Survey: 10% of Hospitalists Work as Locum Tenens

October 11, 2011

A new national survey of Hospitalists shows one in ten working as locum tenens and doing so, for the most part, in addition to full-time employment.

The findings come from a first-ever survey of Hospitalists regarding their locum tenens work patterns. The survey was conducted for Locum Leaders, a national locum tenens company specializing in hospitalist jobs, in conjunction with Today’s Hospitalist magazine.

The survey found that 10% of respondents worked as locum tenens in the past 12 months. Of those Hospitalist locum tenens, 82% said they were employed full-time and also working as a locum. 11% said they were self-employed?working exclusively as a locum tenens hospitalist, while 7% said they were employed part-time and also working locum tenens assignments.

It is common for locum tenens physicians to be drawn from the ranks of salaried doctors. But employed hospitalists, even more than other specialists, may be more inclined to take on locum work, according to Robert Harrington, MD, SFHM, Chief Medical Officer of Locum Leaders.

“Hospital Medicine shift patterns are the biggest reason,” said Dr. Harrington. “Since most hospitalist programs rely on a 7-on, 7-off schedule, you end up with a large population of doctors who have a lot of time-off. They want to use that time productively and so they come to agencies, like Locum Leaders, for additional work.”

Age and financial goals may also play a role, according to Dr. Harrington. As a relatively new specialty, Hospital Medicine skews toward younger practitioners. Because younger doctors have a larger student debt burden, they are more likely to seek supplemental income sources.

The survey supports Dr. Harrington’s contention. Of the Hospitalists who had worked as a locum within the past year, 77% cited “compensation” as a primary motivation.

Hospital Medicine is the nation’s fastest growing medical specialty, and Hospitalists are the number one locum tenens hiring need at U.S. hospitals. A total of 750 Hospitalists responded to the survey.

Click here to download complete survey results.

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Do Hospitalists Reduce Costs or Merely Shift Them?

August 3, 2011

A new study in the Annals of Internal Medicine suggests that cost-savings associated with Hospital Medicine care may be offset by increased costs associated with readmissions and ER visits. The analysis from researchers at the Sealy Center on Aging at the University of Texas Medical Branch, Galveston looked at five years of Medicare admissions from 2001 to 2006.

As reported in  Modern Healthcare:  The study found that “patients cared for by hospitalists had 0.64 of a day shorter average length of stay (5.17 days compared to 5.82) and their charges were $282 lower ($15,019 vs. $15,301). But the researchers said Medicare costs for these patients were $332 higher 30 days after discharge ($3,279 vs. $2,947).

Also, the hospitalist-seen patients were less likely to be discharged to home or have an appointment with a primary-care physician and more likely to have an emergency department visit.

“Hospitalists, who typically are employed or subsidized by hospitals, may be more susceptible to behaviors that promote cost shifting,” concluded the study authors.

The increased costs associated with readmissions and ER visits total $1.1B in added costs to Medicare annually. That figure is creating a slew of negative headlines for Hospitalists, like this one from Fox News:  Hospital-based Doctors Behind Surge In Medicare Spending, Study Finds.  

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Non-clinical Skills Important for Hospitalists

August 2, 2011

Being a great hospitalist goes beyond being just an excellent clinician. While clinical skills remain the most important, there are many non-clinical skills that are essential for every hospitalist.

Leadership: Though not every hospitalist is or will be a medical director, leadership skills are still important. Hospitalists are responsible for their patients from admission to discharge, so effectively managing the care they receive, along with those who administer it, is crucial. The Society of Hospital Medicine (SHM) offers a specialized Leadership Academy just for hospitalists, focusing on the unique challenges they face in their field. Three levels of this course allow participants at all levels to develop their skills and bring them back to their institution.

Communication: This is a critically important skill for every hospitalist. There’s only a short period of time to establish a relationship with a patient and their family. Being able to effectively communicate with them about the patient’s condition, procedures and expectations, is essential in building rapport quickly and establishing trust. Additionally, the hospitalist is in constant communication with internal team members, as well as the patient’s primary care physician. Effective communication regarding a patient’s condition helps to reduce both error and confusion.

Teamwork: This goes hand-in-hand with effective communication. Because hospitalists work with such a variety of people on the patient care team, effective teamwork is crucial. This isn’t necessarily something that’s taught in medical school, but members of the team should always work together with the patient in mind. Everyone is working towards the same goal and everyone’s strengths should be recognized and put to good use.

Quality Improvement: Hospitalists tend to be leaders in the area of healthcare quality improvement. Health care is in a constant state of change and always in need of improvement, and hospitalists are uniquely positioned to lead a number of QI efforts for inpatients. SHM also offers numerous ways for hospitalists to get involved in QI projects.

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Specialty Hospitalists Gain Traction

May 3, 2011

The role of the specialty hospitalist has been gaining momentum in recent years. Just last month, The Hospitalist reported the addition of the first otolaryngology hospitalist to the faculty of the University of California at San Francisco’s staff. And these “hyphenated hospitalists,” as Robert Wachter, MD calls them, are springing up around the country.  

Here’s a quick guide to some of the more common specialists that also wear a hospitalist hat:

Neurohospitalist: Many hospitals, particularly those with dedicated stroke centers, are adding neurohospitalists to their staff. Not only are they able to handle complex cases quickly, but hospitals don’t have to pay the pricey fees to bring in a neurologist on call.

Surgical Hospitalist (a.k.a. Surgicalist): These hospitalists started out as a solution to overcrowded emergency departments. They were brought in to provide timely surgical consults and get patients into surgery quickly, increasing throughput. But the concept stuck, and many hospitals are adding this position as a part of their staff.

OB Hospitalists (a.k.a. Laborists): More hospitals are moving toward using laborists. They’re able to oversee a labor until the mother’s regular OBGYN can make it to the hospital. And because they can more effectively manage tough labors and deliveries, they can reduce a hospital’s C-section rate.

Dermatological Hospitalists: These specialists are integrating themselves back into the inpatient setting after long being a predominately office-based specialty. They can be called upon for a number of cases spanning from adverse drug reactions to stem cell transplant complications.

As inpatient cases become more complex, hospitals around the country are likely to add more  “hyphenated hospitalists” in the near future.

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Hospitalists May Boost Satisfaction Scores

March 31, 2011

Press Ganey, the company whose ubiquitous quality and satisfaction survey tools are used by over half of US hospitals, has reviewed its data to measure the impact of hospitalists on patient satisfaction. The findings, published in the March 1 American Journal of Medical Quality, suggest  “that facilities with hospitalists may have an advantage regarding satisfaction” in certain areas, such as nursing satisfaction and personal issues (eg, privacy, emotional needs, response to complaints).

The authors suggest that positive scores in these areas are more broadly related to succcessful communication.  “Exploring how specific hospitalist functions influence patient satisfaction may reap rewards,” they conclude.

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Hospitalist CMO Elected to SHM Board

March 31, 2011

Robert Harrington, Jr., MD, SFHM, Chief Medical Officer for Locum Leaders, has been elected to the Board of Directors for the Society of Hospital Medicine (SHM), the leading national medical society for more than 31,000 hospitalists. His three-year term on the board will commence at the SHM Annual Conference beginning May 10th in Dallas, TX.

Long active in hospital medicine and SHM leadership positions, Dr. Harrington serves as the Chair of the SHM Family Medicine Task Force and the board liaison to the IT Core Committee. A trained family physician and Senior Fellow in Hospital Medicine, he earned his medical degree from Temple University School of Medicine in Philadelphia, PA, and completed his residency at the Medical Center of Delaware in Wilmington, DE.

Locum Leaders is one of the fastest growing physician recruitment companies specializing in locum tenens hospitalist jobs and other specialists. As Chief Medical Officer, Dr. Harrington is in charge of risk management, which includes physician credentialing and other candidate quality programs.

“It is an honor to serve SHM as an elected member of the Board,” said Dr. Harrington. “I look forward to working with my peers to advance the practice of hospital medicine and enhance our role in the delivery of high-quality patient care.”

“SHM depends on the vision and talent of its leaders,” said SHM President, Jeffrey Wiese, MD, FACP, SFHM. “I welcome Dr. Harrington to the board and look forward to working with him toward SHM’s vision of transforming healthcare.”

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Hospitalist CME Opportunities Abound in ’11

March 11, 2011

 Many organizations are offering great ways for hospitalists to earn CME credit, build their skill base and network with peers. Here are a few notable events for hospitalists for 2011:

  • American College of Physician’s Internal Medicine 2011: This is a great meeting () for internal medicine trained hospitalists. This year’s event will be held April 7-9 in sunny San Diego. Be sure to take advantage of the dedicated educational track for hospitalists, featuring over 40 hospital medicine specific sessions.
  • Society of Hospital Medicine’s Hospital Medicine 2011: This is a must-attend event for all hospitalists. It’s the largest single gathering of hospital medicine physicians in the country. Happening May 10-13 in Grapevine, Texas, this meeting offers fantastic opportunities for networking with peers. Participants can choose from over 90 break-out sessions and nine pre-courses, including four that are new for 2011.
  • University of California, San Francisco’s Management of the Hospitalized Patient Meeting:  This event has grown over the years, due to the popularity of the course chairman, Robert Wachter, MD. It brings together UCSF’s top teachers, as well as guest faculty, to highlight recent advances and current controversies in hospital medicine. Courses are designed to promote interactive learning and audience participation, so attendees will get the most out of their experience.
  • Hospitalist Procedure Courses from the National Procedure Institute: Because many hospitalists come from diverse clinical backgrounds, these types of courses are vital to enhance inpatient procedural skills. Procedures such as arterial line placement, catheter insertion and intubation are reviewed in detail. Not only is this a valuable educational experience, it improves marketability for hospitalists desiring locum tenens positions. Check out their website for more details on schedules and locations.
  • Regional Events: There are a number of regional hospital medicine meetings throughout the year, such as the Southern Hospital Medicine Conference. These events provide attendees with nationally recognized speakers, but in a smaller, more intimate setting as compared to larger, national meetings.
  • On the go: For hospitalists who can’t get their CME on location, there are a number of other options.  Hospital Medicine CME self study is available through Harvard Medical School and comes in a variety of formats, such as DVD’s, CD’s and MP3’s, which is perfect for hospitalists who are short on time. QuantiaMD also offers videos on demand for web and mobile viewing. A great reason to go pick yourself up a new smart phone!

For more hospitalist CME know-how, check out this helpful tipsheet from Locum Leaders.

Filed under Locum Tenens Tagged with ,

Hard Days Night: A Look At Hospitalist Shift Work

March 2, 2011

Data from a Today’s Hospitalist survey suggest that hospital medicine is hardly a nine to five job. While most doctors report that they want daytime shifts only, survey respondents said they often worked a mix of day and night hours. The breakdown of primary shift patterns reported is found below:

  • Only daytime shifts: 29.4%
  • Only nighttime shifts: 4.7%
  • Mostly daytime shifts with occasional night coverage: 34.8%
  • Scheduled rotation with blocks of day shifts and blocks of nights: 21.3%
  • Other: 9.8%

The survey found that academic hospitalists were most likely to have primarily daytime hours. Age and gender also factor into scheduling. According to the article:  “The more experience hospitalists have, the less likely they are to have nighttime hours as their primary shifts. And women are more likely to work daytime only shifts and less likely to have occasional night coverage.”

Locum tenens hospitalist jobs offer a variety of alternative shift opportunities.

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Hospitalist Programs Go 24-7

November 30, 2010

Smaller community hospitals with limited staff may not always have a hospitalist on duty. In a blog post at Today’s Hospitalist, Robert Harrington, MD, explores the timing of expanding in-house programs to nights and weekends. 

Moving to 24 – 7 coverage typically requires additional resources and may mean a fundamental re-structuring of a program, says Harrington, the Chief Medical Officer for Locum Leaders. Reasons to expand may include:

  • pressure from the ED or medical staff to expedite admissions and avoid holding orders;
  • an increasing call burden on hospitalists taking call from home;
  • the need for an in-house physician to provide code coverage or to head a rapid response team; and
  • help for specialists, especially surgeons, with admissions, consults or preop clearances.

His advice?  Plan carefully and consider piloting a program expansion to make the concept easier for the administration to swallow. Rather than hiring additional staff, look for a source of additional staffing such as a locum tenens firm or a community pool of physicians. That can supplement your full-time staff until buy-in occurs.

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Hospitalists Offer Best Guess at Patient Costs

August 10, 2010

It’s often difficult for patients to know how much they’ll pay for procedures, tests and services in a hospital, but the same seems true for their doctors.  In a recent study in the Journal of Hospital Medicine, hospitalists fared poorly in a survey assessing their knowledge of patient costs.

As reported by Karen Cheung for HealthLeaders Media, researchers “asked hospitalists how much a hypothetical unadjusted self-paying patient would be billed for commonly used services, procedures, tests, and physician charges. Out of the 26 completed hospitalist surveys, researchers found that only a tenth of them were within a 10% accuracy rate.”

For example, when asked to price an overnight stay in an ICU bed, hospitalists guessed anywhere from $750 to $6,000. Researchers put the true cost for a night in the ICU at the hospitals in their study at $1,107.

“Their guesses were not very close, in general, to the so-called ‘true price’,” says Jeremy D. Graham, MA, DO, internal medicine residency Spokane faculty, clinical assistant professor of medicine at the University of Washington School of Medicine, and lead author of the study.

Physicians are not generally trained on price awareness and the authors point out that true patient costs are challenging to ascertain because of cost adjustments between hospitals and insurers.

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