Setting Expectations and Outlining Effective Procedures to Locum Tenens Providers
Shawn Mullen, Chairman of the Mediation Committee at the National Association of Locum Tenens Organizations (NALTO)
Shawn Mullen, President at Interim Physicians for almost four years, is the Chairman of the Mediation Committee at the National Association of Locum Tenens Organizations (NALTO). Prior to his current position, he worked at Medicus Healthcare Solutions for six years, was a litigation attorney for over 20 years and switched careers at age 46 to pursue healthcare staffing. His passion for defense litigation drove many successful years of experience representing insurance companies and employers in workers’ comp. matters. He was able to translate his experience smoothly into the locum tenens world. Shawn has now been working in the locum tenens field since 2014.
What market trends are you witnessing right now in the locum contracting process? Are there certain pay/work environment demands locums are making now than say prior to the pandemic?
It’s an interesting two-part question that can be focused on both contracting with clients and providers. We see that clients tend to be more cost-conscious now because during the pandemic, many physician staffing agencies opted not to inflate prices. Certain areas in hospitals where they required additional staffing, such as nursing, saw a significant increase in rates. These facilities are still working through the aftermath of this, causing hospitals and health systems to be cost-conscious right now.
One of the challenges is conveying that the market is heavily influenced by locums’ rate requests. We see this especially in particular specialties or geographies. We try to match the rates that a good physician is going to require to handle a staffing shortage with the expectation of what the hospital health system is willing to cover. It always has been a challenge to some extent but seems to be a little bit more challenging now.
In terms of the locums’ themselves, they want a more detailed job description than in years past. We’ve noticed more locums providers are wary of cancellations prior to their start date. When we contract with them, we enforce safeguards that will ensure payment in case of cancellation. This can also create challenges when matching with the clients.
Are there particular types of practice environments doctors are leaving right now to become locums? And are there specialties or practice areas that you are seeing more interest in from healthcare professionals looking to migrate to locums work?
Providers are looking to leave environments where they feel understaffed, overworked and undersupported. This is typically seen in places that don’t have enough additional support staff. Job roles may extend past patient centric duties in these environments creating undefined boundaries. Providers in these roles then look to locums work for autonomy as an independent contractor and control of their schedule.
For example, they could work for three weeks and then take the next month off. They can choose where they want to go. Often, you’ll find that they see locum tenens as a way to make money without areas of dissatisfaction.
In terms of practices or specialties, it’s everywhere. It’s interesting because we’ll see a six-to-nine-month period where one particular specialty has an increased need and all of a sudden, there won’t be a lot of demand for it. Right now for instance, surgical specialties, emergency medicine, anesthesia and CRNA are all prevalent right now. There are waves of ups and downs in different specialties. Agencies try to figure out market trends and why the needs have increased. I think the anesthesia CRNA shortage is driven mainly by the increase in separate surgical facilities. There are surgery centers now where there weren’t before. I believe the increase in surgery centers are driven by the insurance reimbursements, insurance approvals and easier navigation through getting your consultation and surgery done quicker. People prefer to go and have their surgery at a surgery center rather than wait at a hospital. The influx of these facilities in the market has created an increased demand for surgeons, anesthesiologist and CRNA’s.
What strategies should be employed to efficiently integrate a new healthcare provider under locum tenens coverage?
What it boils down to is two very important things: walking them through the process and setting the right expectations for a provider who’s never done locum tenens work. To start the process, we have to clear their name by ensuring they haven’t been presented there by another agency in the recent past. Once they’re cleared, we present them over at particular rate with an updated CV. After their review, they’ll most likely have an interview. They’ll want to get to know the provider, find out further information and answer questions they may have. Once they accept, they need to be credentialed and given a start date which is all documented in contracts. It’s important you walk them through the process so they understand it and set the right expectations about what they need to do. Challenges can arise if the provider has difficulty supplying the various items needed for credentialing. It can be time consuming and that’s why it’s important to set that expectation upfront.
Secondarily to process and procedure, is making sure that they understand the job requirements. For instance, they need to know everything from what the schedule looks like, what’s a typical day, patient population, do they perform procedures, certifications requirements, etc. They’ll need to get the right certifications if they don’t have them already. We also need to make sure they understand everything, even right down to what EMR they use. They might have to learn a new one and we have to understand how comfortable they’d be in doing that task. Further examples of job requirements extend to work ethic or if they have subspecialty support. Our salespeople provide the job details and the recruiters explain to the providers exactly what this job is. It’s so important that the client, meaning the hospital or health system, and the provider all understand what’s expected. It’s really about communication and setting expectations.
What credentialing process should be employed when starting a new locum tenens assignment?
What’s important for me and my organization is to make sure we’ve got credentialers that understand the process and the timelines. The physician needs to understand this and due dates. It can be a difficult process that requires voluminous paperwork and it’s best to communicate that. For example, imagine you’ve been a doctor for 30 years and they’re requiring a copy of your medical school diploma. In my opinion, the system could benefit from a centralized, national credentialing group. For example, on January 1st, they’ve done all this work backward. In my mind, there should be a group that says “all you have to do is move forward” because they’ve already been credentialed backward. The reality is that every time we present a physician to another location, they’re verifying every place on the physicians CV even though the last hospital that they worked at just did that. It can be repetitive.
It comes down to our credentialing team setting the right expectations with the physician about what’s required. The agency also has to utilize technology to make things more efficient. We cannot answer any questions on an application for a provider, but we can fill in the places that require their information such as name or address. We try to make it as easy as possible for them. It’s really about being organized and keeping track of where things stand in the credentialing process. It’s important to have great communication with the new locum tenens provider or a first assignment at a location. This would include our credentialing specialist, the provider seeking the privileges and the medical staff office at the facility to which we’re presenting the provider. Those who have been in the locums industry for a while understand the process more than a new provider. That’s why it’s important to make sure they’re willing to undergo the undertaking and let them know how hard the MSO at that hospital is going to work on getting first party verifications. For example, verifying the employment directly from the prior hospitals that they worked to ensure there weren’t malpractice claims that we don’t already know about.
Providers can absolutely get burnt out from the process. There’s an art to not only qualifying, but disqualifying, providers that aren’t up to the task. As a recruiter, if we’re having delays in the credentialing process due to the provider, it negatively impacts ourselves and the facility to which we’re presenting the doctor. If we can’t get past a credentialing process, it takes up time from another potential provider. As an example, many physicians have a stretch where they’re working 7am to 7pm for seven days straight and aren’t able to do credentialing during that time they’re seeing patients. They’re also balancing work, commute and family. We have to understand them, and this is where the communication comes in. We have to ask when they’ll be able to get information over by and if they’re able to hit deadlines. It can be an aggravation for the hospital, agency and the provider.
What are you most optimistic and/or concerned about for the future of the locum staffing industry?
I’m optimistic about the industry in a way that really touches on a problem we have in the country: we don’t have enough physicians. That’s not a good thing for anybody. We try to place providers to facilities. For instance, we’ve placed OB/GYN’s in rural hospitals and had we not put them in that position, somebody who’s pregnant may have had to drive two hours to get to a hospital where there is an OB/GYN. That can be a problem and we’re doing really good work to fix it.
I don’t think that the need is going away because the number of people going to med school and getting into certain specialty practices is going down. That means the physician staffing shortage is going up. In particular areas, it’s pretty bad. For example, psychiatry is one of them. We do not have enough people choosing psychiatry for residency and fellowship. We see a big lack of psychiatrists and a big influx of mental health treatment needs. There’s a crisis for mental health in the country and because of that staffing shortage, we play a big role in making sure we fill the gap so that patients can be seen.
I’m not too concerned about the future of the staffing industry but things to be aware of are consolidation of hospitals into large groups and large healthcare organizations being bought up by big corporate health systems. In my opinion, this can create less focus on rural hospitals which is concerning. There’s a bottom line for their hospitals and more detachment away from particular facilities. I think that can be problematic because they may be so distanced that they don’t fully grasp how understaffed they are.