Facing a growing physician shortage, hospitals turn to freelance doctors

The number of physicians working as freelance doctors has nearly doubled since 2002—and will likely double again in the next decade—as a growing number of hospitals try to fill staffing shortages, Max Blau writes for STAT News.

A change in perception

According to Melissa Byington—the group president of CHG Healthcare, a national health care staffing firm—in the past, hospital administrators and physicians who had stable jobs tended to view freelance physicians critically, in part based on the assumption that these "locum tenens" doctors lacked the skills or expertise needed for full-time work.

Moreover, according to Anupam Jena, an associate professor at Harvard Medical School—physicians working on a temporary contract often faced challenges adjusting to a new workplace on short notice. "Imagine going to a brand-new location, seeing brand-new patients you've never met before, operating in an unfamiliar hospital system, and interacting with other nurses and doctors you have little experience with," Jena said. "All of those things could make a recipe for bad outcomes."

As such, according to Jena, 10 years ago, patients of freelance doctors had a higher mortality rate than those seen by established providers. However, Jena said a new research paper—which he helped author and which is currently under review—indicates that the mortality rate under freelance doctors has significantly decreased.

A growing trend

The professional stigma around freelance physicians has steadily declined in recent years, Blau writes, as hospitals and health systems seek to offset a physician shortage, which the Association of American Medical Colleges projects could exceed 100,000 by 2030. Jeff Decker, the president of the physician temp firm Staff Care, said 94 percent of health care facility managers worked with freelance doctors last year.

Physicians also are increasingly willing to consider freelance options, Blau reports. Blau explains that research suggests about 50 percent of physicians are dissatisfied with their jobs.  Freelance providers, however, have voiced praise for the perks of their position—some of which directly address concerns they have about a traditional career in medicine. For instance, freelance providers often earn more per hour, get to decide when and where they will work, and don't have to wait for an insurer to approve reimbursements before they get paid.

In fact, according to stakeholders, the mortality rate of patients seen by locum tenens physicians could be improving because physicians are increasingly considering a freelance career—meaning hospitals have a larger pool of applicants for temporary positions and can afford to be more selective. And Byington pointed out that hiring freelance physicians could help boost a hospital's overall quality of care by enabling staff physicians to take time off and fend off burnout.

But there is a downside to locum tenens work, Blau writes. According to Sam Lalani, a hospitalist from Dallas who currently works as a freelancer, it's difficult to develop any kind of meaningful relationship with patients as a freelancer. He's also constantly on the road, which takes him away from his children. "You're getting paid more," he said, "but you're sacrificing more" (Blau, STAT News, 8/28).

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