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Temp doctors in demand

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Dr. Paul Hoehner has worked as a temp. (Courtesy of Dr. Hoehner)

Dr. James K. Sheffield was looking for a way to make a career transition. After working as a neurologist in Seattle for six years, he decided to go into the administrative side of medicine. So, while studying for his M.B.A. in Houston, Sheffield signed up with a temp agency to see himself through the transition period. The agency set him up with a couple of weeklong assignments in a hospital.

He loved being able to set a limit on the number of hours he would work--not like private practice, which is like running a small business. And, because of his experience, Sheffield provided some special skills in treating conditions hospital neurologists don’t see as often.

“I was kind of in the catbird seat,” he said in a recent interview. “They really needed someone, and they saw me as someone who was there to help.”

The idea of a doctor working through a temp agency may sound bizarre, but it’s fairly common, and getting more so. Hospitals or medical practices have long used temp doctors to fill in for physicians who are sick or on vacation. For doctors looking to avoid administrative hassles, working as a temp, or “locum tenens,” can be an appealing option.

But some say the growing use of temporary doctors is an early sign of a more troubling trend: A shortage of primary care physicians. Primary care doctors--a category that includes family care, internal medicine, pediatric, and geriatric doctors--are most in demand as temps, and this need is expected to grow as the population ages.

“There’s very much a consensus that we have a primary care workforce shortage in bloom,” said Alwyn Cassil of the Center for Studying Health System Change, a nonpartisan health policy research organization.

The use of temp doctors by hospitals and medical groups is growing, according to a recent survey conducted by Staff Care, an agency that places doctors in temporary positions. According to the survey, spending on temp doctors nationwide has more than doubled since 2001, and the number of days worked by physicians on a temporary basis has grown by 20 percent from 2006 to 2007.

For doctors, working as a temp can be a way to escape some of the more tedious aspects of medical practice. A doctor can simply tell the agency in what state or what type of practice he or she wants to work, and the agency takes care of the rest: finding a placement; making sure the doctor is properly licensed in that state; arranging and paying for travel; finding accommodations in a hotel, apartment, or house; and orienting the doctor to the hospital or medical group where they’ll be practicing. The agency also covers the doctor’s malpractice insurance. A placement can be anywhere from a few days to a few months.

“It sort of gets you off the treadmill of medical practice,” said Phil Miller, spokesman for Staff Care. “You’re basically focusing on the patients.”

Many doctors who work this way are older and moving into semi-retirement, but it can also be a way for younger doctors to try out working in different states or different types of practices. Dr. Paul Hoehner, an anesthesiologist in Virginia who worked as a temp for about five years while going back to school for a Ph.D., enjoyed the experience so much that he now tells young residents to try it out before settling into a practice.

“This is a phenomenal way to really learn a practice,” he said. “I don’t think I would join a practice without negotiating with them that I would work with them for a set amount of time as a locums first.”

However useful this type of practice may be for some doctors, the growing demand for temporary doctors is one sign of a coming crisis in primary care. It's hard to convince doctors to go into primary care. A study by the Center for Studying Health System Change found that, adjusted for inflation, primary care doctors’ income has declined by 10 percent over the past eight years, losing ground against already-higher-paid specialists and surgeons. If the trend continues, a serious shortage of primary care doctors will develop.

“I think locum tenens is kind of a way to meet some of the gaps in our current health care delivery system,” said Dr. Anne O’Malley, co-author of the study. “Our primary care infrastructure in this country is not meeting the population’s needs.”

The primary care infrastructure will only become more stretched in the future, as America’s population ages. Geriatric care is under the primary care umbrella. A recent report by the Institute of Medicine, part of the National Academy of Sciences, concluded that the nation’s geriatric care workforce urgently needs to be expanded, as the number of older adults in America will almost double between 2005 and 2030.

Doctors are aging too, and many who chose to go into primary care when they were younger are now approaching retirement age.

“There’s going to be a shortage of physicians,” said Randy Keister, director of physician recruitment for Susquehanna Health, a three-hospital practice system in Pennsylvania. “And everybody across the country is going to be competing for those physicians.”

Keister said that the aging population--a particular concern in Pennyslvania, where the population is older than the U.S. average--had already caused him to seek more temporary physicians.

“In the past 18 months, it’s gone up,” he said of his need for temps. “Because our physician population is much older here.”

As the need for temp doctors rises, the field is attracting physicians because it allows them to focus more on patients than on paperwork.

“Most physicians love doing medicine, love doing what they’re trained to do, love taking care of patients," said Dr. Hoehner. "It’s just all the other stuff that goes along with practicing medicine that drives you crazy."

E-mail: sem2160@columbia.edu