Demand for locum tenens physicians has slowed

With doctors’ visits going down — and more employed physicians available to fill any openings on the schedule — the demand for temporary medical help has softened.

Evidence comes from Irving, Texas-based AMN Healthcare, whose Staff Care subsidiary is a major source of locum tenens physicians. Staff Care filled 219,576 days with locum tenens physicians in 2007, and this went down to 183,252 in 2011. Although that year’s number is up slightly from 181,834 in 2010, it’s still historically low.

Seventy-five percent of the 106 health care facilities participating in the annual Survey of Temporary Physician Staffing Trends issued May 14 by Staff Care used locum tenens physicians in 2011. This represented a decrease from the 79% who reported using them in 2005. Forty-one percent were looking for locum tenens physicians to supplement staff in 2011, but 53% were doing so in 2005. Thirteen percent said in 2011 that finding locum tenens physicians was more difficult than the previous year, but 20% said this in 2005.

AMN Healthcare collected $64 million from locum tenens staffing in the first quarter of 2012, according to results released May 3. This is a 2% decline from the final quarter of 2011 and a 10% decrease from the first quarter of 2011.

Other companies have noted that demand for locum tenens physicians has been flat or growing more slowly than hoped. They said a slow economy and increased employment of physicians by hospitals were the major reasons.

Physician office visits declined 4.7% in 2011, according to data published April 4 by the IMS Institute for Healthcare Informatics. In 2010, visits went down 4.2%. Hospital finances also have been strained. Before the recession, the median annual revenue growth at nonprofit hospitals was 7% or more, but was 5.3% in fiscal year 2011, according to a preliminary analysis published April 26 by Moody’s Investors Service.

Eighty-one percent of health care facilities in the Staff Care survey said in 2005 that cost was a drawback to using locum tenens physicians. This number grew to 86% in 2011. A locum tenens physician may cost a facility more than $1,500 per day, depending on the speciality.

Timothy P. Hand, CEO of St. Louis-based staffing firm Interim Physicians, said hospitals are using staff physicians to cut into that cost. A total of 62,152 physicians and dentists were employed full time by community hospitals in 1998, and this grew to 91,282 in 2010, according to the American Hospital Assn.

“The hospitals are waiting to the last minute [to call locum tenens help] to try to see if they can staff entirely with their own people,” Hand said.

David Rivera, MD, a locum tenens obstetrician-gynecologist based in Lombard, Ill., is still working a steady six to nine months a year, but he has a shorter list of assignments from which to choose.

“Locum tenens has always been hit or miss, but the number of jobs seems to have gone down,” said Dr. Rivera, who has worked as a locum tenens physician since 1996.

Although the number of days worked is declining, demand for primary care doctors, general surgeons, psychiatrists, hospitalists and emergency physicians to work locum tenens remains high. In addition, the Staff Care survey found that the percentage of health facilities relying on a locum tenens physician until a permanent doctor could be found went up from 36% in 2005 to 57% in 2011. The proportion of facilities bringing in locum tenens to meet rising patient demand went from 2% in 2005 to 8% in 2011.

Locum tenens staffing companies expect more patient demand because of an improving economy, an aging population and further implementation of the Patient Protection and Affordable Care Act, assuming the U.S. Supreme Court doesn’t strike it down in June.