Hospital Locum Tenens: An Alternative Value-Add

Episode Overview

So as hospitals put in place these new physician wellness programs or sort of address the, the clinical needs of, of either growth of their programs or maybe some of the turnover that they have, they often have looked to locum tenons companies to provide that level of support. And although locum tenons could be an expensive alternative, it's a really good alternative in order to support a lot of the access challenges that they may have, support some of the growth and certainly provide a nice, a nice interim approach as they begin to recruit. And in some markets, it's hard to recruit, right? So locum tenons is, is really the best, the best option. This has been a topic that I've been interested in for quite some time, certainly as it relates to providing value for patients within the community. I'm really pleased today to have as my guest Rich. Heim Rich is the president and c e o of Locums Pro. Locums Pro provides locum tenon services and contracts to many hospitals around the country. Rich, welcome to the program. 

Richard Heim: 

Good morning, Daniel. Thank you for having me today. I'm excited to sort of present and help you with that discussion you just had. 

Daniel J. Marino: 

So, rich, what are you seeing in terms of some challenges with regards to, say, vacancies in hospitals filling certain clinical roles. Are you seeing a lot of those challenges increasing? Is it staying the same? Is it harder to kind of fill those roles? What are you seeing right now? 

Richard Heim: 

Yeah. As somebody who's been in the health care market for a very long time in my career and mostly in hospitals the, the level of what you deemed burnout is continuing to increase, some specialties more prevalent than others, but some of the most recent information out there is, you know, 53% of physicians today are experiencing some level of burnout, which, you know, above 50%, it's pretty significant. And in some of the specialties emergency medicine, 65% pediatrics and internal medicine, big numbers, 60%. So, wow. 

 
Yeah. Ultimately what you're seeing is sort of that for emergency room specifically, I would say pulse covid burnout again, nobody worked harder than emergency room physicians as people were coming in. And now what you're seeing is the burnout in many of the other areas because of the level of sickness that's out there and the difference in sickness. So you see anesthesia and places where in the procedural areas most of the patients weren't being taken care of. Now there's a big backlog of patients that need to be taken care of. 

Daniel J. Marino: 

Yeah. And we're still playing. I think we're still playing catch up from, from covid, you know, from from the shutdown of a lot of the elective cases, although I think some of that has improved. And we've caught ourselves up. But one thing that you mentioned, which I think is interesting, those are amazing numbers, right? When you talk about 60% of the physicians really, you know, frustrated and having those, those feelings of burnout, I can't help but think that that's contributing to the early retirement. And then you couple that with the fact that there's not enough physicians coming out of residency in some of these specialties. I mean, that in and of itself just creates such a shortage problems in the health care space. Hospitals clearly must be under a tremendous amount of pressure to fill those areas. 

Richard Heim: 
 

Absolutely. And so, you know, in most cases, they're moving much more to an employment model, which allows them to, you know, bring them in at a reasonable salary control their work-life balance. Private practice for most physicians is hard. You have staff, you have just the day-to-day trying to make a living. And it is becoming more, more and more difficult to provide access. Yeah. So physicians are looking for that employment model, and that's where hospitals are trying to create that work-life balance where they're, where it's possible establish, you know, better call coverage so that physicians aren't on every night for call. They're also having physicians split and some become inpatient and some become outpatient hospitalist service, a prime example. 

Daniel J. Marino: 

Yeah. They're looking at different alternative models. I mean, there's no doubt about that. I think private practice, unfortunately, has really become a dinosaur. There's only a few markets that still have private practice and medical groups. You seeing though locum tenons as a, as a good alternative for physicians who maybe don't clearly want to be in private practice and maybe don't necessarily want to be employed by a hospital, but, but still want to practice? Do you see this as a good alternative or are you having some of the same challenges as many of the hospitals have as well? 

Richard Heim: 

Yeah, I think engaging physicians in locum tens, so historically it's been sort of you know, let's do it on the weekends, let's do it on our spare time and make some additional money. I think what we're seeing, and I just read an article that talked about a physician who really took this on as a career, and we have a number of them in our practice today. Physicians who work two weeks a month who then have work-life balance, they travel to the location, but ultimately, they're finding that this is a career rather than just a weekend you know, trip to somewhere. So I think ultimately the engagement in this can be a career where you control your own destiny. You can say, I want to work the first and third week of the month. I have things that go on at home that I need to be home for. So creating that sense of you're in control of your destiny, you can still make good money as a locum tenant. Mm-hmm. <affirmative> and you can for, for the most part, I mean, in all of the situations for us, we cover your malpractice, your travel expenses right. You know, all of those things are part of becoming a locum tenant. So saves expenses and basically puts you more in control of your Yeah. Your life. 

Daniel J. Marino: 

Yeah. Well, I would think just how you're describing it saves some of the frustrations that physicians would have. Right. So you're covering all of that, which again, you know, getting back to what we had talked about, and if we're really thinking about physician wellness and wellbeing, I mean, that reduces some of the frustration and the burnout factor. I know in working with many of the hospitals, we've done a lot of work on improving, say, surgical services, perioperative services, and so forth. Recruiting anesthesiologists has been a big issue. As an example. Are you, are you seeing the same thing from a locums perspective, or have you been able to attract specialists like anesthesiologists in some of the other hard to recruit specialists within, within your company? 

Richard Heim: 

You know, as those specialties see frustration in their workload, whether they're working for a private practice or on in a national company, they're beginning to see just as much burnout. And so we are actually in some cases, benefiting from that because anesthesiologists still want to work. They still do great work, and they're all you know, great clinicians. So from our perspective, they're coming on to basically still continue to provide care, yet they're able to do they're 40 hours a week, they're able to work in these hospitals for a week at a time or whatever their situation is. And so it gives them that control that in private practice and in hospital medicine today, they're really struggling. They're working 60, 80 hours a week. Yeah. And, and no time outside other than to sit and wonder what they're going to do <laugh>. Cause it's, yeah. You know, they're tired. 

Daniel J. Marino: 

Yeah. Yeah. You could see that too. Yeah. That's one of the biggest challenges that we see when we work with hospitals and sort of improving some of the surgical services, for instance. I mean, there's, they're tired, right? They're putting in, they're putting in a lot of hours. So when you're bringing in physicians sort of like you know, surgeons or anesthesiologists or even ER physicians, how do you create that continuity between the physician and the hospital? Do you typically have the same physicians there for say, an extended period of time, 6, 9, 12 months? Or is it more that you would rotate, you know, a couple of physicians through over a six or eight month period? How do you create that continuity with the medical staff in the hospital? 

Richard Heim: 

Yeah, I think it depends on you know, again, it's like a big puzzle matching the skills that the physician has and wants to perform, along with what the hospital needs. I will say we have two gastroenterologists who are spending time at a particular hospital, almost back to back. So we do try to provide that continuity in order to make sure that the handoff is good, the one physician came as a reference from the first physician. Hmm, so ultimately referrals become a big source of recruitment for us. 

Daniel J. Marino: 

Yeah. Word of mouth. I can see that. Sure. 

Richard Heim: 

Yep. If physicians are pleased with what they're doing and where they're doing it, they're able to talk to their friends and say, listen, this might be good for you. Why don't you test it and see if it's, it's what you're looking for. 

Daniel J. Marino: 

If you're just tuning in, Daniel Marino, you're listening to Value-Based Care Insights. I'm here today talking to Rich Heim. He is present and c e o of Locums Pro. We're spending a little bit of time today talking about the whole locums environment, and Rich providing a lot of good insights in terms of some of the things that are driving physicians. Rich. One of the things that, you know, I had heard recently is that you know, there's a growing number of, of women in the, the workforce, women physicians and, you know, again, with women in the workforce, it does lend a little bit more, I don't want to say a challenge, but things that have to be considered around work life balance and family obligations and so forth. I'm sure the, the same holds true with men, but, but does that ha, have you may have been, have you had to make additional adjustments to that? Or are those factors that you consider as you're beginning to either recruit female physicians into your practice or even place female physicians at some hospitals? 

Richard Heim: 

Yeah, I think ultimately, we are garnering more female physicians, and I do think male physicians, and that's largely because, you know, in today's dynamics of family the, the guy has just as much obligation to stay home with the children, or, or that's true, whatever. So, ultimately you know, that's part of one of the articles that I read was, you know, it allows me to be home and my wife to go to work. And so I can, I can set my own schedule and say, here's when I want to work. So I do think it adds an additional complexity for hospitals. It adds an additional complexity as well because you know, many of the locum tenants positions I'm seeing right now are to cover maternity leaves. So, interestingly enough, you know, as women go out on a maternity leave that general surgeon needs to be backfilled. And if there's nobody internally, that's where it comes, it becomes a potential locums tenant, locum tenants opportunity for us. So I'm continuing to see increases in, in that on our side. And that's, that's just nationally. I mean, we see all specialties, I would say that the physician, female physicians, there are a number of them are looking for tele opportunities. So we have become more electronic fabulous.  

Daniel J. Marino: 

So you're incorporating virtual health into the locums tenant process. 

Richard Heim: 
 

Many of the health care organizations have, have done that. So that makes it a great opportunity for physicians who don't want to be onsite to provide either psych care, psych is a big one that has gone to telephonic. There's now opportunities for physicians to do primary care. 

Daniel J. Marino: 

Yeah, primary care, I would think. Yeah. 

Richard Heim: 

So ultimately those will continue to be great opportunities for locums, again, looking at their credentials and what states they're in, it still becomes a bit of a challenge, but ultimately providing that telephonic online opportunity is also becoming great for the, the specialties involved. So, 

Daniel J. Marino: 

Yeah. So do you, within your organization, are you, do, do you have a full breadth of, of, of medical specialties? Or has there been particular specialties that has just been really difficult to recruit for? 

Richard Heim: 

Yeah, right now, I'm really some part of our focus is on hospitalists. Hospitalists has become a very big specialty for many health care organizations. 

Daniel J. Marino: 

Oh, yeah. Right. Well, many of them moved to the hospital, the hospitalist programs, right. So many primary care physicians are not seeing their patients in the hospital. They're turning over to the hospital. So I could see that. 

Richard Heim: 

Correct. And physicians like it because it's, you know, 12 hours in the morning Yeah. Or 12 hours at night. And you know, your schedule you're focused on inpatient length of stay, which is a huge issue for hospitals. So ultimately the, the private attending rounding on their physicians is becoming fewer and farther between. And so ultimately, hospitalists is a big recruitment. A lot of places are looking for those nocturnists and hospitalists. So I'm spending some time in that particular area. Many of the surgical subspecialties are, are really, there's a lot of, physicians out there in the locum tenons world today. So I'd say it's another big one that we're struggling with is ob. 

Daniel J. Marino: 

Yeah. OB 

Richard Heim: 

OB is one of those where, you know depending on the state patient physicians do or don't want to be in that state today. 

Daniel J. Marino: 

Do you think it's because of the malpractice issues related to 

Richard Heim: 

I'd say it's malpractice and the ongoing political struggles related to, you know, what's going on in our nation today? So from that perspective, I think they, you know, there are certain states that, you know, they're, they're just not going to work in. And so, and I also think that that specialty is it, they're just not looking at locums right now. Yeah. 

Daniel J. Marino: 

Yeah. That's interesting how the political environment would really kind of affect some of the, the, some of the trending of recruitment. That's really, that's really interesting how that works. But yeah, I mean, I would imagine, you know, it would create some real challenges there. But I think getting back to the hospitals, you brought up a really good point. One of the things that we've worked with hospitals is improving their length of stay and a lot of the value-based outcomes, you know, readmissions and so forth of which hospitalists provide a lot of influence. Boy, if, you know, if you have a seasoned hospitalist within your practice and you bring them to a hospital that maybe doesn't do such a good job with their length of stay or their readmissions and they can help them put in maybe your program or help them really impact a lot of those readmission outcomes, that's a huge value add that I think your organization could provide, that's something in my mind as you were talking about that really resonate. 

Richard Heim: 
 

Sure. Absolutely. I mean we have great docs on our side and building in in many of the specialties today. Yeah. And, you know, we always have an opportunity for a a company to actually employ them. I mean, ultimately, if, if it's right for the physician and it's right for the hospital we absolutely would move them into something other than locum tenons, but ultimately, it's still going to be the physician's decision and the hospital's decision together. Sure, 

Daniel J. Marino: 
 

Sure. But they almost come in as like subject matter experts in a couple of those areas, which I think you know, as organizations, hospitals are continuing to think about how they position themselves around quality or some of the value-based purchasing outcomes, I think that could be a really big value add. Talk a little bit rich about the challenges you see in recruiting or placing physicians in the rural areas versus the metropolitan areas, and, you know, one of the questions that I had was, you know, we do a lot of work in the rural hospitals, and one of my clients who I've worked with for a long time has built out a strong orthopedic service line. And they're a rural hospital and they've gone to great lengths to recruit physicians to the point where these orthopedic physicians would even travel home every weekend cause they're not from that rural community. And they have used locum tenons and they've actually done pretty well. But I can't help but think that it's clearly a recruiting challenge. What do you see as a big difference between the rural communities versus metropolitan? 

Richard Heim: 

Yeah, I think ultimately it comes back to, you know, the physicians seeing this as a career path for them. And again, travel becomes an issue in some of these communities. You don't want to spend a day and a half to get to the location that you're going to. If people see locums as just a weekend fling, it's going to be wanting to go to a warm climate in the winter, in a skiing place in the in the summer. So you know, it's all based upon what's out there. But ultimately, as people see it more controlling their lifestyle I think most physicians go into health care and their role to give back to their community, to give back to their to their practice, to give back to their patients. So I think that everybody has that down deep in them to, to give back to a rural community, which would be nice to see. There's a, 

Daniel J. Marino: 
 

Yeah. Right. Yeah, I can see that. Rich, this has been great. And I'll tell you, this is an area that I've fought long and hard about, certainly as we've helped hospitals pull together different types of programs. If you're a hospital leader, you know, one of the listeners who runs a hospital or even a physician that is interested in getting into locums, any advice that you might give them or thoughts that might help them think about looking into locums as a strong alternative? 

Richard Heim: 

Yeah. I mean, the access to locums companies, large locum companies is fairly easy these days. Again, good references out on the on the web for finding it. I think that ultimately, or potentially historically, physicians got into this for a lot of different reasons. I do believe people are in it today because of wanting to give back to their communities. So ultimately, they're great physicians with solid malpractice backgrounds. Many organizations have great stability in mm-hmm. <affirmative> in a lot of their physicians providing coverage. 

Daniel J. Marino: 
 

Yeah. Yeah. That's great. Well, Rich, I can't thank you enough for joining the program. This was a good discussion. As I mentioned, I really feel like having a strong locums partner is just a great way for a hospital to continue filling the needs and support within the patients within their community. If any of our listeners wanted to get in touch with you or have further questions anything you would feel comfortable sharing with them in terms of how they need it, how they can potentially connect? 

Richard Heim: 

Sure. Yeah. I mean we're all over social media. We have our website is locumspro.org, you can also reach us at Locums Pro on LinkedIn. You can email me if you'd like at Richardheim@locumspro.org. 

Daniel J. Marino: 

Um, wow. That's great. Well, thanks again, rich. I really appreciate it. And you're doing, you're doing great work, especially as you're placing a lot of physicians around some rural communities and fulfilling some of these challenging programs and specialties. So I commend you on a lot of the work you and your colleagues are doing. 

Richard Heim: 

Well, thanks for bringing this forward, Daniel. I really appreciate the opportunity to talk about it. 

Daniel J. Marino: 
 

And I want to thank our listeners for tuning in today. I'm Daniel Marino. Until the next insight, happy to bring you 30 minutes of value to your day. Take care. 

About Value-Based Care Insights Podcast

Value-Based Care Insights is a podcast that explores how to optimize the performance of programs to meet the demands of an increasingly value-based care payment environment. Hosted by Daniel J. Marino, the VBCI podcast highlights recognized experts in the field and within Lumina Health Partners