Substitute Physicians Are Safe for Patients, Study Shows

Debra Shute, December 6, 2017

Despite some reassuring findings, authors say more research is needed to identify hospital-level factors associated with the quality and costs of care related to locum tenens physicians.

Patients treated by a locum tenens physician in the hospital are no more likely to die within a month of discharge than those treated by full-time doctors, according to a study conducted by Daniel M. Blumenthal, MD, MBA, of Massachusetts General Hospital in Boston, and colleagues. The findings are published online in JAMA.

While the retrospective analysis of 1.8 million Medicare beneficiaries hospitalized during 2009–2014 found no statistically significant difference in 30-day mortality between the two groups of patients—8.7% for those cared for by staff physicians versus 8.8% among those treated by temporary doctors—the hospitals' pattern of locum tenens use played a notable role in mortality.

Related: The Balancing Act of Clinician Supply and Demand

In particular, hospitals that used substitute physicians less often had somewhat worse patient mortality outcomes. In the lowest third of locum tenens intensity, adjusted 30-day mortality was 11.63%.

As for other metrics, patients treated by locum tenens physicians had significantly higher Part B spending, significantly longer mean length of stay, and significantly lower 30-day readmissions.

"Our findings so far are reassuring, but some of the trends we found demand that we look more closely at how the system works in a more granular way,” said study senior author Anupam Jena, MD, PhD, the Ruth L. Newhouse Associate Professor of Health Care Policy at Harvard Medical School.  

Debra Shute

Debra Shute is the Senior Physicians Editor for HealthLeaders Media.

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