Navigating the Ebbs and Flows of Today’s Healthcare Staffing/Locums Marketplace
Jarin Dana, cofounder of Fusion Healthcare Staffing in Salt Lake City, is President of the National Association of Locum Tenens Organizations (NALTO). NALTO is committed to a code of ethics and representation of all agencies that place locum tenens providers. NALTO looks to create standards, ethics, guidelines, best practices, industry advocation, and things that benefit the industry as a whole and each of its members individually. With a background in tax, finance and accounting, Jarin serves as Fusion’s Chief Financial Officer and works extensively to promote and improve locums/healthcare staffing programs and protocols. Before he became NALTO President, Jarin served as treasurer, vice president and president-elect of the organization. In this interview, he offers his thoughts on some of the challenges – and opportunities – that exist in today’s rapidly changing healthcare environment, as well as things that physicians and risk managers should consider when working with locums staff.
Regarding the overall growth of the locum marketplace – who wants locum talent today and why?
We’ve seen growth ever since inception, paired with contractions for a variety of reasons. Over the past 40 years, we’ve probably seen market contraction happen three or four times. The most recent incidence would’ve been during COVID-19, when we saw the demand drop by about 30 percent. That decrease was primarily driven due to the suspension of elective surgeries and things associated with care around those procedures. However certain specialties saw an increase, such as pulmonary critical care or care situations that may have been directly related to the treatment of COVID-19.
This started in mid-2021 and continued through all of 2022, 2023 and the better part of 2024. “After the pandemic, or I should say on the heels of coming out of the pandemic, we saw a tremendous burst in demand.“ Demand is still much higher now than it was pre-COVID, but slightly down from the peak in 2023. We’re still seeing demand from the same players in large healthcare facilities, all the way down to independent rural clinics or any place there is a need for a physician on a temporary basis. We’ve got a wide range of settings in which providers are working temporary shifts.
Are there any physician specialties that are particularly sought-after in locum work?
It ebbs and flows all the time. Currently, there’s a high demand for anesthesiologists and CRNAs. We saw a big spike in that but we’re also seeing a little bit more demand for medical oncology and radiology, which had its ups and downs over a period of 10-20 years. You tend to see the ebbs and flows by specialty.
Regarding if there are patterns to those ebbs and flows, I’d say it’s difficult to quantity why those come about. Some of it could be market conditions and the supply-demand dynamic in that particular specialty. It could also have to do with how consolidation among practice environments occur. For example, if you look at emergency medicine and hospitalists, these are two specialties that are really dominated by large national contract groups. Consolidation, mergers and acquisitions in those could be significant shifts in how we place providers in the specialties with our clients. Our clients are changing and consolidating, breaking up or splitting off. As that occurs, the demand can be affected.
If the locum environment is so highly competitive now, where are you looking for physician talent?
You look across the entire age spectrum. A physician who is in their late 60s to early 70s, someone perhaps looking to retire, is a great candidate because they can get out of the busy rat race of having their own practice or working for a large healthcare system. They can pick up shifts as they move toward retirement. That’s one good example. Another area are new physicians finishing their residency. “Twenty years ago, healthcare professionals who went into locums/staffing positions were unable to get a 'real' job.” They’re young and motivated to travel. They’re looking for exciting practice environments. They don’t quite know where they want to settle down. Those are great candidates. Then there are physician candidates in the middle that are looking to pick up a little extra money. For example, if they have kids going to college, they might be looking to pick up extra shifts. A lot depends on the age group and how an agency targets those different groups.
I will say that there are a lot of ways to go about it and resources to use, but at the end of the day, we tend to be all fishing in the same pond. We’re looking to constantly recruit physicians to do locums work, physicians that have never done it before. Today, many providers doing locums are very talented, high-caliber people have found satisfaction and flexibility in doing locums. They’ve realized they can provide a valuable service to the communities in which they live or that they’re close to and have other benefits that they want in their own lives.
From your perspective, how has the pandemic impacted locums work – good or bad – over the past few years?
If you look at some of the headlines related to healthcare staffing, what might jump out is what the nurse staffing industry saw. During COVID, nurse billing rates and pay rates skyrocketed because the demand was so high, and there was not enough supply to meet that demand. You saw a major spike from 2020 to mid-2023 in that space. Specialties had some spikes and some valleys, but on average the market rates for locum tenens physicians stayed relatively stable and that’s despite even seeing the demand spike post-pandemic. I think it’s a good thing that those remained stable.
As an industry, we’re trying to fill staffing shortages and staffing gaps for our clients.“The pandemic highlighted and emphasized the shortage that we have as a country for physicians nationwide. It’s certainly a problem we must come up with creative solutions to solve.” We want those to be fair market rates to maintain a competitive landscape for the physicians that are doing the work and the agencies that are doing the placements. What is not a good trend though, and I think what the pandemic and post-pandemic have shown us, is the shortage that we have in our physician talent pool in the United States. We are staring down the barrel over the next 10 years of a significant physician shortage. We think locum tenens will play a big role in that because we facilitate flexibility in the workforce.
We already know that younger physicians explore locum work in part because of the medical debt issue and late-career physicians often test locum as they transition into retirement, but are you saying locum may become an option for mid-career physicians as well?
Absolutely, I think the pandemic really pushed our society to flexible work arrangements. There are certain professions that inherently don’t have the flexibility that an office type position would have with working from home. That doesn’t mean physicians didn’t feel a desire for a better, flexible work arrangement and that’s a major reason why people do locums. I think it will continue to attract physicians that are looking for that flexibility and how they control their work schedule so that they can work where they want, when they want, and for the rate they feel they deserve.
If a physician is considering locum work, what should they ask their prospective staffing agency?
It’s less a matter of asking and more a matter of telling them what they’re looking for because it’s a different recruiting environment. If a physician is willing to travel, they get on a plane and travel to the local area or across the country versus whether they’re looking for something within driving distance. Their goals matter. Do they have kids at home? How busy do they want to be? Do they want to go work in a large hospital or they looking for something in a more rural “Understanding what the physician wants is where a physician should start when talking with a staffing firm.” setting? Once you articulate those goals, it’s easier for the agency and the recruiter to find the right placement at the right facility. Hospitals come in all shapes and sizes, they have different volumes, bed counts and things like that.
Most recruiters are very good at asking the right questions if the physician doesn’t quite understand how it works. Some important questions would also be understanding malpractice coverage. Doctors need to understand how that works, how tail coverage works, what the risks are based on the facilities they’re going to and how compensation works. Then you start getting into personal things that the doctor needs to understand. If they’ve been a W-2 employee their whole life and now they’re going to be receiving compensation as a 1099 independent contractor, that has different tax and financial implications. They have to understand and learn, none of which is difficult – it’s just different.
How did the pandemic impact/change locums work for physicians and other healthcare professionals? And how have staffing agencies adjusted/shifted their efforts today to accommodate those impacts?
We’ve gotten a little help from a regulatory perspective. One example of that is the expansion of the interstate medical licensure compact. As of now, 39 states have joined the compact. This provides a pathway for faster licensure in the states that are a part of the compact. For example, if I’m a doctor and I’m licensed in the state of California but I want to work in Nevada, we need to make the licensing process more efficient. This is so that that doctor in California stays motivated to go work in Nevada because that doctor in California may be filling critical gaps. I think our agencies are taking advantage of the interstate medical licensure compact more now than ever before because of its wide adoption.
What are you most optimistic and/or concerned about for the future of the locum staffing industry?
I’m probably most optimistic about the flexibility the workforce seems to be adopting. I do believe that the shortages can be mitigated, “I think we need to continue regulating around making that an easier and more affordable process so we can encourage the younger generation to choose becoming a physician as a profession.”to a certain extent, by the further adoption of locums. I’m optimistic because we see more and more doctors [doing locums work]. This will help get doctors where they need to be, when they need to be there. What concerns me is our overall shortage, especially with how difficult and expensive it is to become a doctor. I’m concerned about future regulation that would only make our staffing shortage harder to fix rather than easier. I’m confident in the physicians we have now. They’re willing to be flexible but the worst thing that could be happen is a regulation making it difficult to want to be a part of locums.