Growing number of locum tenens doctors strive for simpler life

A stable demand for physicians is creating a new breed of doctors who work only part-time, temporary assignments.

By Jay Greene, amednews staff. Jan. 29, 2001.

For Mary Nguyen, MD, 38, working temporary assignments as an internist frees her from the grind of administrative paperwork and hassles of HMO care approval and payment denials. She loves the feeling of riding up on a white horse to a new assignment where she is really wanted.

For Dave DeVere, MD, 50, working as a locum tenens anesthesiologist enables him to take off three months a year to travel to places like Ireland, Germany and Alaska or to attend personal finance meetings. He also likes his family-friendly schedule and the control he has over job assignments and work environments.

Changing trends

For Robin Staebler, MD, 64, working part-time jobs as a family physician allows him to enjoy the pleasures of semiretirement along with the satisfaction he always feels when taking care of patients. He also likes the additional freedom he has to travel with his wife, relax with his ham radio hobby and visit grandchildren.

Although few data are gathered on part-time physicians, most experts believe their numbers are growing. One survey last year found 15% of all physicians worked locum tenens during their career compared with 4% in 1987, said Staff Care, an Irving, Texas-based locum tenens company.

"We are seeing more younger doctors and residents become locum tenens. It is not just for older or retired doctors anymore, although doctors ages 45 to 60 still represent the largest group," said Dustin Koger, Staff Care's vice president of operations. "Locum tenens doctors have more freedom to practice medicine than anyone today. It is a significant draw."

AMA data indicate that semiretired doctors increased to 1.7%, or 13,585, in 1999, from 1.1%, or 5,908, in 1985. Inactive doctors, which includes those who are part-time, semiretired and retired, increased to 9.5% in 1999 from 7% in 1985, the AMA said.

With experts now saying the nation is facing a growing shortage of specialists, locum tenens companies say demand and pay are increasing for anesthesiologists, radiologists, cardiologists, pulmonologists, psychiatrists and other specialists.

Fees increased 31% for anesthesiologists between February 1998 and June 1999, Staff Care said. During that same period, cardiology fees jumped 30% and radiology fees increased 16%, but primary care physician fees increased only an average of 3%. "The fee increases are related to the greater demand for specialists," Koger said. About 70% of fees go to physicians as salaries. Locum tenens firms generally provide malpractice insurance, licensing assistance, travel expenses and other administrative paperwork costs.

"We can't find enough psychiatrists to fill the jobs," said Scott Webb, vice president of psychiatry for Staff Care. "It is an especially hard market for child psychiatrists."

At U.S. Radiology Partners, Greg Lowenstein, company president, said radiologists are in such short supply that the Dallas-based firm now uses locum tenens to fill slots. Some 45% of hospitals report they have insufficient numbers of radiologists, according to a recent U.S. Radiology Partners survey of 245 hospital imaging departments.

"Radiologist compensation really has shot up the past two years," Lowenstein said. "It looks like a couple years before the shortage alleviates. So we will continue to use locums."

Many reasons for part-time work

"When I was in practice I had so much paperwork and [so many] Medicare regulations to follow. There were personnel and management problems. It was too much," said Dr. Nguyen, who just completed a six-month stint at the Veterans Affairs Medical Center in Houston. "Now I don't have to worry about paperwork ... and whether I am reimbursed. I just deal with patients, which is why I first got into medicine."

But for Dr. Nguyen, a primary care physician who started locum tenens work last year, there are tradeoffs for an improved professional life. "The pay is lower. I thought it would be 10% to 20% less, but I earn between 30% and 40% less," she said. "The benefit is that I am able to schedule more time off -- about two months a year -- and I have much less paperwork."

Koger said that although the fastest growing group of locum tenens comprises residents and new physicians, only a minority of part-time doctors make temporary assignments a career. "It is not surprising to me that primary care doctors earn less money right now than specialists," he said. "There is not much of a shortage for primary care internists."

At Project USA, a 27-year-old division of the AMA that helps physicians find part-time jobs with the Indian Health Service, residents and new physicians are representing a small but growing number of physicians, said John Naughton, its director.

"Many are residents looking to earn extra money. Most are physicians in practice who just take time off once or twice a year for an assignment," Naughton said. About 300 physicians each year are placed at federal sites in Arizona, Montana, Nebraska, New Mexico, North Dakota, Oregon, South Dakota and Washington, he said. The top salary for experienced physicians is $1,500 a week.

Three years ago Dr. Staebler decided that he wanted to escape the piles of paperwork of private solo practice and joined locum tenens. Where Dr. Staebler lives in Belfast, Maine, half the town's 46 physicians are part-time, he said.

"I have been working ER two days a week at the local hospital," said Dr. Staebler, who works four 12-hour shifts over six days, then has eight days off for vacation or locum tenens work. "I work at the hospital mainly because health insurance [costs are high] and I can get access to the group plan."

As an anesthesiologist, Dr. DeVere is in high demand. "This is much different than in 1994, when there was a surplus of anesthesiologists," he said. "I can work two-thirds of the year and pretty much make the same income as I did full-time."

While on assignment, Dr. DeVere lives in hotels that have some of the comforts of home, including microwave ovens and refrigerators. "When I worked in Erie [Pa.], they put me up in a Marriott Suites," he said. "I always make sure I am in decent quarters."

Since November 2000, Dr. DeVere has worked for J&C Nationwide, an Atlanta-based recruiting firm. Working for a locum tenens company frees Dr. DeVere from the time-consuming tasks of licensing and credentialing paperwork. He is licensed in seven states.

"I am here [at Reid Hospital, Richmond, Ind.] for four weeks," he said. "That is the longest I will work at any one place. I work Monday through Friday and drive home [about 250 miles] for the weekend. I limit my locums jobs to driving distance home. That will change after my daughter graduates from high school. I might look for a full-time job after she starts college, but I really don't want to be low man on the totem pole in a practice."

ADDITIONAL INFORMATION:

Changing trends

Numbers of part-time, semiretired doctors are increasing:

Locum tenens physicians increased from 4% in 1987 to 15% in 2000.
Inactive physicians increased from 7% in 1985 to 9.5% in 1999.
Semiretired physicians increased from 1.1% in 1985 to 1.7% in 1999.

Sources: Locum tenens, Merritt, Hawkins & Associates; other, American Medical Association