The History of Locum Tenens
The Latin translation for Locum Tenens is “to hold in place of” or “one holding a place”, and although I wish I could tell you a unique story of medieval doctors traveling around Europe in a 1972 VW minibus, it didn’t play out that way. The oldest logical origin of locum tenens work dates back hundreds of years, evolving into the business it is today and picking up the name along the way. In today’s post, we dissect the origins and history of locum tenens, starting way back in the 1800s and detailing the evolution and historical moments that shaped what locums is today. We will finish up with the current state of locums in 2018. Now gather round young kids and let grandpa tell you a story….
The earliest origins of modern locum tenens can be traced back to the mid 1850s, when California had just become a state and The New York Times was recently founded. At the time, frontiersmen had moved west in droves in search of gold and land in the rapidly growing number of new states. With expansion came new problems and a major source of concern was a lack of medical care in these newly founded towns and farms. The earliest ancestors of modern locum tenens can be traced to this period of American history, as records indicate both nurses and doctors would travel west for periods of time to provide medical care, albeit with limited resources. Although these physicians lacked a structured system of work, it would not take long for demand to be met with policy with the start of the Civil War in 1861. During the Civil War, doctors and nurses were assigned temporary positions by the government and would return to their pre-war practices, compensated for their time.
From 1900-1930, several medical advances brought a growth in locum tenens work. The newly developed mobile X-ray machine was used in limited capacity until the start of World War 1, when it was used with mobile technicians and radiologists in the treatment of wounded soldiers. At the conclusion of the war, a demand for physicians to treat returning soldiers provided the impetus for the opening of the first veterans emergency hospital in Virginia. Several years later President Hover would sign into law the creation of the Veteran Administration, providing the backbone for modern governmental locums as physicians often traveled between VA hospitals as they still can do today.
For almost 50 years, non-governmental physicians practiced locum tenens type work, but it did not take on a formal structured system until another demand surfaced. At this time, from 1968-1979, the modern era of locum tenens developed. In 1968, a group of American doctors would travel to Biafra Nigeria to aid in much needed medical care following a brutal civil war. Only 3 years later, the group would formalize itself under the name Doctors Without Borders. At the same time, in 1970, a need for rural physicians to receive continuing medical education training was proving to be an issue in Utah. Secondary to limited resources, doctors could not leave their towns for much needed education. To help with the growing problems of education and rural physician burnout (sound familiar!) an organization known as Health Systems Research Institute (HSRI), began offering a program at the University of Utah. Rural physicians were able to come for education and training largely because the program provided temporary physicians to cover their practices. This represented the first modern utilization of locum tenens physicians. As the program’s success grew, so did its demand, with similar programs starting in Alaska and California’s Yellowstone National Park. In 1979, the first true locum tenens staffing agency was founded when Dr. Alan Kronhaus and Dr. Therus Kolff, both prior travel doctors with HSRI started KRON Medical and Comprehensive Health Systems. I wondered why these two original founders wanted to do locum tenens, and the answer was easy to find. Dr. Kronhaus just wanted to ski. He took advantage of the opportunity HSRI provided and would take locum assignments all summer outside of Utah and save his money. He would return to Utah and take the winters off while pursuing his passion for big mountain skiing. Dr. Kolff’s story was slightly different, his entry into the locum tenens world started with a demand for visiting physicians in Yellowstone National Park to care for visitors and park rangers. These two had similar goals for life balance, to get off the hamster wheel and practice medicine on their own terms in a location they found inspiring. Together, they would set in motion the modern system of locum tenens.
From 1979 to 2001, the number of locum tenens agencies grew rapidly in response to demand for physicians by hospitals and practices. The original two staffing agencies saw competition in the form of specialty specific and expanded allied health locum tenens companies. In 2001, the National Association of Locum Tenens Organizations (NALTO) was founded with a commitment to ethics and to maintain the highest standard in the industry. NALTO provides guidelines of practices that protect both the agency and the physician. Such things as maintaining signed contracts, ownership and use of CV, resolution of disputes, and practice standards have allowed for transparency in the market. In 2018, NALTO has a total of 81 members, with a large majority being relatively young companies born out of a 20% growth in locum tenens demand in the past 5-10 years.
With the growth of physician’s locum tenens opportunities, many of the original and largest staffing agencies have grown in size and scope of services. Currently the 5 largest staffing agencies provide not only physician jobs, but service the nursing and allied health fields. The largest remains CHG Healthcare Services, the current name for the parent company of that small staffing agency in Yellowstone almost 40 years ago. Since 1979, it has grown to incorporate numerous smaller locum tenens agencies and recently expanded into international placements. In 2015 CHG represented 29% of the total locum tenens positons available with a revenue of 1.1 billion dollars. Not bad for a ski bum and a rural doctor in our national park!
Locum Tenens started over 150 years ago, with several adventurous doctors serving the frontier of a growing American landscape. In a way we have come a long way, both as a medical profession and a country, but the common reasons for interest in locum tenens work have not changed. Despite exponential growth over the past 10-20 years, the advent of technology and much needed regulation, the strong allure of locum tenens work remains. Within us all is a personal interest in adventure, a commitment to serving those in need and an earnest belief that doctors can still practice in an environment and a manner they believe in.
~The Locums Life~