MEDICAL ECONOMICS SPECIAL SECTION: Locum tenens: When you need one, how to get one

No doubt about it-hiring a locum tenens physician is costly. However, it's costlier if you don't. If you belong to a group practice, a substitute doctor with the fancy Latin name can save you from burnout-and all its costs-when a colleague suddenly quits and somebody else must pick up the slack until a permanent replacement comes aboard. Maternity leave and illness also create vacancies to plug.

If you're a soloist taking a vacation, you need to provide your patients with continuity of care. Plus, you don't want them switching to a competitor. Losing patients is painfully costly.

A locum also produces revenue that otherwise would go unearned. You may not break even with your fill-in, but instead of being $15,000 in the hole over a 2-week stretch, you may only be down by $5,000.

Anyone who spends that kind of money should shop wisely. We've interviewed consultants, executives at locum agencies, and doctors who've used locums to advise you on hiring that substitute stethoscope.

What a locum agency will do for you-and for how much

Perhaps the simplest way to land a temporary doctor is calling a locum agency. Locate one by Googling "locum tenens jobs," visiting the Web site of the National Association of Locum Tenens Organizations ( http://www.nalto.org/), or asking peers for recommendations.

A locum firm will connect you with candidates who are vetted as qualified and competent in your specialty. Once you select someone, the company can book the locum's lodging and transportation and help get him credentialed with hospitals. Dissatisfied with his performance? The agency will replace the replacement.

The vast majority of assignments, though, are successful, notes Clarke Shaw, a senior vice president with VISTA Staffing Solutions in Salt Lake City. Several decades ago, locum work was viewed as a refuge for doctors who couldn't survive in private practice, but the bar has been raised since then, he says.

"Locums are in a fishbowl," says Shaw. "Every time they receive an assignment in a new state, they must be licensed there and credentialed at new hospitals. They're reviewed constantly. If they have skeletons in their closet, they won't work."

Agencies charge clients a daily rate that can be roughly $700 a day for a primary-care physician and almost triple that for a radiologist. Between 70% and 80% of the agency rate goes into the locum's pocket, says Pam McKemie, a senior vice president with http://LocumTenens.com/ in Alpharetta, Ga. The rest covers the locum's malpractice coverage, agency overhead, and profit.

The daily rate is based on 8 hours, with overtime typically calculated on a time-and-a-half basis that's prorated per hour. Weeknight call is worth an hour of pay; carrying a beeper an entire weekend equals a day's compensation.

Locums from an agency usually come from out of town, so you'll also be responsible for their airfare, rental car, and lodging. When assignments are longer than a week, locums end up in "executive housing" where they can cook their own meals. Otherwise, they stay in hotels.