I recently wrote about my experiences as a traveling physician and how to navigate locum tenens work. Today I want to talk about the client (in this case, hospital) side of the equation. I’ve had the chance to speak with several executives (some were physicians themselves) about the overall process of hiring and managing temporary physicians. What I heard wasn’t pretty. I thought I’d summarize their opinions in the form of a mock composite interview to protect their anonymity — I’m hoping that locum MDs and agencies alike can learn from this very candid discussion.

Dr. Val: How do you feel about locum tenens agencies?

Executive: They’re a necessary evil. We are desperate to fill vacancies and they find doctors for us. But they know we are desperate and they take full advantage of that.

Dr. Val: What do you mean?

Executive: They charge very high hourly rates, and they don’t care about finding the right fit for the job. They seem to have no interest in matching physician temperament with hospital culture. They are only interested in billable hours and warm bodies, unfortunately. But we know this going in.

Dr. Val: Do you try to screen the candidates yourself before they begin work at your hospital?

Executive: Yes, we carefully review all their CVs and we interview them over the phone.

Dr. Val: So does that help with finding better matches?

Executive: Not really. Everyone looks good on paper and they sound competent on the phone. You only really know what their work ethic is like once they’ve started seeing patients.

Dr. Val: What percent of locums physicians would you say are “sub-par” then?

Executive: About 50%.

Dr. Val: Whoah! That’s very high. What specifically is wrong with them? Are they poor clinicians or what?

Executive: It’s a lot of things. Some are poor clinicians, but more commonly they just don’t work very hard. They have this attitude that they only have to see “X” number of patients per day, no matter what the census. So they’re not good team players. Also many of them have prima donna attitudes. They just swish into our hospital and tell us how they like to do things. They have no problem complaining or calling out flaws in the system because they know they can walk away and never see us again.

Dr. Val: Yikes, they sound horrible. Looking back on those interviews that you did with them, could you see any of this coming? Are there red flags in retrospect?

Executive: None that I can think of. All of our problem locums have been very different — some are old, some are young — they come from very different backgrounds, cultures, and parts of the country. I can’t think of anything they had in common on paper or in the phone interviews.

Dr. Val: So maybe the agencies don’t screen them well?

Executive: Right. I think they probably ignore negative feedback about a physician and just “solve the problem” by not sending them back to the same hospital. They just send them elsewhere — and so the problem continues. They have no incentive really to take a locums physician out of circulation unless they do something truly dangerous at work (medical malpractice). That’s pretty rare.

Dr. Val: I recently wrote on my blog that there are 4 kinds of physicians who do locums: 1. Retirees, 2. Salary Seekers, 3. Dabblers and 4. Problem personalities — would you agree with those categories?

Executive: Yes, but I think that a large proportion of the locums I’ve met have been either motivated by money (i.e. they want to make some extra cash so they can go on a fancy vacation) or they just don’t get along well with others. There are more “problem people” out there than you think.

Dr. Val: This is rather depressing. Have you found that some agencies do a better job than others at keeping the “good” physicians coming?

Executive: Well, we only work with 2 or 3 agencies, so I can’t speak to the entire range of options. We just can’t handle the complexity associated with juggling too many recruiters at once because we end up with accidental overlap in contracts. We have booked two doctors via two different agencies for the same block of time and then we are legally bound to take them both. It’s an expensive mistake.

Dr. Val: Does one particular agency stand out to you in terms of quality of experience?

Executive: No. Actually they all seem about the same.

Dr. Val: For us locums doctors, I can tell you that agencies vary quite a bit in terms of quality of assignments and general process.

Executive: There may be a difference on your end, but not much on ours.

Dr. Val: So, being that using locums has been a fairly negative experience for you, what do you intend to do to change it?

Executive: We are trying very hard to recruit full time physicians to join our staff so that we reduce our need forlocums docs. It’s not easy. Full time physician work has become, quite frankly, drudgery. Our system is so burdened with bureaucratic red tape, decreasing reimbursement, billing rules and government regulations that it sucks the soul right out of you. I don’t like who I become when I work full time. That’s why I had to take an administrative job. I still see patients part-time, but I can also get the mental and emotional break I need.

Dr. Val: So you’re actually a functional locums yourself, if not a literal one.

Executive: Yes, that’s right. I have some guilt about not working full time, and yet, I have to maintain my sanity.

Dr. Val: Given the generally negative work environment that physicians live in these days, I suppose that temporary work is only going to increase exponentially as others take the path that you and I have chosen?

Executive: With the looming physician shortage, rural centers in particular are going to have to rely more and more on locums agencies. What agencies really need to do to distinguish themselves is hire clinicians to help them screen and match locums to hospitals. Agencies don’t seem to really understand what we need or what the problems are with their people. If they had medical directors or a chief medical officer, people who have worked in the trenches and understand both the client side and the locum side, they would be much better off. Until then, we’re probably going to have to limp along with a 50% miss-match rate.

Val Jones is founder and CEO, Better Health.