Urgent message: Medical staffing agencies extend an urgent care center’s recruiting and staffing capabilities with solutions to fill all operating hours with qualified providers.
Alan A. Ayers, MBA, MAcc Practice Velocity
The United States faces a shortage of primary care and emergency medicine physicians – the provider force feeding urgent care.
When an urgent care center has an insufficient number of providers to adequately cover its schedule, the patient experience suffers due to extended wait times, being turned away without receiving treatment, and poor service from providers who have become tired and frustrated with their inability to keep pace with an ever-increasing workload.
As the adverse effects of provider shortage escalate, overworked physicians leave for better working environments – leading to more unfilled shifts and management’s time consumed by recruiting and staffing tasks.
Medical staffing agencies enable urgent care operators to stay focused on day-to-day operations by finding qualified locum tenens (temporary) and permanent providers for the center.
Locum Tenens: A Ready Solution to Scheduling Shortfalls
Medical providers are subject to periods of absence due to personal or family illness, vacation, continuing medical education, or unexpected events.
Urgent care centers are also subject to increased provider turnover due to greater family mobility, “baby boomers” approaching retirement age, and market demand for providers leading to better job opportunities. And even when a center is fully staffed, ebbs and flows in patient volume may lead to occasions (such as flu season) in which permanent providers cannot keep pace.
But unlike front office and medical support staff that can easily cover the workload of a missing colleague, entrepreneurial urgent care centers rarely have a “bench” of underutilized medical providers to step up to the plate.
Locum tenens – temporary, substitute providers – enable urgent care centers to remain open and continue generating revenue when permanent providers are away from the center, while searching for a permanent provider, or to augment providers during busy seasons.
Table 1 compares the benefits and drawback of locum tenens in urgent care.
Locum tenens providers are, typically, independent contractors who enter into an agreement to perform pre-defined services for a set period of time at a fixed daily or hourly rate. Although practices usually reimburse direct expenses related to transportation, meals, and lodging – and staffing agencies typically provide the malpractice insurance coverage – as independent contractors, locum tenens providers are not employees of the practice or staffing agency and are therefore responsible for their own benefits, taxes, unemployment, and workers compensation coverage.
Urgent care operators can expect to pay between $95 and $125 per hour for locum tenens coverage, depending on the scope of practice (e.g., urgent care, occupational medicine, and/or primary care), the volume and acuity of patients, required board certifications or procedural training, and the location of the assignment.
Randy Sparks, regional vice president of Irving, Texas-based StaffCare, explains that “The more detailed the requirements for a locum, the less available matching candidates will be, and therefore, the greater effort by the agency in finding a good fit. Pricing is also highly regionalized because not only must a provider be licensed in a state – and the supply of providers varies by state – but some work locations are just more appealing to prospective candidates than others.”
Ultimately, Table 2 illustrates, the value of locum tenens to an urgent care center is the difference between lost revenue and goodwill due to uncovered shifts, the direct and indirect costs paid for the locum, and differentials in productivity and quality between locums and staff providers.
Although an urgent care center can directly recruit and contract with a locum tenens provider without outside assistance, there are advantages to utilizing an agency, including a “bench” of qualified candidates to choose from, medical malpractice coverage arranged by the agency and included in the hourly rate, and agency support of medical credentialing and licensure processes. In addition, many agencies arrange for the travel and housing needs of temporary providers.
The downside is that fees charged include the agency’s operating expenses and profit margin – typically resulting in a higher hourly rate than hiring providers directly.
Table 1. Benefits and Drawbacks of Utilizing Locum Tenens Providers in Urgent Care
Table 2. Value of Utilizing Locum Tenens Providers in Urgent Care
|Lost revenue due to inability to treat patients
+ diminished brand equity due to patients seeking care elsewhere
– daily or hourly cost of locum tenens provider
– differential in productivity (number of patients seen, gross charges entered)
– differential in quality of clinical care delivered
– differential in quality of patient experience (bedside manner, quality and continuity of care)
= value retained by locum tenens provider
Locum Tenens form a Provider’s Point of View
Medical practice has been evolving rapidly over the last 10 to 15 years, as many providers move away from the traditional full-time, private practice model to other modes of practice, including hospital employment, part-time practice, concierge medicine, and locum tenens.
When locum tenens providers first came into use, their quality sometimes was questioned. Colleagues, administrators, and patients might ask, “Is there a reason they’re on the move?”
Today, locum tenens practice has become widely accepted as a “lifestyle” choice – appealing to older physicians who have retired from private practice but want to stay active in their licensure, young parents desiring to spend time at home but also retain their clinical skills and transitional providers who want to “try out” a certain practice type or geographical area without long-term commitment. Table 3 outlines the benefits and drawbacks for the provider doing locum tenens work.
Locum tenens providers vary widely in terms of medical practice experience, although the majority are tenured physicians who see temporary assignments as a way to augment their income. According to Sparks, 67% have 21 years or more experience as physicians while less than 7% have been in practice fewer than six years. This includes veteran physicians who “moonlight” during evenings, weekends, or vacation – including many who cover the extended operating hours of urgent care centers.
Because locum tenens providers are independent contractors, they can negotiate all terms of their assignments, including location and pay. Physicians can find locum tenens engagements on their own – through the Internet or by contacting urgent care centers directly – or they may work with one or more locum tenens agencies.
The leading reasons that physicians choose one agency over another include:
- number and location of practice opportunities
- pay rate (including malpractice coverage and benefits)
- quality of service offered (including logistics and travel)
- reputation and/or name recognition.
When a medical provider expresses interest in doing locums work, staffing agencies typically start by discussing the provider’s objectives, experience, and availability. The staffing agency also begins credentialing the provider – verifying education and licensure – and securing malpractice coverage. Once the provider is qualified to work locums, the staffing agency reviews available opportunities and circulates the provider’s credentials to those that seem most appealing.
The following are questions that a locum tenens provider might ask when considering a particular assignment:
- What is the location of the opportunity?
- What is the length of the assignment?
- What is the type of facility, how large is it, and how many (and what type of) providers work there?
- What shifts are included and how long is each shift?
- What is the average patient load and acuity per shift?
- What accommodations and/or reimbursement for travel expenses will be provided?
- What is the availability and quality of equipment and supplies?
- What charting/billing systems are used and what training/orientation will be provided?
- What is the pay rate?
When an opportunity appears to be a good match for both the provider and the practice, the staffing company negotiates the terms of the assignment and coordinates travel details with the provider. Once engaged, the provider submits a log of hours worked to the staffing agency, which bills the practice and issues a paycheck to the provider.
Table 3. Benefits and Drawbacks to Providers Working Locum Tenens
Permanent Placement: Outsourcing the Recruiting Function
Few entrepreneurial urgent care centers have sufficient scale to employ a full-time physician recruiter. Using a medical staffing company, an urgent care center may “outsource” this vital capability – supporting the entire process of recruiting, hiring, and on-boarding.
The advantages of using a medical staffing company for permanent placement include:
- time and attention focused on finding the “right” candidate for a practice (without the distraction of day-to-day operations of the center)
- consulting assistance in outlining job responsibilities, setting compensation, and defining benefits (to assure the center is competitive in the employer market)
- ability to conduct a national candidate sourcing campaign through multiple channels (including recruiting at conferences, capturing referrals from previous placements, and direct Internet and media job postings)
- thorough screening of prospective applicants through background searches, technical skill evaluations, and pre-interviews (saving time by “weeding out” unsuitable candidates)
- ability to “try out” prospective permanent hires through “temporary to permanent” programs or service guarantees such as professional fees refunded if a placement does not work out
- support with physician licensure, credentialing, and hospital privileging
- relocation assistance, including moving, housing, childcare, and even job placement for spouses. Some staffing agencies also handle immigration-related issues for international medical graduates.
The cost of utilizing a staffing agency for permanent placement of an urgent care physician average $15,000 to $20,000, depending on the location of the center, the scope of work, provider qualifications, and other factors affecting how many providers meeting the criteria are available in the marketplace.
The cost of bringing a locum tenens physician from temporary to permanent can be even higher – around $25,000 – because the staffing agency is losing a provider it previously expected to have available for locum assignments.
Likewise, a staffing agency may require payment of its fee in whole if a practice identifies and hires a physician on its own without the agency’s assistance – the rationale being that staffing agency still incurred recruiting and screening efforts.
Just as the nation’s provider shortage affects the ability of urgent care centers to attract and retain qualified candidates, some professional recruiters are having increased difficulty finding viable candidates for their clients. As a result, many urgent care centers choose to utilize several different search firms, staffing agencies, or recruiting channels to find qualifies providers. Table 4 outlines factors to consider when evaluating a medical staffing company.
Table 4. Factors to Consider When Evaluating Medical Staffing Companies
|What is the staffing company’s size? How many facilities and physicians do they represent?
Urgent care centers are differentiated by extended evening and weekend hours, with seasonal ebbs and flows in patient volume. A national shortage of qualified providers creates challenges for urgent care centers to appropriately match staffing levels to demand during all operating hours.
In addition, tasks related to provider recruiting and staffing can distract urgent care operators from managing the day-to-day business.
Medical staffing agencies are a resource available to urgent care operators – on a one-time or ongoing basis – to augment their own capabilities and assure all slots on the provider schedule are filled.