Sandeep K. Aggarwal, MD, discusses the importance of continuity of care and ways to maintain it as a locum tenens physician.
Continuity of care is the mainstay of the medical profession to help ensure patient compliance, safety, and good health. However, with the advent of new healthcare models, this has become more challenging. Healthcare providers are leaving their practices or hospital jobs more frequently than in the past. Indeed, the old private practice models where providers tended to stay for years — if not decades — allowed for more stability and consistency. Patients benefited, and providers had the satisfaction of seeing their patients throughout treatment and (at times) healing of their ailments.
Short-term coverage and continuity of care
Of course, the ideal is to have the same patients see the same doctors throughout their treatment, but in practice, that isn’t always possible. Inevitably, providers need to take a temporary leave from work for a variety of reasons, including maternity leave, illness, or vacations. To continue with patient care, many practices and hospitals turn to locum tenens for coverage.
For the most part, this process runs rather smoothly. Typically, the locum tenens provider will onboard with the hospital or practice via a short orientation process. Then, they will follow-up with existing patients or treat new patients to prevent any delays in scheduling and patient flow. Depending upon the specialty, the provider may also be granted hospital or clinic privileges for procedures. Of course, there are always practice dynamics: patient flow, the politics of referral sources, and the capabilities of a particular health care system can all affect the locums hiring and onboarding process.
The main challenge of the locum provider is making patients feel comfortable while their usual provider is away and ensuring all questions are addressed. Once the contract has ended, the locum provider will hand the patients back to the practice and finish up any remaining paperwork so the regular provider can pick up where the locum left off.
Long-term coverage and continuity of care
In cases of long-term contracts with hospitals or communities where there are shortages of providers, locum providers can be invaluable in helping address the backlog of patients. Rather than just filling in, locum tenens providers actually support patient retention and continuity of care. In fact, some locum providers work these longer-term contracts full-time, which allows for more consistency for patients.
Most of these positions are in rural areas or smaller towns where the distances to larger centers are quite far. The challenge in these cases is getting to know patients who may have seen other providers and then have to develop a new relationship knowing that it will also be temporary. Many patients complain about this arrangement, but they also understand that there is now local support to care for them.
Continuity of care in a long-term coverage situation is affected by the length of contract, the availability of support staff (e.g. nurses, MAs), the number of weeks per month at work, and call schedules. For example, if the provider or hospital can only allow for two weeks a month due to budgetary constraints or locum provider availability, continuity of care can be more challenging, because there may not be anyone available to cover the other two weeks.
Continuity of care when no one is available
To help maintain continuity of care when no one is available on site, some providers write contingency/algorithmic plans in their notes or give instructions to the support staff in the event of questions in management. Others arrange to field calls remotely as part of the contract. In some cases, the primary care providers may have to answer the messages or rely on telemedicine for specialty support.
Most of these details are discussed in the interview prior to starting, but certainly circumstances can change partway through a contract. Clinic and inpatient settings are always in a state of flux due to the dynamic nature and unpredictability of patient care. But if both parties are flexible and adaptable, this translates to a more congenial working relationship, and ultimately to better patient continuity of care.