The 2024 NALTO Fall Fly-In Conference, held September 24-25 in vibrant Austin, Texas, was a celebration of innovation and growth in the locum tenens industry.
Over two action-packed days, industry leaders gathered to explore new opportunities and tackle the biggest challenges facing healthcare today. From the shifting expectations of physicians to the financial strains on hospitals and the rise of corporate medical ownership, the conference offered fresh insights and strategies.
Daniel Kuzmanovich from the Advisory Board kicked off with an engaging keynote, highlighting how autonomy and flexibility have become the cornerstones of physician career decisions, with locum tenens emerging as a key solution.
The event was also a platform for essential legislative updates, helping agencies navigate evolving state and federal regulations. From addressing workforce burnout to supporting pro-rural healthcare legislation, attendees were equipped with actionable knowledge to drive their organizations forward.
The conference closed on a high note with JT Thoms’ motivational keynote, encouraging leaders to embrace steady progress over perfection. This year’s Fly-In not only fostered collaboration and innovation but also set a bold course for the future of locum tenens, leaving attendees energized and ready for what’s next.
Let’s dive into the deets!
Adapting to New Realities
The keynote presentation by Daniel Kuzmanovich from Advisory Board explored how physician expectations have shifted dramatically from previous generations. In the past, doctors aimed for stable hospital jobs post-residency, staying for years—sometimes their entire careers. Now, autonomy and flexibility are top priorities.
Kuzmanovich attributed much of this change to the pandemic, which exacerbated burnout and dissatisfaction, leading doctors to seek more flexible opportunities. Many have retired or transitioned into corporate roles, while others are embracing locum work as a solution to their frustrations.
“Autonomy is now the name of the game,” Kuzmanovich noted. “It’s the No. 1 attribute they’re asking for. They want to make decisions for their patients, spend more time with their families, and shape the practices they work in.”
Citing an Advisory Board study, Kuzmanovich shared that 49% of physicians have reported feeling burned out since 2022, resulting in an 8% turnover rate and reducing doctors’ average time in their first post-residency job to just two years.
“Autonomy is now the name of the game. It’s the No. 1 attribute they’re asking for. They want to make decisions for their patients, spend more time with their families, and shape the practices they work in.”
Financial Strain and Corporate Takeovers
Beyond workforce burnout, the pandemic also hit hospital finances hard. Most facilities have yet to return to pre-pandemic levels of elective procedures, leaving many with slim operating margins. Even top health systems need help.
Kuzmanovich explained that this financial strain has fueled a surge in corporate medical groups buying up independently owned practices. Since 2019, corporate entities like Optum and private equity (PE) firms have doubled their ownership of physician practices—from 14% to 30%. Health systems own another 28%, leaving just 42% independently owned by physicians.
Initially, PE groups focused on single-specialty practices, but they’ve since expanded into multispecialty practices and ambulatory surgery centers, drawn by their lower operating costs and high revenue potential.
Doctors, however, dislike being absorbed into these corporate structures, Kuzmanovich said, but starting their own practices is often too costly. Centers for Medicare & Medicaid Services reimbursements have declined annually since 2017, while practice costs continue to rise, making private practices less viable.
“This is creating chaos for both your customer bases: facilities and providers,” Kuzmanovich warned, urging locum tenens organizations to step in and help doctors find the flexibility and independence they desire.
Legislative Updates Impacting Locum Tenens Agencies
On the legal front, Sarah Kroll-Rosenbaum and Montaye Sigmon of Akerman LLP presented updates on evolving state laws affecting locum staffing firms. They highlighted confusion surrounding pandemic-era staffing laws, which often need clarification on whether they apply to physicians, PAs, and NPs.
Key legislative updates included:
- Kansas HB 2551: Requires supplemental healthcare staffing agencies to register and submit quarterly reports.
- Delaware SB 150: Mandates dementia care training for staff working with affected residents.
- Delaware HB 204: If enacted, this bill would require temporary staffing agencies to submit annual reports, including billing and credentialing details.
- Minnesota HF 5247: Introduced civil fines for agencies failing to verify providers’ credentials, with penalties reaching up to $3,000.
Sigmon also discussed Akerman’s advocacy on behalf of NALTO concerning New York’s 2023 Temporary Healthcare Services Agency Law. This legislation requires temporary staffing agencies to register with the state and file quarterly reports on every provider sent to work in New York, creating additional administrative burdens for agencies. Akerman has been in talks with state representatives to clarify whether the term “direct care workers” includes APPs and physicians, but a definitive answer has yet to be provided.
Federal Advocacy: Pro-Rural Healthcare, Not Anti-Labor
During the federal legislative update, Ryan Bernstein and Gina Sherick of McGuire Woods Consulting shared insights into HR 5208, the Healthcare Provider Shortage Minimization Act. Sponsored by Rep. Buddy Carter (R-GA), the bill would codify locum tenens providers as 1099 contract workers, ensuring that underserved communities continue to have access to quality care.
The bill has nine co-sponsors, all Republicans, but Bernstein warned that gaining bipartisan support could be difficult in an election year. Sherick added that the upcoming elections may reshape the political landscape, affecting the bill’s progress.
NALTO board member Matt Young pointed out that many Democratic lawmakers confuse locum tenens providers with gig workers, complicating advocacy efforts. “We make sure to tell them we’re not anti-labor; we’re pro-rural healthcare,” Young emphasized.
Despite growing support, more grassroots advocacy is needed to advance the bill. Young urged NALTO members to engage their clients and networks to rally congressional support, particularly in states like Alabama, Oregon, and North Carolina.
“We make sure to tell them we’re not anti-labor; we’re pro-rural healthcare."
Progress Over Perfection
The event closed on a high note with JT Thoms from Jackson + Coker, who challenged the audience to shift their focus from perfection to progress. His closing keynote, “Pictures Are Powerful,” captivated the crowd with an interactive game that used Disney emojis to highlight how quickly we process visual messages.
Thoms encouraged attendees to let go of the unrealistic pursuit of perfection and instead aim for steady progress. “We all put this strange pressure on ourselves to appear perfect,” Thoms said, “but we end up sabotaging ourselves because we can’t live up to that.”
He introduced the “Four Phases of Progress” framework—moving from unconscious incompetence to unconscious competence—and emphasized the importance of self-awareness and feedback in fostering growth. “It’s not about winning or losing,” he said. “It’s about improving every day.”
For locum tenens leaders, the takeaway was clear: focus on making informed, confident decisions rather than trying to please everyone. In doing so, they’ll build the trust and success needed for long-term growth.
“We all put this strange pressure on ourselves to appear perfect, but we end up sabotaging ourselves because we can’t live up to that.”
A Stronger Future for Locum Tenens
The 2024 NALTO Fall Fly-In offered invaluable insights into the challenges and opportunities facing the locum tenens industry. From Kuzmanovich’s data-driven outlook to Thoms’ motivational push for progress, attendees left with actionable strategies to adapt to a rapidly changing healthcare landscape.
As the locum tenens industry continues its upward trajectory, events like this remind us of the power of collaboration, even among competitors. Now, it’s up to each attendee to apply these insights to help their agencies—and the industry—thrive.
