Introduction

The healthcare landscape is continually changing and in this second issue of the Locums Staffing Journal we address a few the changes that you are likely dealing with every day.

We have helpful information from The Advisory Board on how to identify declining volumes, as well as the five biggest trends affecting medical groups today. It also includes ways to boost provider engagement, the pros and cons of using a locums right out of residency, and how hiring a locum tenens can become an integral part of your permanent position recruitment strategy.

I am a new member of the Weatherby executive team, but have been working at the company for more than 13 years. As part of my responsibilities I oversee all our customer experience initiatives. This gives me great insight into the issues and problems that you deal with daily. Our goal with the Locums Staffing Journal is to share information that will help you address those issues and be more productive in your staffing initiatives.

I hope that you find the content of this issue informative. Thank you for allowing us to be your staffing partner; we appreciate the relationships we get to build with you as we work together to meet your staffing goals.

Cindy Slagle

Vice President, Business Development

Weatherby Healthcare


How to improve provider engagement and prevent physician burnout

Physician burnout is real. In fact, 44 percent of physicians say they are experiencing burnout, according to the Medscape National Physician Burnout, Depression & Suicide Report 2019. And a full 10 percent say their burnout is so severe they are considering leaving medicine.

In an effort to retain those valuable physicians — and to address and prevent burnout — many healthcare organizations are beefing up their provider engagement efforts. CentraCare Health, based in St. Cloud, MN, decided to go big with its provider engagement program. It hired a provider engagement officer to raise awareness and promote meaningful, long-term provider engagement.

Dr. Dawn Ellison, the Provider Engagement Officer for CentraCare, says the organization “recognized the severity of the burnout problem,” and knew it needed more than “a one-off presentation” or sporadic retreats to keep people engaged in the issue. “There needs to be follow up,” says Dr. Ellison. “Provider engagement is a marathon not a sprint. It’s a major culture shift.”

Here are some of the things Dr. Ellison has learned during CentraCare’s provider engagement marathon.

Seek the providers’ voice

Before jumping in with new strategies and programs for provider engagement, Dr. Ellison says it’s important to get providers involved “in addressing the drivers of burnout. I’m a big proponent of the team approach, getting all the stakeholders involved in the solutions.”

“It’s about voice,” she adds. “Give them voice regarding things that take them away from patient care. There are things that other people can do for them, but there are a lot of problems that we need their voice to solve. If what leaders do is just take the pebbles out their shoes, we miss the opportunity to discover with them that the real solution may be to pave the road.”

Be patient with the process

Effective provider engagement simply takes a lot of time and effort. And you can’t do it in the top levels of the organization and hope it somehow trickles into departments. The work must take place on the ground within the various departments and work groups.

Dr. Ellison explains that it’s important to have a “champion” within the department to spearhead the process and keep it moving forward. Then the department must schedule meetings where providers can pinpoint issues and develop a ranked list of possible solutions. Within CentraCare, Dr. Ellison educates change agents so they can take their teams through the process. She is available to help as needed, and she also provides individual coaching.

Build strategies for success

In addition to the strenuous, department-by-department work of engaging providers, Dr. Ellison created organization-wide programs to bring providers together across departments. Some of those strategies include:

Clinical provider forums. Dr. Ellison says the quarterly provider forums are a “high-level” way to engage physicians and other providers. “Providers are assigned to represent the different departments, but anyone can come if they are interested in the topic,” she says. “The time is spent learning from the providers and discussing how they are implementing things. The goal is for our leaders to say, ‘This is what I heard from you, and this is how what you said is going to make a difference.’”

Wisdom Circle. The Wisdom Circle is an opportunity for providers “to reflect on the joys and challenges of our privileged presence working with patients and families.”

Wellbeing retreats. These retreats offer keynote speakers and workshops. “Some of the sessions at past retreats were healthy diet, accessible mindfulness practices, healing touch, and the mental health stigma,” Dr. Ellison says. “It’s kind of a wellbeing buffet that they can sample and get involved with if they want to learn more about it.”

Working for change

Dr. Ellison says CentraCare Health is on a long-term provider engagement journey, but the organization is starting to see results from its efforts. “We have participated in a Minnesota Hospital Association burnout survey for the past 3 years, and we have seen improvement on the burnout part of the survey,” she says.

Make no mistake — provider engagement requires a real investment of both time and resources. But the effort is crucial if you want to keep providers happy, prevent burnout, and retain your doctors.


Pros and cons of using a locum tenens doctor right out of residency

Locum tenens positions can be great opportunities for early career physicians who want to explore their options. But can physicians just out of residency be a good fit for your healthcare facility’s short-term needs? Here are the pros and cons of bringing on newly minted physicians for locum tenens positions.

Pro: You can bring them on quickly

One very practical upside to bringing on early career locum tenens physicians is that you can typically bring them on board quickly. With a shorter work history along with few or no malpractice claims, they can often be easier to credential and license. Plus, many early career physicians are single or don’t have children, making it easier to recruit them for harder-to-fill shifts.

Con: They can be outspoken

Studies have shown that younger doctors are often more comfortable speaking out when they disagree with senior colleagues or believe something can be improved. This could cause a generational friction between younger and older staff. However, it can also help spur positive change — for example, a greater focus on work-life balance or physician wellness.

Pro: They have energy and enthusiasm

Many young physicians bring energy, enthusiasm, and fresh ideas to the practice of medicine. They also bring a digital native’s comfort with adopting new technologies, like EHRs. “Everywhere I go, I have to learn their particular EHR platform. I actually enjoy learning that,” explains Dr. Simran Kalra, a pediatrician who began working locum tenens jobs from the start of her career. “It’s pretty straightforward, but it might be harder with somebody who’s not as tech savvy. And it can slow the flow, too.”

Con: They have less experience

Brand-new doctors simply lack the years of experience that more senior physicians can bring to the job. Physicians just out of residency may require a little bit of extra training up front. And the way your practice operates may not exactly match what they learned during their residency or schooling, which will require some adjustment for the physician.

“You can’t go in there and just have your set ways. You have to work with people. You have to be able to work with the tools they have,” says Dr. Kalra. “Yeah, you’re going to be a little bit slower your first day compared to their regular physician, but you do have to adjust pretty quickly just to keep the flow, so it definitely keeps you on your toes.”

“You can’t go in there and just have your set ways. You have to work with people. You have to be able to work with the tools they have,” says Dr. Kalra. “Yeah, you’re going to be a little bit slower your first day compared to their regular physician, but you do have to adjust pretty quickly just to keep the flow, so it definitely keeps you on your toes.”

Pro: They are eager to learn

On the other hand, fresh-out-of-residency physicians are eager to learn as much as they can from each new practice setting. Dr. Kimberly Atiyeh obtained her education in New York City, then completed her residency in Pittsburgh. After that, she accepted a locum tenens position in a rural area. “Something that I’ll always carry with me is that exposure to a different type of community that I hadn’t had in the past,” she says. “It was really cool to be able to experience something totally different. You can really see the pros and cons of being a specialist in that type of environment.”

Pro: They may become your next new hire

Locum tenens positions are a good way for facilities and new physicians to try each other out. If it proves to be a good match, the arrangement has the potential to become permanent. Dr. Atiyeh’s exposure to a rural setting as a locums physician ultimately helped her become excited about accepting a permanent position in Colorado.

That was also the case for Dr. Kevin Porciuncula, a family medicine physician who began working locum tenens for a clinic with three locations. “They liked me enough that they offered me a position,” he says. “I wasn’t really sure what I wanted to do, and I think locums gave me the best opportunity to try out different things — although the job I ended up signing with was my first job.”

Finding the right fit

When looking to fill a position, don’t overlook early career locum tenens physicians. They can bring energy, flexibility, and fresh ideas to your facility. And in turn, you will give them valuable experience in a new setting. With the right fit, it’s a win-win for everyone.


Hiring locum tenens as part of your permanent recruiting strategy

Every facility wants to secure great physicians who provide excellent care and plan to stick around for at least five years. Unfortunately, keeping your hospital or private practice fully staffed is easier said than done.

According to the most recent benchmarking survey from Association of Staff Physician Recruiters (ASPR), it takes an average of 222 days for a hospital’s in-house recruitment team to fill an open position. In many cases, this long hiring process results in significant revenue loss for the facility. Fortunately, locum tenens doctors can be a solution to your hiring needs. Not only does it take less time to get a locum into a position (usually about 60 days, and sometimes sooner), but using locum tenens ensures that your patients can still be seen, you can earn revenue, and that your existing staff don’t burn out.

Hiring takes more time than you expect.

You might be wondering how it could possibly take more than six months to hire a new physician. Here are a few reasons the hiring process can be lengthy:

  • It can take several months to evaluate CVs and choose potential candidates to interview, especially in a highly competitive field like family practice.
  • Even if a physician signs a contract within a few months, he or she may have to complete a 90-day out clause with a current employer before beginning a new job.
  • Many doctors must relocate for new positions, which can take up to 60 days, depending on individual situations.
  • New staff physicians must be credentialed and signed up with insurance companies through the hospital, which takes 30 days.

When it takes nearly eight months to get another physician on board, what happens to the other doctors at your hospital or practice? They may become overworked and consider a new career altogether, or they may begin looking for other opportunities at a different hospital. Don’t risk losing more of your staff members while you’re trying to hire a replacement. Bringing locum tenens doctors on board can have the following benefits:

Preventing burnout by hiring temporary physicians.

Hiring locum tenens physicians also ensures patients are seen more quickly and have no reason to look elsewhere for care.

(Daily gross charges – daily locum coverage rate) x 200 days = ROI.

You must also consider the cost of the locum provider, but by using the simple formula below, you can easily calculate the ROI:

If you hire a locum tenens doctor during that time, you’ll net 200 days of billable gross charges for the facility, adding up to $451,400 (based on the MGMA 2015 Report), even if it takes 60 days to get him or her on board.

Each day that a physician is not working, you’re losing revenue. For example, say it takes you 260 days to recruit a new family practice physician who accounts for $2,254 in daily gross charges. You could be losing out on approximately $586,000 before you fill the job.

Losing money while you look for a new hire.

All of these steps can add up to an additional 140 days before a physician can begin his or her new job, not to mention time needed for onboarding.

  • Lighter patient loads. Even hiring just one locum tenens doctor at your facility can mean a shorter work week for other physicians and care for hundreds of patients.
  • More vacation time and flexibility. Some of your doctors may not have taken a day off in months, and the daily grind of medicine is a big contributor to burnout. Having another staff member to take care of patients means others can enjoy a well-deserved break.
  • Time to pursue professional opportunities. Maybe one of your surgeons wants to attend a big conference but hasn’t had the time since you’re short-staffed. With a locum tenens doctor to fill the gaps, she can finally attend.

Locum tenens staffing can help address staffing challenges in both rural facilities and hospitals in some of the largest metro areas of the country.

Making locum tenens part of your strategy.

Hiring physicians to help your facility temporarily shows you’re committed to helping staff members achieve a better work/life balance and can lead to stronger employee loyalty.



Investigating declining patient volumes

Declining patient volumes is an issue faced by many healthcare facilities. A recent Advisory Board article investigated the root causes of the decline and outlined ways to address them.

Are volume declines unique to my organization?

Is the decline unique to your facility or reflective of a broader market trend? If your facility is seeing a greater volume decline than the wider market, the cause is specific to your organization. How you respond will be different based on where the decline is coming from.

Is the volume decline a result of internal factors?

If your volume decline is unique or steeper than a generally declining market, analyze internal factors first. You may want to evaluate whether your current providers are at capacity, or able to take on more volume. Or you may want to analyze patient wait times. Have there been changes in practice patterns? One organization found their radiation volumes declined not due to fewer patients but because care delivery had changed, and those patients were now receiving half the treatment rounds as they had in prior years.

Could external factors explain the decline?

If internal factors aren’t the cause, investigate external causes. Your organization should uncover patient preferences. Then ask how your facility and your competitors compare on these preferences. What percentage of referrals from area physicians go to you versus competitors? How have those patterns trended over time? One organization determined that women were traveling out of the area to give birth, since alternative birthing techniques weren’t available at the local hospital.

Is the answer: All of the above?

Sometimes your volume declines due to multiple factors, such as a falling population and a mix of internal and external challenges. Therefore, you’ll need to investigate as many potential explanations as possible, confirming or thoroughly ruling out each as you look for ways to improve.

*Volumes declining at your organization? Here’s how to identify the root cause by Austin Terry and Lauren Lawton, https://www.advisory.com/research/market-innovation-center/the-growth-channel/2019/10/volume-decline-root-cause


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