a prisoner.”2 While he had taken the job as a means of seeing some of the Alaskan wilderness, he was unable to leave the clinic and was unaware of the contractual arrangement that stipulated that he must remain within 10 minutes of the clinic.
Obviously, not all bad experiences are this extreme; however, during the interview process, getting to know the locum tenens physician is important. Letting the locum tenens know what your specific needs are and what contractual expectations you will have is crucial as well in setting up for a positive experience for both physicians.
Locum tenens physicians decide to practice as contractors for a number of reasons. Locum tenens work offers pros and cons from their perspective. Ask candidates why they are interested in the assignment. Perhaps they are drawn to travel opportunities in your area. Perhaps they like the freedom of not being tied to a specific practice. Some locum tenens physicians may have already run private practices and are semi-retired.
Talk to candidates about their role as a locum tenens provider and what they like or don’t like. Ask about any negative experiences they may have had and what their ideal experience would be. You’ll find out a lot about what motivates them to work as locum tenens physicians, and you’ll get a sense of how they will or won’t be a good fit for your practice.
With proper research of locum tenens firms and proper vetting of locum tenens physicians, you will be able to take time away from the office while still earning revenue and ensuring continuity of care. A locum tenens physician can help you strike the balance between professional life and personal life that you need in order to remain energized and enthusiastic about your work and can give you peace of mind as you embark on a personal journey outside the office.
References
1. Centers for Medicare & Medicaid Services (CMS). Medicare Claims Processing Manual. Rev. 3933, 12-07-17. “Chapter 1 — General Billing Requirements.” (accessed 5/8/2018)
2. Cushing, William T. “A Physician’s Guide to Locum Tenens.” Family Practice Management. 1999 Feb;6(2):41-44. (accessed 5/8/2018)
Additional Linked Sources
National Association of Locum Tenens Organizations (NALTO). “The Pros and Cons of Locum Tenens for Physicians.” (accessed 5/8/2018)
