"The most striking finding was this emphasis on a more controllable work schedule and flexibility, especially among women physicians," said Angelo Alonzo, co-author of the study and professor of sociology at Ohio State University.
"If more women physicians seek temporary jobs so they have less stressful lifestyles, it raises issues about the future of health care staffing."
Alonzo conducted the study with Arthur Simon, a physician with the Dean Health System in Madison, Wisc. Their results were published in a recent issue of the Journal of Healthcare Management.
Temporary staff physicians are known as locum tenens (LT), from the Latin "one holding a place." Hospitals, clinics and physician practices hire LTs to cover for vacations, short-term leaves and seasonal demand, as well as other reasons, such as shortages of various specialists.
Although the number of LT physicians is not known for sure, one LT placement firm estimated that 15 percent of all physicians worked locum tenens sometime during their career in 2000, up from 4 percent in 1987 – nearly a four-fold increase.
Alonzo and Simon surveyed 776 physicians who worked at least one assignment with CompHealth, an LT placement agency in Salt Lake City. (CompHealth provided the names of those surveyed.)
While about 70 percent of those who responded to the survey were men, the findings suggest women may be particularly drawn to LT jobs, Alonzo said. Women were 30 percent of the LT group, but only account for 23 percent of active U.S. physicians.
For women, the top reason for choosing LT assignments (mentioned by 37 percent) was schedule flexibility.
"Many of the women, as well as some of the men, just don't want to work 50 to 70 hours a week, or don't want to be on call," Alonzo said. "Some doctors choose LT assignments in which they can limit the number of hours they work and are on call."
For men surveyed, the top reason for being a locum tenens was the ability to work part-time (mentioned by 38 percent). Many of these were older physicians who were transitioning into retirement, he said.
Some doctors may want schedule flexibility to spend more time with children, but that wasn't an issue with most doctors surveyed – only about 28 percent said they had a dependent child or parent in their home.
In addition to schedule flexibility and the ability to work part-time, the other top reasons for choosing LT work was to increase income (15.5 percent), to travel (9.5 percent) and to experience a different practice setting (9 percent).
About 3 percent said their main reason was to be free from administrative responsibilities.
"It wasn't a dominant focus, but some physicians don't want to deal with insurance companies, reimbursements, and all the office management hassles that come when you run your own practice," Alonzo said. "You certainly reduce these hassles when you're a practicing locum tenens physician."
While temporary employees may have negative connotations in some professions, the results suggest LT physicians have more training than average. The survey found 85 percent of the LT sample was board-certified – meaning they met objective measures of training and competence in specific fields. That compares to about 65 percent of active U.S. physicians who are board-certified.
"LT physicians tend to be very well-trained and that means patients are going to get good care from them," he said.
Alonzo said it was significant that a third of doctors surveyed planned to make LT a permanent career choice. This means they will be going from assignment to assignment with no intention of remaining in one place for long.
The fact that such a large minority of LT physicians has no intention of settling down to one job has positive and negative implications for health care, according to Alonzo.
"The good news is that we get more providers who are happier with their lifestyles. But if this becomes too popular, it could lead to physician shortages in some areas," he said.
In addition, LT jobs give physicians less autonomy in how they practice medicine. Because of their short-term assignments, LT physicians have to follow practices styles of the hospital or clinic that hires them.
"That means LT physicians may have less autonomy in their temporary practice setting – they have new practice styles to follow," he said. "They are giving up some of their autonomy in order to have a more comfortable lifestyle where they have flexibility and the opportunity to explore new areas of the country and different practice settings.
"There seems to be both an upside and a downside to this trend of increasing numbers of locum tenens physicians."
Contact: Angelo Alonzo, 614-292-6616; Alonzo.1@osu.edu
Written by Jeff Grabmeier, 614-292-8457; Grabmeier.1@osu.edu
Journal
Journal of Healthcare Management