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December 8, 2017

Locum tenens doctors are just as safe as staff physicians, study suggests

Daily Briefing

    Temp doctors, called locum tenens, provide a similar level of care as staff physicians, according to a study in JAMA—a finding that could help alleviate the stigma of locum tenens physicians as less skilled doctors. 

    In a physician shortage, win talent in a candidate-centric market

    According to Staff Care, a national recruiting firm that connects locum tenens physicians with hospitals, the number of temp doctors has almost doubled since 2002, totaling about 48,000 in 2017. The growth of such positions could reflect hospitals' response to an increasing physician shortage, STAT News reports.

    Study details

    For the study, researchers analyzed data on more than 1.8 million Medicare beneficiaries who were hospitalized between 2009 and 2014.

    According to the researchers, during the study time frame, one in 10 full-time physicians was replaced by a locum tenens doctor for some period of time. Overall, 38,000 patients (2%) received care from a locum tenens doctor, and there was no significant difference in patient characteristics—including type of medical condition or reason for hospital admission—among those treated by locum tenens physicians and those treated by staff physicians.

    Overall, the researchers found that 8.8% of the patients who had been treated by locum tenens doctors died within 30 days of hospital admittance. In comparison, 8.7% of patients treated by staff doctors passed away within 30 days of admission—a difference that according to the researchers was too minute to rule out the possibility it was due to chance. Meanwhile, patients treated by locum tenens had "significantly lower" 30-day readmission rates, at 23% compared with a 24% 30-day readmission rate among those treated by staff physicians.   

    However, the researchers also found that patients treated by locum tenens doctors had significantly higher Medicare Part B spending ($1,836), compared with those treated by staff physicians ($1,712). Further, patients treated by locum tenens doctors remained in the hospital for an average of 5.64 days, while those treated by staff physicians stayed an average of 5.21 days.


    Daniel Blumenthal of Massachusetts General Hospital and Harvard Medical School, who lead the study, said, "Our work indicates that locum tenens physicians caring for patients hospitalized for treatment of general medical conditions likely deliver equivalent quality care to non-locum tenens physician." He added, "While it is unlikely that patients would ever know whether or not their physician was a substitute physician, our work indicates that patients should not worry about whether or not their physician is a locum tenens."

    Anupam Jena, an associate professor at Harvard and one of the authors on the study, added that the findings should help dispel stigma around locum tenens physicians, noting that while such doctors might have had worse patient outcomes in the past, that's no longer the case. "There appears to be very little difference, if there's any difference at all," he said.

    Jena also suggested that the difference in spending between temp and staff physicians could stem from their patients' longer length of stay. "It makes sense because (locum tenens) doctors providing care don't know the system as well," he said. "That might mean inefficient spending in ordering tests or procedures. They may keep patients in [the] hospital longer. The care is more inefficient."

    Blumenthal recommended that hospitals improve their onboarding process for locum tenens physicians to cut costs and improve patient outcomes. "Any doctor who is new will go through a period on how to best deliver care, access the right resources, and what kind of acute-care facilities exist for patients," he said.

    However, Karl Bilimoria, the director of the Surgical Outcomes and Quality Improvement Center at Northwestern University's Feinberg School of Medicine, cautioned that the study results don't necessarily mean the quality of care from locum tenens doctors and full-time doctors are the same. He pointed out that Medicare requires locum tenens physicians to substitute for a minimum of 60 days, which may give them time to familiarize themselves with a hospital's practices and culture. The study did not account for locum tenens physicians who may only temp for a few days or a week at a time, he said.

    Further, "just because the patients did not die more frequently under the care of locum tenens docs, does not mean that their disease-specific outcomes are equal," Bilimoria said. "There may be more nuanced outcomes that could show a difference" (Bean, Becker's Hospital Review, 12/5; Blau, STAT News, 12/5; Rapaport, Reuters, 12/5; Blumenthal, JAMA, 12/5).

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    Health care is in the midst of another labor shortage. Vacancies are on the rise and demand for health care talent will continue to increase over the next decade.

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