AAEM-LG June 2021 President's Message
Dear Physicians, Hospitals, and Locum Tenens Companies:
The state of the locum tenens market is weak. There is a paucity of jobs, and reimbursement rates are low. As physicians, we don't know if we are being treated fairly. Meanwhile locum companies and hospitals have difficulty staffing a quality physician for the rates being offered. What remains is a sentiment of mutual distrust. Enter the American Academy of Emergency Medicine Locum Group (AAEM-LG). We exist because we feel matching a physician with a job should be conducted with more dignity than a used car deal. As the AAEM-LG Board of Directors President, I know through honest transparent conversation that all parties can win. Welcome to what I hope is a referendum on how locum tenens is conducted.
To Our Physicians
Locum tenens is a lifestyle. From the moonlighting resident, the “pit doc” looking to supplement their income, or the full time traveling physician; locum tenens is a means to freedom and the reclamation of autonomy. Locums can be a scary place. Negotiating the job shouldn't be. When you are entering a new marketplace it's hard to know what your worth is or if your altruism and naivete are being exploited. AAEM Locum Group strives to make this conversation one hundred percent transparent by partnering with locum agencies that have met rigorous standards and demonstrate a commitment to integrity. This means you know not only what you are being paid, but also what the agency is billing the facility. You know what your malpractice costs are and whether or not travel and lodging are included without having to deal with nebulous contract language. We also feel that non-restrictive covenants are an important part of a good physician-agency relationship so you will never be considered “presented” by a locum agency without your express written permission that is site and offer specific. Additionally, if you want to work for a client after months of service, a prohibitive buyout clause should not get in the way. We espouse the values of the American Academy of Emergency Medicine and see experts in emergency medicine as more than just a cog in the wheel. All “providers” are not created or trained equally and we recognize the value of a physician that has put in tens of thousands of hours to attain mastery of the practice of emergency care.
To Our Clients
Finding a quality physician can be daunting. It’s frustrating to sort through vaguely worded CVs and discern who is qualified and who isn’t. Furthermore, just because a doctor checks the boxes on paper doesn’t mean they are going to show up ready to move your department forward. This is why the AAEM Locum Group seeks to work with clients to ensure that qualified doctors who understand the importance of team dynamics are put forward. We strive to internally vet and maintain high quality physicians that you are proud to have in your department. When adverse outcomes occur, we want to partner with you to ensure that the patient, the physician, and the hospital’s interests are fairly represented and that process improvement and quality control occurs.
We feel by disclosing margins both parties actually come out ahead since clients and physicians know and can trust that opportunities are represented fairly. You may think you are paying market standard rates only to find the locums company is recruiting below average “providers” as a result of high markups. This puts morally forward companies ahead and discourages companies that rely on exploitative practices thereby tipping the scales towards those who are conducting honest business. You get great physicians who are happy to be working for you and know what they are walking into.
In order to guide both industry and our colleagues in conducting negotiations the AAEM-LG has compiled a list of best practices through which we feel the interests of both parties are fairly represented.
AAEM-LG Best Practices for Locums Physicians
- Transparent negotiation is facilitated by clearly discussing margins with physicians.
- Physicians will be privy to what they are being presented at
- What the markup is for their placement
- What the cost and terms of contract buyout consist of
- Buyout provisions
- Terms should be clearly stated
- Preferentially include a “diminishing buyout” to facilitate permanent placement for longer term contracts
- Physician contractors will understand what is paid for by the client, by the locums company, and what will come out of pocket.
- Travel costs including hotels, airfare, car rental, mileage reimbursement, and who pays them (if they are included in markup or separate)
- The cost of state license and the terms of repayment if this is included
- Presence/absence of state income tax
- Malpractice company, policy type, and/or the inclusion of tail
- Markup (if any) of malpractice policy
- The rating of the malpractice company providing coverage
- Any requirements to participate in “Patient Compensation Funds” for liability protection and who pays them
- Disclosure of Consent to Settle authority
- Disclosure of who named insured party is (physician vs agency)
- Clearly stated contract cancellation deadlines and guaranteed payment to the physician if contracts are cancelled within 30 days no matter the reason
- Reimbursement policy in the event that a client refuses or is unable to pay
- Inclusion of a due process system to resolve conflicts with patient care, administrative conflict, or personal misconduct
- Delineation of liability for on-the-job injuries for independent contractor physicians.
- Worker’s Comp inclusion/exclusion should be clearly stated
- Assignments should be accepted by written agreement only.
- Non-compete agreements shall be site specific only and for a term of 1 year or less
- Global (non-site specific) non-compete agreements to nationwide groups are unethical
- Non-compete agreements do not extend to other clients represented by the same locums company
- Expected patient volume should be stated in writing including average patients per hour and range.
- Supervision of NPPs should be clearly delineated including requirements to staff charts for patients not seen by or discussed with the physician.
- Orientation shall be provided and shall be paid at the physician’s hourly rate.
- Physicians will be presented to a facility only after explicit, written permission to a specific singular site. This permission must be renewed in writing every 30 days.
The locum tenens market is highly variable for both clinicians and clients, but together we can mutually advance by ensuring that both parties are treated fairly and transparently. I look forward to developing this project and changing the way conversations occur in locum tenens.
Robert Mohr, MD FAAEM
Assistant Professor of Emergency Medicine
Penn State Hershey Medical Center
President, AAEM Locum Group