The best physician to replace a family physician is another family physician, yet finding one can be difficult and expensive.
First consider whether the entire practice needs coverage, or if portions could be left uncovered. For example, leaving the hospital or obstetrical part of the practice uncovered or with a local colleague could reduce cost and liability. Also, consider utilizing non-physician providers, which are very cost-effective. Usually, the hiring physician provides the malpractice insurance for the locum tenens.
Background and reference checks need to be performed prior to hiring a locum, and many times local law enforcement officials can be of assistance. Even so, the hiring physician should always allow provisions for termination of the locum in the event of significant deviation from medical standards of care. Even if the locum is terminated, the contract must still be honored in full.
The hiring physician should choose the dates of his or her absence from the practice well in advance. In general, three months would allow ample time to hire the locum tenens and coordinate schedules. If a new locums doctor is hired, arrange to have key office staff present. For example, the nurse that knows the patients best, the office manager, and the Spanish interpreter, if applicable. These employees can provide continuity and protection for the practice.
In rural areas, the local hospital can often provide free lodging and meals for the locum tenens. The hiring physician may offer his or her house to a well-known locum.
The locum should arrive one to two business days before the hiring physician leaves. This would allow the locum to be oriented to the office and the community. This time should be included in the fee.
The hiring physician should start making a patient list two weeks before the locum arrives. The list should include the sicker, more chronic patients, obstetrical patients that are near term, hospice patients, narcotic-seekers, higher acuity nursing home patients, and patients recently discharged from the hospital.
The locum should be appraised of the practice's follow-up schedule and billing procedures. The technology that the office uses should be demonstrated, particularly electronic medical records or mobile devices. The practice's typical referral patterns should also be reviewed.
The hiring physician should attempt to anticipate upcoming events and try to resolve these prior to leaving. Near term obstetrical patients should be delivered, if possible, and elective procedures should be delayed until the physician returns.
Before leaving the office, the hiring physician should provide contact numbers to the office staff and the hospital, especially if the locum is unfamiliar. The hiring physician should be prepared to send the locum tenens home (with pay) if there are big deviations from medical standards of care.
The hiring physician should review charts, particularly for sicker patients, and all charges, especially outlier charges. Any concerns of the office staff should be addressed. Consider a written evaluation form, which many nation-wide companies can provide.
If the locum tenens was particularly well-liked and skilled, contact that provider. A thank-you note or gift may encourage repeat business or facilitate recruiting. A good locum tenens provider is a valuable resource, especially for the rural family physician.
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