Who Handles the Details in Setting Up a Locum Tenens Job?
When I first started my research into locum tenens positons in my field, there were several big questions I had. The main issues that concerned me were: a) The location of the practice b) The nature of the practice, exactly what I would be doing and c) The pay structure. We have addressed these topics in prior blog posts, but these three items were the most important to my success and happiness with a career in locums. However, even with these three items maximized, there are several smaller issues that cannot be neglected. The devil is in the details.
Credentialing, Licensing, Malpractice, Travel, Accommodation and Support
While I plan to break each of these items down in future blog posts, it was important to me to fully understand how these items would be addressed for me. Let’s be honest, a great position could turn into a nightmare if I showed up and couldn’t work because of one of these issues. Even worse, what if I got sued and wasn’t covered to the standard I expected?
When you are starting the process of locum tenens, the first step is to find a position that you want. Typically, these positions are made available to doctors through locum tenens staffing agencies. These agencies are contracted out by health systems, hospitals, or practices in need of locums coverage. Each locums agency will then advertise the position and serve as a line of communication between the doctor and the health system or practice. Locums staffing agencies fully understand that their main function is to advertise and secure quality practitioners. However, they also understand how to mature relationships with both the physicians and the practices. They certainly want the health system to be happy with their placements and to maintain that relationship for future staffing needs. They also want the doctors they work with to be happy, as the will have future assignments they need to fill. A quality medical doctor that can fill many locum tenens positions as a career is incredibly valuable. In short, they want you to be happy but they have a reason. Like any other agent working for or with a client, they make money with each position they fill.
The second role of locum tenens staffing agencies, beyond making the connection and finalizing the deal between you and the hospital, is to ensure that the details are taken care of for you to be able to practice. What details? Well, there are several. Let’s break them down.
The point of credentialing is to identify and validate your qualifications as a practitioner and to ensure your professional identity is correct. The hospital or practice that is contracting with you needs to be able to ensure you are going to provide quality care and you don’t have a history that is questionable. This is accomplished in several steps. First, the locums staffing agency will request you provide documentation for them to provide to the institution hiring you. You will need proof of training, including college, medical school, residency and fellowship documentation. Most of us have this filed away somewhere and the first time you do locums I recommend you make an electronic copy for future use. Board certification documentation for your specific specialty, life support documentation, DEA number, and specialized training for your specialty requiring formal documentation will also be needed. In addition, most positions will require between 3 professional references, with several of these coming from doctors practicing in your own specialty. Ultimately, your references should be able to provide a clear evaluation of your competence over the past 3 years of practice, although, older references are often accepted. Finally, your hospital vaccination records may be required for certain specialties and locations, so it is best to have this up to date and provide the documentation early. Once this information is acquired, the locum tenens staffing agency will file it and keep it current for up to 2-3 years within their system. They then put it together and submit to the hospital for review, a process known as external credentialing. Some hospitals will have additional information they require, depending on the specialty, state and position. In reality, the majority of these aspects of locum tenens credentialing are on the practitioner to obtain, and the first time you do locums work, it may take a few days to weeks to round up all your information, especially those letters of recommendation. However, once on file and organized, the impact to the practitioner is minor and the responsibility of credentialing falls on the contracting hospital or health system. If your hospital is like most of the ones I have practiced in, this typically can take months. It is the locum tenens agent working closely with the contracting hospital that expedites this and ensures everything is finalized in a rapid fashion so you can get to work caring for patients.
Embracing the adventure and travel aspects of locum tenens work has its benefits. However, when it comes to being able to practice wherever you want and when you want, there are some pitfalls. I am sure many of you remember the stress of getting your new state license prior to residency, fellowship or your first job. It seemed unnecessarily onerous, and frankly it was. There is little reason it should take you 6 months to get a California medical license when you already have one in good standing in New York or Pennsylvania. Especially when you are scheduled to start in 2 weeks! Now imagine doing that every 3 to 6 months, it can be even more frustrating. Luckily, there have been some changes in the licensing process for physicians in recent years. There are several items all medical licensing departments require. Verification of identity, malpractice verification, and controlled substance registration will be required by individual states. How quickly each state puts these items together with other state specific demands is variable. The Federation of State Medical Boards website provides a breakdown of each state’s requirements. In the past, locum tenens doctors quickly learned that they would be in a better position to land the coveted spots if they maintained active medical licenses in several key states for their specialty. However, when it comes to specific positions, the locum tenens agency will work quickly through back channels to expedite the process whenever possible. For short term locums positions, this is often not possible and agencies will look to fill these spots with practitioners already licensed in that state. However, for longer term positions, agencies can often jump through hoops to get you licensed quicker than you could on your own. Recently, the Interstate Medical Licensure Compact has set to expedite the process for doctors looking to practice in multiple states. The compact allows doctors to be licensed and practice is 22 states if they meet the minimal requirements for the compact. If you are considering locum tenens as a permanent practice option, or even for intermittent work, maintaining certain state licensing can be critical in your ability to secure the coveted positions.
Even talking about malpractice sends shivers through my body. You spend nearly half of your life training to help and serve mankind, but mistakes still happen, and you need to make sure you are thoroughly and appropriately protected. Most of us are familiar with the two main types of malpractice insurance, claims-made and occurrence-based policies. Occurrence-based policies cover the practitioner for any alleged acts that take place while the policy is active, regardless of when the claim is filed. As an example, a doctor misses a diagnosis in 2016 and then retires or changes his policy. If the doctor had occurrence-based insurance, the insurance would cover the claim even if it was filed in 2018. Claims-made policies cover the practitioner for alleged acts of malpractice that take place AND are reported to the carrier during the policy period. Once the policy is over, the coverage ends, and a new policy is needed. Most claims-made policies will require a doctor to purchase tail coverage, or a policy to cover them after they retire, and their prior claims-made policy is no longer active. Occurrence based policies tend to be more expensive on a yearly basis when compared to claims-made, but when you add in the tail coverage, they often cost the same over a career. Always remember, insurance companies have done their math.
A locum tenens doctor will need to be covered for malpractice while they are working and in most situations these costs are covered by the locums staffing agency. I reached out to 10 different staffing agencies for the details of their offerings and found 100% had claims-made policies. The malpractice policies typically had a 12-month duration, although 6-month policies were available on some plans. Regardless of duration, the policies will typically have a per claim payment of $1,000,000 and a $3,000,000 maximum per year. When comparing this to industry standards for hospitals and private practices, these policies are reasonable. It is important for you to ensure that the policy is acquired through an A-rated insurance carrier through A.M. Best, the definitive ratings organization. In addition, because your locum tenens agency handles the paperwork for your malpractice coverage, it is critical that you request and file a copy of your certificate of insurance. As a senior resident once taught me in training, trust no one!
The last issue is tail coverage. Assuming your locum tenens agency provides claims-made coverage, what happens when you move on to your next assignment or retire? Most reputable locum tenens staffing agencies will provide and pay for prior acts or tail coverage. This is one very big reason to work with a locums agency that has a strong history of financial stability and a track record of success. If the staffing agency goes out of business and has purchased a limited tail coverage policy for you, you may be in a bad situation. Ensuring you are working with a reputable company with unlimited tail coverage can be your best deicision. Another option frequently used by locum tenens companies with claims-made policies is for new policies to carry a retroactive date to the company inception date, resulting in an extended reporting period for prior exposure. This may eliminate the need for tail coverage. Regardless, having a clear understanding and documentation of your specific policy and the possible need for tail coverage is critical for any physician signing up for a locums assignment.
Travel, Accommodation and Support
You arranged and negotiated a great position, who wouldn’t sign up for that hospitalist position in Aspen this winter? Everyone knows you have always dreamed of a winter in the mountains to work on your snowboarding skills. The pay is great, the clinic is nice, your credentialing is finalized, and you are licensed and insured. The next step can make or break your experience. How are you going to get there, where are you going to stay, do you get a car and what happens when things go wrong?
In general, the locum tenens agency will handle most of the details of your travel, lodging and experience when working on an assignment. Of all the prior topics discussed, this aspect of locum tenens work can have the most variability. Some agencies will handle all the details, including paying up front for your expenses, and allow you to provide some degree of reasonable input into the decisions. In general, assignments that require you to travel further than four hours in the car will allow for airfare payment. Most locums agencies will handle your flights and pay for them up front. In addition, they will handle the hotel and rental car you will need. The types of places used for lodging are on the lines of an extended stay hotel and not a luxury resort or home rental. However, in some markets, availability dictates where you stay, and nicer options are used. You should never be expected to stay in a hotel that is unsafe or not to reasonable standards. Some agencies require you to pay for your expenses and will reimburse you at a later time. Flights, hotels and car rentals can add up to a sizable balance, but agencies know this and on average, most will reimburse you on a biweekly basis. You will be provided with a schedule for pay period dates and expense forms with instructions. While this may seem like a down side to some agencies, astute locums doctors will utilize the points and travel miles associated with these expenses in their favor. A year on the road can add up to sizable travel benefits for you and your family, a possible small perk of the work! Additional expenses need to be defined before the assignment starts but often are not covered by the staffing agency. Such things as meals, mileage on your own car for close assignments, and business-related expenses may not be covered but often times can be used as a tax deduction on a partial basis. Once the details of your assignment are finalized, you typically will receive an itinerary of all of the items you need.
The final item is support, and my hope is this is never something you need. However, if you plan on doing locums work more frequently, issues are inevitable. What happens when your flight gets canceled and you are scheduled to start in the morning, or the car rental runs out of SUVs for that Aspen assignment? It is in these situations that you will be happy you chose a reputable company to work with. Locums agencies respond quickly to issues and will work hard to get you back on track. Keep in mind, the staffing agency wants you happy, and tries their best to work hard for you.
Individual experiences with locums will vary with each assignment, agency and location. I have started an online forum for clinicians to interact and discuss anything they find important. From one doctor to another, we are stronger with information and the ability to dissect both the big issues of locums and the small details that happen on the road. I encourage you to sign up and post!!!
~The Locums Life~