It’s long been thought that hospitalized patients are better off getting treatment from full-time doctors instead of temp physicians. Those temps are called in to cover for doctors’ sick days, vacation, or staff vacancies. But new research finds that a doctor’s employment status may have little to do with quality of care.
Doctors who are employed under short-term contracts — called locum tenens (Latin for “to hold a place”) — provided a similar level of care as staff doctors, a study published Tuesday in the Journal of the American Medical Association found. Researchers came to that conclusion after analyzing 1.8 million Medicare patients hospitalized between 2009 and 2014 who were treated by general internists. No significant difference in 30-day mortality rates was seen between patients treated by temp physicians compared to those treated by staff physicians.
That finding could help dispel the stigma that temp doctors have long faced, researchers said.
“Years ago, locum tenens doctors might’ve had worse outcomes than non-locum tenens docs, but that’s changing,” said Dr. Anupam Jena, an associate professor at Harvard Medical School and one of the study’s authors. “There appears to be very little difference, if there’s any difference at all.”
Dr. Daniel Blumenthal, an internist affiliated with Massachusetts General Hospital who was the paper’s lead author, said little to no research had previously been conducted on the difference between full-time and temp doctors before this study.
For years, a common bias was that locum tenens doctors simply lacked the credentials to land permanent gigs. “Early on, locums [tenens] physicians were looked upon as ‘less than,’” said Jeff Decker, president of Staff Care, a national recruiting firm that connects locum tenens doctors with hospitals. “They were seen as a necessary evil.”
But growing numbers of hospitals have turned to temp doctors in the face of a national doctor shortage — one that could grow to more than 100,000 unfilled positions by 2030. Staff Care has found that the number of U.S. doctors employed as temps — now at 48,000 — has nearly doubled since 2002.
As part of that shift, Decker believes more physicians are choosing to freelance for a variety of reasons. Young doctors can test out different kinds of medicine to see which ones they like. Mid-career doctors can take on more shift work to pay off medical school debt faster. And older doctors can partially retire but still see patients.
“The paradigm is shifted,” Decker said. “They’re a fill-in … but they’re no less of a physician.”
But on one measure researchers did see a difference. Locum tenens doctors were associated with a higher spending on patient care than full-time doctors, the study found. Some of those costs can be attributed to longer lengths of stay, researchers said.
“It makes sense because [locum tenens] doctors providing care don’t know the system as well,” Jena said. “That might mean inefficient spending in ordering tests or procedures. They may keep patients in hospital longer. The care is more inefficient.”
As physician demand continues to grow, Blumenthal believes hospitals should find ways to better onboard and educate locum tenens doctors in order to lower costs and boost 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.
Blumenthal would like to see further research conducted on locum tenens doctors in other specialties, including emergency medicine, psychiatry, and anesthesiology.
Studies of the same facilities involving the same populations should almost always demonstrate no differences – because the outcomes are about the patients, the populations, and the social, local, community, family determinants of health. Examples include MD vs NP, some matched PCMH studies, resident work hours before and after.
Studies involving difference populations and facilities should demonstrate differences as seen in the BMJ hospitalist studies (different gender, age, origin in different places and populations), in the urban vs rural, in the high vs low volume studies, some PCMH studies, and others.
Clinical factors have little influence. It is sad that we consider a few minutes with a certain type of provider as important compared to a lifetime of influences before an encounter that impact the encounter and after the encounter.