Twenty years ago, locum tenens physicians were a relative anomaly at hospitals and medical groups. Today, 77% of facilities are using locum tenens physicians to maintain services while they seek hard-to-find permanent staff, a trend driven in part by the physician shortage.
Locum tenens physicians are important to providing continuity of care, but their impact on revenue should also be considered. By treating patients who might otherwise not have been seen or who may have gone elsewhere, they can maintain revenue streams in the absence of permanent physicians.
Locum tenens physicians are paid on a per diem basis, and from the facility’s perspective, daily rates must be balanced against revenues that physicians are likely to generate while working as locum tenens to measure a return on investment. The daily rate for a family practitioner, for example, is in the $750–$800 range. Rates are similar for general internists and run several hundred dollars per day higher for surgeons.
On average, a family physician generates approximately $1,433,000 a year on behalf of his or her affiliated hospital, according to Merritt, Hawkins & Associates’ 2007 Survey of Physician Inpatient/Outpatient Revenue. This equates to approximately $4,000 per day.
Similarly, a general surgeon generates about $2 million a year on average for his or her affiliated hospital, based on the Merritt Hawkins survey. This equates to about $5,400 per day. In some situations, locum tenens physicians will be net revenue producers, in some cases they are a break-even proposition, and there are instances when they represent a net cost.
However, additional factors should be considered. By helping to alleviate physician burn-out, particularly in cases where deficits on the permanent staff are causing physicians to be overworked, locum tenens physicians can prevent the significant cost of physician turnover. Long-term, locum tenens physicians can help maintain patient satisfaction levels, which have a considerable impact on the reputation and market brand value of hospitals and medical groups.
Like other types of temporary clinical professionals, locum tenens physicians provide the most value when they are integrated into a facility’s strategic staff plan. Planning in advance to use locum tenens physicians during peak usage times, to transition the practices of retiring physicians, and in other situations, is less stressful and often less costly than turning to them in emergencies. As a growing number of doctors embrace alternative practice styles, locum tenens physicians are one more piece of an increasingly varied mosaic.
This story was adapted from one that first appeared in the May edition of Physician Compensation & Recruitment, a monthly publication by HealthLeaders Media.
A teacher at the Hospital of the University of Pennsylvania is leading a worldwide network of Myanmar-educated physicians in launching a relief effort to get aid to victims of a catastrophic cyclone in Myanmar. Jennifer Chu, a Philadelphia physician specializing in pain management, said her group's intention was to "get the relief directly to the people who need it." The organization is called the Alumni Myanmar Institutes of Medicine Association, and hopes to funnel donations directly to doctors on the ground or to the Yangon General Hospital, the one closest to the disaster.
Spanish health authorities have launched a virtual portal through the Second Life Web site designed to help young people too embarrassed to speak to a doctor about potentially embarrassing problems, such as addiction or sexually transmitted diseases. Real doctors will log on and offer advice to their anonymous patients, and both will see an image of a consulting room with a doctor and a typical patient. The authorities said the idea started as a way to connect health professionals and adolescents and to give internet users a reliable space to get health advice.
Scientists at McGill University in Montreal have developed an automated anesthesiologist, and believe they are the first in the world to perform surgery using a totally automated system for administering the drugs needed for general anesthetic. The computerized system administers three standard drugs used for putting patients under for surgery and monitors their separate effects automatically. Researchers say "McSleepy" can calculate the appropriate drug doses for any given moment of anesthesia faster and more precisely than a human.
What distinguishes a physician leader from other doctors? The AMA puts the number of physicians in the United States at roughly 940,000, which includes both active and inactive doctors in virtually all practice settings and represents many top-notch clinicians, researchers, and residents. But how many of them can be considered leaders?
I posed the first question to Richard Schwartz, MD, a professor of surgery at the University of Kentucky College of Medicine who has researched and written about physician leadership development. His answer, in short: A physician leader is someone who is able to deliberately put on a different hat—clinical or managerial—depending on the task at hand.
It sounds simple enough, and the hat analogy certainly isn't new to discussions of leadership. But for hospital administrators and executives, putting on a different hat typically means shifting their focus to a specific area of management—patient safety, finance, or human resources, for example.
For physicians, it isn't so easy. The skills that make physicians excellent clinicians are in many cases "diametrically opposed" to the qualities needed in a manger or organizational leader, Schwartz says. Physicians are trained to interact one-on-one; leaders must deal with multiple constituencies at once. Physicians, particularly surgeons, are accustomed to making life-or-death decisions on the spot; leaders incorporate feedback and work on long-term projects. Physicians are trained to think of the patient first; leaders must consider all stakeholders. To throw another analogy into the mix: Physicians play solo sports, like tennis; leaders play team sports, like soccer.
So for a physician to step out of an operating room and into a board room requires not just a shift in focus, but an entirely new skill set. Successful physician leaders are aware of the distinct skills needed in each situation and are able to switch hats at will. They are able to put a foot in both worlds, and that's precisely what makes them such an asset. "The goal of the physician leader is educate the administrative hierarchy about clinical issues and physicians about administrative issues," Schwartz says. No one else has the perspective and skills to pull off both of those tasks.
Where many physicians go wrong is assuming that the quick thinking that makes them successful in the emergency room will translate at an organizational meeting. And where many organizations go wrong is in promoting physicians to leadership positions based on their clinical expertise. Just because a cardiologist is the rock star by every clinical measure doesn't mean he or she has what it takes to be a department head.
In fact, sometimes the physicians with the most influence in an organization don't hold traditional leadership positions. These "opinion leaders" are able to bridge the administrative-clinical gap without official titles.
So is physician leadership development simply a matter of identifying physicians who already have hat-switching abilities? That's part of it, but physician leadership can also be developed. "A lot of the popular literature would say leaders are born, not made. But there's no data to support that, whether you're talking about running GM or a healthcare system," Schwartz says. "You can groom yourself to be a good leader if you put in the time and the effort."
It's just a matter of learning a few new tricks.
Elyas Bakhtiari is a managing editor with HealthLeaders Media. He can be reached at ebakhtiari@healthleadersmedia.com.Note: You can sign up to receive HealthLeaders Media PhysicianLeaders, a free weekly e-newsletter that features the top physician business headlines of the week from leading news sources.
The CDC speculates that 1.7 million patients get hospital infections each year, and some suspect that it is actually several times that number. By screening patients for infections, however, hospitals can identify MRSA positive patients, isolate them, use separate equipment and insist on gowns and gloves when treating them, experts say. Despite this evidence, only 30% of hospitals in the U.S. are screening for MRSA.