Locums Digest 9: Docs Sound off on COVID, Staffing Firms Reach $18B in Revenue, the Business of Locums & More

Locums Digest is Locumpedia’s roundup of hot topics, top stories, and social media posts of interest to the locum tenens and medical communities. Subscribe to our newsletter to receive Locums Digest before it’s published here.

Surveys Say Physicians Hurt by COVID & Healthcare Comms Changing

As the crazy year that is 2020 begins to wind down, there’s a lot of data relevant to physician recruitment and locum tenens medical practice scattered across the healthcare landscape. Let’s take a look at a few recent examples.

Merritt Hawkins 2020 Physician Survey

First, there’s Merritt Hawkins’ 2020 Survey Of America’s Physicians, COVID-19 Impact Edition. The “largest physician search and consulting firm in the United States” and an AMN Healthcare (NYSE: AMN) company, Merritt Hawkins changed its biennial physician survey this year in light of COVID-19. Considering physicians might “have even less time to devote to completing surveys” this year, The Physicians Foundation decided to conduct the 2020 survey in three smaller parts, rather than as one extensive survey (as has been the case since 2008). Each part is “designed for rapid completion and will focus on a different aspect of COVID-19’s impact on physicians,” as follows:

Part One: The Impact of COVID-19 on Physicians’ Practices and Their Patients
Part Two: The Impact of COVID-19 on Physician Well-being
Part Three: The Impact of COVID-19 on the Healthcare System

The survey was conducted between July 15 and 26, 2020, and the findings are based on 3,513 responses.

Here are highlights of “part one” findings.

•  86% of physicians believe the pandemic will not be under control until after January 1, 2021, with 50% of them believing it will take until some time after June 1, 2021.
•  72% of physicians have experienced an income reduction as a result of COVID-19. Of these, 55% have experienced income losses of 26% or more.
• 43 percent of physicians have reduced staff during the pandemic.
• 41 percent of respondents saw practice-volume decreases of 26% or more, “which could be difficult for most physician practices to sustain for more than a few months,” according to The Physicians Foundation. Meanwhile, 37% saw practice-volume decreases of 25% or less.
•  Of those physicians who applied for Paycheck Protection Program support, 75% indicated they received support sufficient for them to stay open.
• 52% of physicians plan to increase use of telemedicine in their practices.
• 8% of responding physicians have closed their practices as a result of COVID-19. That’s an estimated 16,000 practices nationwide, The Physicians Foundation reports.
•  More than half of respondents (59%) agreed that COVID-19 will reduce the number of independent physician practices in their communities.
• Most physicians (96%) will not leave medicine because of COVID-19 health risks.

Spok 2020 Healthcare Communications Survey

Next on our tour of recent, physician-related research results, Spok, Inc. (formerly USA Mobility Wireless and Amcom Software) produced an incredible amount of data in its 2020 Report on The State of Healthcare Communications , Trends and Data from More Than 600 Healthcare Professionals.

Spok, which “enables smarter, faster clinical communication,” according to its website, notes that, “All of the 21 adult hospitals on the U.S. News & World Reports ‘best hospitals’ honor rolls rely on Spok communications technology.”

In its report introduction, Spok offers, “As we look toward the future of healthcare communications, there are many unknowns. Yet one thing is certain: Healthcare has changed, but the importance of care team communication hasn’t.”

Also conducted in July 2020 with hospitals and health systems nationwide, the report is “an in-depth look at trends, challenges, and predictions for the future of healthcare communications.” Fifty-five percent of respondents worked for health systems, while 45% worked for independent hospitals.

Here are some highlights of the research findings.

• Approximately 92% of healthcare professionals said enterprise-wide communication technology is “very important” or “extremely important” in improving clinical outcomes.
•  Only 22% report their organization is “extremely effective” in adopting hospital-wide communication technologies.
• Smartphones, supported by 54% of hospitals employing survey respondents, have remained the most-supported devices since 2012. Use of encrypted pagers (introduced in 2016) has increased to 43%.
•  Notably, the percentage saying a given type of device is supported declined in all categories between 2011 and 2020.
•  82% of responding healthcare professionals report some level of concern that patient information and proprietary health system data are being communicated via unsecured or personal communication tools. Only 17% are not concerned.
•  ‘Poor integration into clinical workflow’ is the most common clinical-technology contributor to alarm fatigue or clinician burnout (selected by 59% of survey respondents).
• Email was the tool used most often by hospitals and health systems to communicate hospital-wide during the response to COVID-19. Of those who answered “other,” the most common response was for various forms of virtual conferencing.
•  Nearly 67% of healthcare professionals report they are satisfied with the current clinical communication methods. Yet, 15% report being either “dissatisfied” or “very dissatisfied.”
•  The least common hospital system staff can access with mobile devices is critical test results (30%).

PoF: Potential for Locum Tenens Co-op

PoF: Potential for Locum Tenens Co-op Finally (for now), let’s look at survey results from Physician on Fire (PoF) Leif Dahleen’s physician survey about the possibility of a physician-owned locum tenens co-op that would undercut typical agency fees for locum tenens placements.

“In a nutshell, most of you enthusiastically support the idea,” Dahleen reports, as he highlights survey results from some 227 physician responses. Almost 78% of respondents were currently taking locums assignments or planning to do so in the near future. (Pay attention, locum tenens agencies, thi s guy could become your worst nightmare.)

Here’s what Dahleen’s physician-respondents said:

• 95% of respondents would want a prospectus or brochure.
• Almost two-thirds (65%) think employers needing locums docs would try the co-op on a limited basis, while 31% think they would “flock” to this co-op as a much more efficient alternative to locum tenens agencies.
• 42% of respondents “would strongly insist” that healthcare employers interested in them fill all their locums needs through the co-op, while 48% would mention it as an option, but not try to persuade their employers. Only 10% said they wouldn’t mention it.
•  On the downside, only 11% think a number of their friends and colleagues would join. The bulk of respondents (67%) think a lot of their friends and colleagues would be curious about it, but only a small percentage might join. Almost 23% don’t expect much enthusiasm from their friends and colleagues.
•  Interestingly, were they to join such a co-op, 46% would be “enthusiastic ambassadors,” while about half (49.8%) would spread the word, but not really try to persuade friends or colleagues to participate.
• 41% of responding physicians would be willing to commit to 10-20 shifts per year, while another 33% would commit to 5-10. Sixteen percent would do 3-5 shifts a year, while almost 11% would commit to participate in co-op management, but not to shift work.
•  Regarding potential investment in a co-op, 42% would be willing to pony up $1,000 to $5,000; 29% would possibly commit $5K to $10K; and 9% would consider $10K to $25K.
•  Roughly 59% would be “somewhat likely” to become a co-op member, while 36% would “very likely” do so.

Interestingly, more than ¾ of respondents (78%) were iPhone users. Forty-three percent had 5-15 years’ practice experience; 28% had less than five years; 17% had 15 to 30 years’ experience; and 8% were residents or fellows.

In summarizing the survey results, Dahleen notes that, while “the survey results indicate pretty strong support for the idea” and sufficient support to raise the launch capital needed, “It will be far too risky to start anything until we gauge employer interest.”

All News Is Locums

“Independent Contractor” Status Critical for Locum Tenens

(Edited from a post on SIA’s “The Staffing Stream” by Matthew Baade )

Even before the term “gig economy” described the modern labor market, locum tenens was a highly sought-after profession. The flexible, mobile nature of locum tenens means professionals stay on an assignment for a short time, then move on to another one, perhaps in a different area, city or state. This freedom to choose when and where to work is a core benefit of locum tenens, and it’s the main reason locum providers are classified as independent contractors.

As the gig economy continues to gain momentum, a growing number of employers are struggling to define the difference between full-time employees and independent contractors. This worker classification matters because it impacts overtime, pay, taxation and more.

In response to the changing labor market, the US Department of Labor (DOL) submitted a new proposed rule on September 22 to streamline the criteria for classifying workers under the Fair Labor Standards Act (FLSA). While locum tenens providers always have been considered independent contractors, the proposed rule invites greater interpretation on what distinguishes an independent contractor from an employee – and it could have a negative effect on locum tenens. This is precisely why entities like the National Association of Locum Tenens Organizations (NALTO) are working diligently to protect the classification by pushing for legislation that statutorily defines locum tenens as independent contractors.

Right now locum tenens clinicians have the unique opportunity to participate in the process, namely by advocating for their independent contractor status and making their voices heard.

Financial Benefits

As an industry, locum tenens has a huge impact on patient care. Locums professionals provide an estimated one million days of coverage and more than 20 million patient visits annually. In addition, the Association of American Medical Colleges (AAMC) estimates some 250,000 physicians will retire over the next decade. Many of them would like to continue working on a part-time basis, and the locum tenens industry empowers them to remain active.

These stats are important to consider because today, 85% of facilities utilize locum providers to solve staffing shortages, realize operational efficiencies, and meet seasonal or temporary patient demand.

Since locum tenens providers are considered independent contractors, the IRS defines them as self-employed business owners who report taxes through Form 1099. As a self-employed business owner, the tax structure empowers independent contractors to write off travel, lodging, meals and other job-related expenses.

Independent contractors also can maximize their retirement savings by contributing the full amount allowed to a self-employed 401k account while also lowering their taxable income.

Autonomy Benefits

Independent contractors enjoy freedom and autonomy from controlling their work schedules and income potential. Locums clinicians can decide where they want to work, when they want to work, and what assignments to take to fulfill their career goals. In essence, the career of a locums provider is customized to his or her ambitions.

What’s Happening Now: Proposed Rule

The proposed DOL rule is designed to help employers distinguish between full-time employees and independent contractors. The rule includes an “ economic reality ” test to help classify the worker’s status by determining if he or she is self-employed (an independent contractor) or economically dependent on the employer (an employee).

The rule also lists five factors to help employers classify workers. While the criteria is specific, the interpretation of the criteria is much more subjective.

How to Participate

The decision on the proposed rule, which may come at year’s end, will directly affect the locum tenens profession. Now is the time to speak up. Contact your Members of Congress and organizational leaders to ask them to support the proposed rule statutorily defining locum tenens clinicians as independent contractors.

Cross Country Healthcare Leader Elected to NAMSS Board

(Edited from BUSINESS WIRE, October 15, 2020)

Cross Country Healthcare, Inc. (Nasdaq: CCRN) announced that Diana “Di” Hall, CPCS, CPMSM, FMSP, senior director of compliance and QI at Cross Country Locums, has been elected to the National Association [of] Medical Staff Services (NAMSS) board of directors.

“We are extremely proud of Di’s appointment to the NAMSS board of directors,” Cross Country Chief Executive Officer Kevin Clark said. Her extensive locum tenens credentialing knowledge and experience will be a great asset to furthering NAMSS’ vision of ensuring healthcare quality and patient safety.”

NAMSS is committed to enhancing the professional development of and recognition for professionals in the medical staff and credentialing services field. Its member base includes more than 6,000 medical staff and credentialing service professionals from medical group practices, hospitals, managed care organizations and credentials-verification organizations. Hall is the first locum tenens company-based director to serve on the NAMSS board of directors.

What’s In A Locum Tenens Agreement?

(Edited from October 21, 2020, post by Jen Hunter)

Physicians who work locum tenens with Global Medical Staffing (GMS) are considered independent contractors, so before you take your first assignment with us you will be asked to sign a locum tenens agreement. But what’s in that agreement? This article will help you understand what Global Medical Staffing is agreeing to do for you, the physician, and what you’ll be asked to agree to as an independent contractor.

Physician Provisions

In the simplest terms, “the agreement defines the working relationship between GMS and a provider — all of the generalities that protect both the physician and GMS through the course of the assignment,” according to GMS Senior Director Tim Smart.

For example, Global Medical agrees to take care of travel, transportation and housing. GMS will also provide malpractice insurance (for US assignments) or help secure it in countries where we don’t provide direct coverage. Additionally, the agreement spells out logistics like the payroll schedule.

Physician Conditions

The locum tenens agreement includes a few conditions the physician must meet. For example, you agree to complete the assignment once you accept it, and to cooperate in the credentialing process by providing accurate and complete information.

You also agree to a noncompete clause, in effect for two years either after you’re presented to the hiring healthcare facility, or after you’ve accepted an assignment. The “noncompete” doesn’t preclude your working for other staffing agencies — just from working for those specific clients where you’ve either worked assignments through GMS or were presented for assignments by GMS. However, if you’re interested in accepting a permanent position at a client facility, there’s a provision in Global Medical’s agreement for the client to initiate a contract buyout.

Confirmation Letters

Once you accept a locum tenens assignment, you’ll receive a confirmation letter serving as an extension of the locum tenens agreement and specifying the job’s rates and details.

The confirmation letter also covers you. For example, if a domestic (US) client cancels with fewer than 30 days’ notice, you’ll still be paid for the time they would have worked — as specified in the confirmation letter — up to 30 calendar days.

For international assignments, GMS requires clients to give 90 days’ notice for cancellations, particularly because physicians will be uprooting their lives — sometimes for a year or more.

“Physicians want assurance that if they go down this path, the assignment won’t be cancelled two weeks before it’s supposed to begin,” Smart says.

Agreement Restrictions

Another key stipulation is that you provide notice if you are unable to fulfill an assignment once you’ve accepted it. Global Medical is sensitive to the fact that situations beyond your control can arise, and we do what we can to work with you wherever possible.

“You can request a notice of termination from Global,” Smart says. “We’re going to do our best to ensure a fair and balanced outcome.”

The agreement allows you to perform clinical work only on your assignments. In other words, you can’t provide administrative services for the client. Also, you must be paid by the hiring agency, rather than directly by the client.

International Vs. Domestic Locums Assignments

Global Medical Staffing’s agreements for domestic and international assignments are different.

“GMS doesn’t provide malpractice insurance for nondomestic locum tenens assignments. Instead, international clients cover their providers’ medical liability insurance,” Smart says.

However, a physician will not be placed at a facility without coverage. “We won’t leave our providers unprotected.”

Another important distinction between international and domestic agreements is that taxes are sometimes handled differently. All US.-based physicians working locum tenens assignments are considered 1099 independent contractors and must manage their own taxes. However, for some international assignments, GMS will withhold the taxes on your behalf.

Some locations require brokerage agreements, rather than traditional locum tenens agreements. The two are similar, but differ regarding who will cover malpractice insurance, process payroll, and manage other expenses. Your recruiter can explain your assignment’s requirements.

Business Entities

Sometimes physicians prefer to be paid through a business entity for tax or other purposes. In these cases, the agreement is with the legal entity, not the individual physician, and it will need to be renewed annually. Typically, our agreements are evergreen and automatically renew until you terminate them.

Ultimately, Global Medical wants to establish a mutually beneficial, long-term relationship with you. A locum tenens agreement sets the framework for our relationship.

Focusing On Rates Misses The Point

(Edited from LocumsMart post , October 21, 2020)

When you need a physician to fill in for a couple of shifts — or even a few months, hiring a locum tenens physician is a great option. “Locums” means care continuity for patients and helps lighten the workload for staff physicians. It also affects your bottom line.

“In healthcare the assumption is locum tenens providers are too expensive,” LocumsMart Client Services Director Bob Shumard says.

Finding Patients the Best Care

Many health care organizations focus too much on getting a low rate for each locums physician they hire, Shumard says. “That’s a mistake. While I understand price is important, if you beat up on agencies in trying to get a one-percent discount, you’ll get fewer bids per job.”

He notes that fewer bids per job means fewer qualified clinicians willing to work at your facility, which ultimately affects the standard of care your patients receive. Receiving more bids ensures you’ll pick from a wide range of qualified physicians, so you can pick the best one for the job.

“Providers aren’t commodities and they don’t want to be paid below-market rate, so they’ll select a different option,” Shumard says. “You’re better off paying fair market value.”

Modern Healthcare: LocumTenens.com Is a “Best Place to Work in Healthcare 2020”

(Edited from Cision PRWeb , October 12, 2020)

Modern Healthcare has named LocumTenens.com 12th on its “Best Places to Work in Healthcare” for 2020.

Modern Healthcare gives the “Best Places to Work” distinction to 150 organizations based on how well they “empower employees to provide patients and customers with the best possible care, products and services.” This year’s contestants also were scored on pandemic response, in addition to employee benefits and internal communications.

“Our company’s culture and amenities make LocumTenens.com a great place to work, but it’s our associates who truly make it a ‘best workplace,’ ” LocumTenens.com President Chris Franklin said. “Every day, they go above and beyond to ensure an exceptional experience for clients and clinicians, and they’re passionate about the work they do and the difference it makes in people’s lives.”

The Healthcare Staffing Story

Largest US Healthcare Staffing Firms Reach $18 B in Combined Revenue

(Edited from SIA press release, October 28, 2020)

48 Firms Ranked in Latest Report

Staffing Industry Analysts (SIA), the global advisor on staffing and workforce solutions, has released its 2020 report on the Largest Healthcare Staffing Firms in the United States. Ranked by revenue, the report covers 48 firms that generated at least $50 million in US healthcare staffing revenue in 2019, along with segment-specific rankings for travel nurse staffing firms, per diem nurse staffing firms, locum tenens staffing firms and allied healthcare staffing firms.

“Last year the US healthcare staffing industry generated a record $18.1B in revenue, roughly double the $9.1B achieved in 2011 when the last economic expansion began,” SIA North America Research Director Timothy Landhuis said. “This report highlights the market-leading firms that have substantially grown the healthcare staffing industry through innovation and efficiency, while also increasing the depth and breadth of service offerings to clients.”

The five largest Healthcare Staffing firms in the US are:

The full “2020 Largest Healthcare Staffing Firms in the United States” report is available for SIA’s Corporate and CWS Council Members.

News You Can Use

HHS To Send $20B to Healthcare Providers: 5 Things To Know

(Edited from Becker’s Hospital CFO Report, October 2, 2020)

HHS is sending $20 billion in new funding to healthcare providers to help offset financial strain linked to the COVID-19 pandemic.

Five things to know:
1. Healthcare providers who previously received, rejected or accepted provider relief payments are eligible for the new funding.

2. Providers previously ineligible to receive relief funds, such as those who began practicing in 2020, can apply for a portion of the new relief aid.

3. Providers who have already received payments of about 2% of annual revenue from patient care will need to submit more information to become eligible for additional payments. Those who have not yet received relief payments equaling 2% of patient revenue will receive a payment that, when combined with prior payments, equals 2% of patient care revenue.

4. The remaining balance of the $20 billion will be used to provide add-on payments to providers based on several factors, including changes in patient care revenue and expenses incurred related to the pandemic.

5. Healthcare providers can apply for funds between October 5th and November 6th.

Physician Assistants, Nurse Practitioners: Meet the AAPPAA

The Advanced Practice Provider Association of America (APPAA) is the only trade association that represents both nurse practitioners and physician assistants.

“Your APPAA membership is a statement of empowerment. APPAA was established to provide [members] with the tools and resources to be successful in the workplace and at home.”

The group’s member benefits include getting paid for views posted on its website and for referral fees, accessing a job bank, networking opportunities, connections to financial advisors and educational resources.

How ‘Bout This?

New Drug for Hypochondria Soon to Be OK’d (Satire)

October 7, 2020

Disclaimer: This post is from GomerBlog, a satirical site about healthcare.

Expect GiantDrugCo’s stock price to hit record levels soon — the company expects to launch the first-ever drug to treat hypochondria.

To be marketed as Placebadil, it’s an enteric-coated sucrose-(2R,3S,4S,5R,6R)-2-(hydroxymethyl)-6-[(2R,3S,4R,5R,6S)-4,5,6-trihydroxy-2-(hydroxy methyl)oxan-3-yl]oxy-oxane-3,4,5-trio, also known as “sugar” and “starch.”

In phase I and II trials, the drug was successful at treating myriad perceived illnesses such as 2-day-old sinus infections, COVID-19, brain cancers, and appendicitis. The trials were so successful that it was placed on the fast track to be approved before the end of the year.

One participant in the study was cured of her perceived endometriosis after only three doses. That study was conducted in a double-blind fashion with the participant not knowing if she was getting the placebo or the placebo. After she declared that she no longer suffered from endometriosis, she learned that she did indeed get the placebo.

Placebadil is slated to hit the market in the next 2 months. It will provide doctors with another tool in their armamentarium to treat hypochondriacs. Patients with perceived illnesses will no longer have to suffer in perceived silence.

University of FL Sponsored “Gator Sedator” Residency

“Physician on FIRE” Leif Dahleen, a Minnesota native who now calls northern Michigan home, acknowledges he was a “Gator Sedator” as an anesthesiology resident at the University of Florida.

Dahleen is a former board-certified anesthesiologist who achieved financial independence (the “FI” in “Physician on FIRE”) at age 39 and retired early (the “RE” in “Physician on FIRE”) at age 43 after deciding to buck the trend of physicians’ legendary inadequacy as business people. He says he completed his internship at Gundersen Lutheran in La Crosse, WI, a city known for “having the most bars per capita in the whole country.”