It’s no secret that the healthcare industry is currently experiencing unprecedented levels of healthcare provider shortages. While there are many reasons for this, including increased workloads, lack of work-life balance, an aging population, and a lack of incoming students, burnout among healthcare providers is at an all-time high since the COVID-19 pandemic. As a healthcare administrator, it can be difficult to create solutions for this dire issue. However, finding strategic ways to use locum tenens in your staffing mix can be a simple resolution to avoid provider burnout.
What Provider Burnout Can Look Like
Working without regular time off and the additional stressors of being a full-time healthcare provider leads to burnout, without a doubt. Burnout has many faces: anger, frustration, apathy, loss of attention to detail, a visible attitude of “what’s the use?” and unhealthy coping behaviors. When one person feels burnout and begins to show it, the negativity spreads and influences others. Burnout can become toxic and lead to low morale in the whole workplace.
The other side of this is when providers display an attitude of taking care of themselves regardless of the impact on others. When you have one or two providers who do this, and one or two who feel guilt or pressure if they take time away, that’s a recipe for anger and resentment. Providers who end up feeling “stuck” with call on major holidays or have more than their fair share of weekend call will be acutely aware of the situation, no doubt of that.
If the practice managers are reluctant to use locum coverage, even when staff are out for planned absences, some people may feel pressure to forgo time away. They realize their absence will create a hardship for the rest of the providers, and they feel guilty for taking time off. The knowledge that they’ll get “behind” with their patient load or concern that patients who need to be seen won’t be able to get an appointment can also be a burden, and impact willingness to take time off, causing more of a threat of burnout.
Incorporating Locum Tenens Within Your Practice Model
While there are many strategies and tools to use to address provider burnout within your healthcare facility, considering your practice model should be a starting point. Clinic managers have a wide variety of practice models to choose from, and there are many factors to consider. But whatever the model, eventually, the practice will need additional help.
Locum tenens coverage is traditionally used when a practice has an open position or a longer provider absence, say two weeks or more. While day-to-day staffing for patient care is always needed, additional support may be critical if the practice covers call with their local providers.
Locum support isn’t just for times when you have permanent staff out of office, or you have a staff vacancy. You may want to bring in additional help if you’re making a major change to your clinic processes, such as converting to a new electronic health record, making significant changes to your staffing model, or when you have a community health need that is greater than usual.
You may be accustomed to thinking of using locum providers only when absolutely necessary.
But what if you use that resource strategically?
Creating Your Rotation Schedule
You could use any rotation schedule that makes sense for the locum providers you’re working with and your needs. You could choose to have two people alternate, each working a month on, month off. You could choose to cover a few weeks each quarter with more than one locum provider if you have multiple permanent staff scheduled to be off at the same time. And you can set up shorter rotations…perhaps you have a provider who is with you each quarter for a set period and who shares regular rotation time with another one or two providers.
Although you can’t forecast when you’re going to have an uptick in flu or seasonal illness, you may want to consider adding staffing in times of historically higher patient volumes, or for example, during a time when you’re making a push to see all your diabetic patients or meet some other metric, and know you’ll need help to meet that goal. Look at any major events or push your scheduling and consider if having an additional provider on hand would make things easier and smoother. Any large change or event at your facility can add to the stress of permanent providers, potentially leading to burnout. Finding ways to mitigate friction points during these high-stress events can keep them at your facility.
Locum providers know when they arrive, they have a limited amount of time to work in the practice. They’re typically not going to get involved in community or office politics; they come prepared to work and view the experience as a time of being “on.” Of course, it’s helpful to discuss call schedules and expectations with your locum providers. You don’t want to treat them poorly or unfairly by putting too much of a burden on them. But generally, if a locum provider is working, they want to cover weekends and holidays. That’s part of the job, and they know that. If you have two locum providers on-site at the same time, that’s even better, they can potentially share the bulk of call and really take that pressure off the permanent staff.
Leave Full-Time Positions Open to Staff with Locum Tenens
Perhaps you have a practice model that has four full-time provider positions and requires call coverage. In small communities, particularly if climate and location are factors, it can be challenging to keep full-time providers, and it’s equally difficult if you make up your shortfall with individuals who are unfamiliar with the community and practice. Having a new locum provider come in every time you need coverage can be tiring and frustrating to everyone: the provider who has to ask questions about everything, perhaps learn a new EMR, and get to know the area; and the staff who have to answer, educate, and bring the locum provider up to speed on patient issues, clinic protocols, and getting acquainted with a new place.
One way to staff that helps with both these issues is to intentionally leave one FTE open and fill that vacancy with rotating, regularly returning providers who will get to know your patients, become familiar with your staff and processes, and help to smooth other gaps in coverage when you have someone out on vacation, family leave, etc. Allocating the funds you would have spent on a permanent provider to pay for multiple locum providers and/or sequential locum rotations throughout the year can be a strategic win, and you may not even see an appreciable difference in costs between the two models.
Your model of using one FTE to pay for locum coverage likely won’t allow for two locum providers all the time, but there may be weeks when you can get by with less staff, and other times when you’ll need the additional help. You may choose to staff with a bit of a shortage at times to allow for extra help during seasons of higher need.
I’ve seen this exact model work well over a number of years in multiple sites. The permanent staff benefit, the locum providers who rotate benefit, and most of all, the patients benefit.
You can also scale up or down, depending on the number of FTEs allocated to your practice. While no model fits every situation, use the examples given here to assess your staffing needs and think creatively. How can you make locum staffing part of your strategy to combat burnout and other administrative issues, and not just an inconvenient, expensive solution when it’s forced on you?
The Cost of a Full-Time Provider vs. a Locum Tenens
When you bring a permanent provider to join a practice there are many fixed costs to consider. You may be using a search firm and advertising; you may have multiple interviews, including site visits. When you choose someone to move to your area, you’ll pay relocation costs, likely a placement fee. You’ll likely pay a sign-on bonus. For a permanent provider, you have the overhead of benefits and salary, perhaps assistance with loan repayment or other incentives. The long-term gain is that you (hopefully) have someone who will become part of your community for several years, maybe even the rest of their career. You expect to hire a provider who will grow with your practice and provide continuity of care for patients, someone who will eventually have valuable historical knowledge and insight, based on a long-term presence.
While the benefits of having permanent providers (whether full-time or part-time) on staff are indisputable, there may be other costs, far beyond the number that shows up on a spreadsheet.
When you look at the costs of having a locum provider on site, of course, you’re paying a premium rate for them as well as travel and lodging costs. However, you’re not paying benefits and relocation costs, assisting with loan repayment, or other incentives used to attract permanent staff. You’re not paying a sign-on bonus, annual bonus, or productivity pay. Your locum costs are fixed and can be budgeted and forecasted to make strategic use manageable.
You may not need a locum provider to be present at all times, but you should have a low bar for bringing someone in to help support your permanent staff. When your permanent providers feel appreciated and cared for, you’re building relationships that can truly be long-term, and you’re combating provider burnout. The cost of locum staffing as a part of that support system is minimal compared to the potential return.
How Does Using Locum Tenens Coverage Help With Burnout?
In the model described above, three permanent providers are regularly supported by rotating locum providers who make up the fourth FTE. Having a minimum of two, and up to four or five providers who work a few times throughout the year keeps fresh energy coming in the door.
When someone is always rotating in, the locum provider will usually be happy to take a disproportionate number of days on call because they’re (usually) paid an additional sum to be on call. When you have the same locum providers returning to the practice and community regularly, they get to know the staff and patients. Their familiarity will take longer to achieve, but eventually, they’ll be less like a locum provider and more like permanent staff in that regard.
Use locum staff to give permanent providers a lifestyle that allows them to have regular vacations, holidays with family, and the ability to see patients without feeling overwhelmed. Use locum staff to handle the problems of the day that need urgent care or same-day appointments. Permanent staff are the ones who should be seeing patients with chronic diseases and complex needs if both permanent and locum staff are working.
Having reliable and known providers you can bring in if you have an unexpected absence is a win too. If a permanent provider has an unplanned departure or life event, that’s stressful enough. Having a few providers in the wings who can quickly be part of a solution is another benefit to intentionally building a locum pool and then utilizing it regularly. No worries about credentialing or getting a new person up to speed…just call your account executive and ask for your regular locum providers. Let them know what you need. If you’ve built good relationships you’ll be far ahead of the situation.
How to Keep the Locum Providers From Burning Out
Even locum tenens can be subject to burnout. To keep your healthcare providers engaged and happy, here are a few tips that will keep them coming back to your facility, eager to work.
To help avoid burnout, foster a sense of belonging, even though the locum providers and staff know there’s no contractual commitment. That means that you include the locum providers in clinic social gatherings and community events. They may not be able to attend everything but let them know they’re welcome.
Provide housing that is comfortable and meets expectations. Don’t ask a locum provider to stay where you wouldn’t want to stay yourself. In some situations, it may be a good long-term strategy to have dedicated clinic housing set aside for locum needs. In other scenarios, you may be able to rent an apartment or extended-stay hotel space that’s sufficient.
We have a whole article about welcoming locum tenens into your facility, which you can find here.
By incorporating locum tenens in your rotations, you also have a chance to see if you and your staff are compatible with the locum provider. If you find someone who’s a great fit with your staff and they’re willing to become part of a rotating pool, that’s wonderful! If you’re not a good match, you don’t have to repeat the experience. Keep looking for the two to four providers you want to have in your pool and invite them back regularly.
At Wilderness Medical Staffing, we have so many providers who would be excellent choices for the type of rotation model described here, helping to alleviate burnout of your full-time staff! If you’re considering how to use locum providers to be more creative and strategic with staffing, reach out to our team to review your clinic needs and your wish list for your provider model. We’d love to be part of creating a stable and reliable pool for you, and we’re always willing to work with the needs and unique situations of our clients.