It seems quite a number of physicians have reservations about full-time employment. A mixed method study found that the physicians surveyed on the impact of salaried contracts expressed negative perceptions regarding their clinical autonomy (66.8%), the quality of care they provide (62.7%), and their relationships with patients (56.8%).
Establishing private practices could be a solution, but this comes with significant responsibilities, including management, extensive paperwork, and substantial financial overhead. These factors can detract from the primary focus—patient care.
Understandably, freelancing emerges as an appealing alternative. Medical freelancing seems to be on the rise because although the overall market size of the healthcare staffing industry declined by 24% in 2023, medical freelancing experienced a 17% growth during the same period.
The allure of freelancing is seen in the rationale for introducing these positions in healthcare facilities. A systematic review found that the primary strategies for promoting the recruitment and retention of contract physicians included offering financial incentives (83%), addressing educational and career development opportunities (67%), providing personal facilitators (67%), and accommodating a desire for flexible contracts (58%).
Source: https://credsy.com/blog/more-physicians-are-locum-tenens
So, what is medical freelancing? Could this new-ish trend be the answer to the elusive work-life balance? This blog examines what medical freelancing means for physicians and whether you can use it to supplement earnings and improve your quality of life.
The Surge in Freelancing Among Physicians
If you thought medical freelancing, or locum tenens as it is known in the profession, is on the rise, you are on to something. Locum tenens is a term derived from Latin meaning “placeholder.”
According to a report by The Wall Street Journal in March 2017, over 90% of hospitals employed physicians to fill approximately 50,000 positions. Further, the demand for such temporary assignments was increasing at a rate of 6% annually.
Recent estimates show that 7% of physicians, or roughly 52,000 doctors, were engaged in locum tenens work in 2023. In a 2024 survey, 44% of physicians reported transitioning to locum assignments, either on a full-time or part-time basis, compared to only 28% who indicated the same in a 2022 survey.
Nearly 85% of healthcare facilities now employ locum tenens providers. Between 2015 and 2023, the number of physicians accepting locum tenens positions rose by 88%.
The steady rise is partly fueled by the subsisting physician shortage. An AMA report projects a 37,800 to 124,000 physician shortage between 2019 and 2034.
Locum tenens is not a new model but a system in which physicians contract with hospitals or clinics. As Dr. Brian Sachs, a hospitalist in North Carolina, notes:
“This model can be found across all fields of medicine, from surgery to primary care to psychiatry. Contracts can vary tremendously, depending on patient needs and physician preference.”
Locum tenens emerged as a healthcare delivery model in the 1970s, originally designed to address physician burnout in rural areas and to provide opportunities for physicians to receive updated training.
Why medical freelancing is growing
Over the past three years leading to 2017, the number of physicians transitioning directly from residency into freelance work has increased by 50%.
The insurance industry has gained significant influence in the current healthcare landscape, where the cost of care is exceedingly high. Insurers dictate nearly every financial transaction between patients and physicians.
Additionally, the government, through its private contracts with healthcare providers and hospitals, exerts considerable authority over these financial interactions. This effectively establishes private contracts as the governing framework.
Over the past 20 years, little has been done to alleviate these burdensome requirements placed on physicians. As a result, many individual doctors have sought alternative solutions by either limiting their practices, discontinuing insurance contracts (especially with Medicare and Medicaid), retiring, or shifting to locum tenens work.
Further, 40% of physicians in the CHG Healthcare survey preferred locums because of increased autonomy and flexibility of schedules and financial affairs. Other compelling reasons included supplemental income (37%) and attractive compensation packages (30%).
According to a 2023 study conducted by CHG Healthcare, 82% of healthcare facilities indicated that their primary motivation for hiring locum tenens physicians was to temporarily fill vacancies until permanent replacements could be secured. 28% used locums to supplement their staffing requirements during peak periods.
The US is also facing an aging problem, which necessitates frequent healthcare demands. According to the Bureau of Labor Statistics, the number of Americans aged 65 and older is projected to exceed those under the age of 18 by 2034.
Older adults are set to surpass the number of children by the year 2034
Source: https://www.census.gov/library/visualizations/2018/comm/historic-first.html
As of 2022, 30% of physicians involved in patient care were aged 60 or older. This demographic trend suggests the possibility of a “retirement cliff,” posing a significant risk to the depletion of experienced medical professionals in the near future Top of Form
Benefits of Freelance Work
A survey found that 19% of physicians were highly interested in working locum tenens in 2023, up from 9% in 2019. This sentiment is further reinforced by the high satisfaction rate among those who have participated in locum assignments.
Most physicians (70%) hold a positive view of locum tenens employment. Indeed, 81% of current or former locum physicians reported a favorable experience with this type of work arrangement.
1. Improved work-life balance
In a survey by AMN Healthcare, 86% of respondents cited achieving a more desirable work schedule as the primary reason for seeking locum tenens employment. 80% of the survey participants indicated that addressing feelings of burnout was the second most important reason.
Jeff Decker, President of AMN Healthcare’s Physician Solutions division, had this to say on the subject:
“During the COVID pandemic, healthcare professionals began to rethink how, when, and where they work. Locum tenens offers relief from the long, inflexible work hours and onerous bureaucratic duties that often cause dissatisfaction and burnout among physicians and other healthcare providers.”
According to a LocumTenens.com survey, 73% of physicians expressed interest in local contract work, while 63% indicated a willingness to consider contract positions that involve travel. 50% said they prefer working more hours virtually through telehealth.
According to recent data, 61% of physicians currently in practice indicated that they are likely to seek new employment within the next year. Additionally, 27% of those intending to pursue a new position expressed general dissatisfaction with their current roles.
Findings by AMN Healthcare show that 47% of those surveyed expressed more satisfaction with locum tenens work than with permanent positions. Only 12% found permanent employment more fulfilling. Further, 95% of respondents rated their morale level during locum tenens assignments as either high or moderate, indicating a positive work experience.
Benefits of locum tenens employment
Source: https://chghealthcare.com/chg-state-of-locum-tenens-report
Locum tenens positions offer a level of flexibility that traditional full-time roles cannot match. These temporary assignments provide healthcare providers the opportunity to work in diverse practice environments and engage with a variety of patient populations. This option is particularly advantageous for new physicians who wish to explore different care settings and specialties before committing to a long-term employment contract.Top of Form
2. Minimizes burnout
A survey revealed that nearly 60% of physicians report experiencing some degree of burnout, compared to 4 in 10 in 2018. 17% of physicians indicated that they are either “significantly” or “completely” burned out. More than 50% of primary care physicians under the age of 55 reported experiencing burnout.
63% of physicians under the age of 55 reported that their job was stressful, in contrast to 54% of physicians aged 55 and older who expressed the same sentiment. According to an MGMA Stat poll, approximately 30% of medical groups experienced early physician departures or retirements in 2023 as a result of burnout.
Locum jobs could provide a solution. In the LocumTenens.com survey, 71% of contractors and locum tenens clinicians reported experiencing “little to no burnout,” compared to 40% of physicians who self-reported experiencing at least moderate levels of burnout.
Stress among physicians in the year 2022
Healthcare facilities are increasingly employing locum tenens to combat physician burnout. 56% of the survey participants indicated that utilizing locums helps reduce burnout among existing staff, a figure that has almost doubled from 2020’s 30%.
By helping reduce burnout, locum could help in physician retention. The rate of physicians who are “currently not practicing” is rising among younger cohorts. 21% of these physicians are under the age of 40, 34% are in their 40s, and 24% are in their 50s.
3. Higher pay
Locum positions can offer compensation that is 30-50% higher than full-time hospital roles. This allows healthcare providers to maintain or even increase their annual income while working fewer hours, although only 13% of respondents in a 2023 survey point to this as the main reason for continuing to work locum.
Part-time work in telemedicine and locum tenens can serve as an additional source of income. Providers can use this to alleviate medical school debt, considering 73% of medical school students graduate with educational debt, with an average loan debt of $250,995.
4. Better care for patients
Patients will no longer have concerns about whether their physician will be around, as they have the assurance that a qualified medical practitioner will be present on-site to manage any emergencies or to step in if the patient’s regular physician is unavailable.
Physicians also have the opportunity to expand their patient base and, through innovations like telemedicine, reach new patient populations and engage with cases in remote locations that they may not have otherwise encountered.
5. Minimize costs of operations
Healthcare facilities also benefit from locums. Understaffed healthcare facilities are costly, often experiencing high turnover rates among full-time staff and extended average lengths of patient care, which contribute to increased overhead expenses.
Locum positions enable facilities to efficiently scale services to meet patient demand and increase revenue. Balancing locum and full-time positions allows healthcare facilities to adopt a more efficient, cost-effective, and patient-centered model of care. Top of Form
Challenges and Implications for Job Security
Adopting locum tenens is not without its challenges:
1. Lack of continuity
The main disadvantage of locum tenens is the lack of continuity and relationship between the doctor, patient, and community. Doctor-patient relationship is a cornerstone of medical practice, fostering the trust and understanding necessary to deliver high-quality care.
The practice of medicine has increasingly become impersonal, whether patients receive care from freelance or full-time physicians at hospitals or medical practices. As of 2017, the average face-to-face time with a physician is approximately seven minutes.
This limited interaction makes it challenging to gather a thorough medical history, let alone engage in a meaningful discussion of diagnostic evaluations and treatment options.
2. No benefits
Locum physicians are viewed as independent contractors. Unlike those with employer-provided benefits packages, locum tenens physicians are responsible for independently researching and securing their own benefits, such as health insurance, life insurance, and retirement plans.
Additionally, as 1099 employees, they are responsible for managing and filing their own taxes.
3. Lack of support
Some locum physicians may experience feelings of loneliness or isolation during short-term assignments. The temporary nature of these positions can limit opportunities to form lasting friendships with colleagues and hinder their sense of social integration within the workplace.
In a systematic review, 67% of the studies indicated that 42% of respondents identified professional isolation as the primary deterrent to pursuing locum work.
4. Difficulties integrating into new workplaces
Adjusting to a facility’s systems, processes, local teams, guidelines, and culture can be challenging with each new locum assignment.
In particular, learning different electronic medical record (EMR) systems at each hospital can be a significant challenge if the physician is unfamiliar with the specific system in use.
Final Word
The US is facing a healthcare professional shortage that jeopardizes the continuity of patient care, particularly in areas outside major cities. As of September 2024, 67.99% of Primary Care Health Professional Shortage Areas (HPSAs) were located in rural regions. The AAMC also projects a shortage of 86,000 physicians by 2036.
Additionally, more than 50% of primary care physicians under the age of 55 reported experiencing burnout because of the punitive working schedules. Locum tenens might be a solution to the rigid routine of full-time employment.
82% of health organizations have embraced locum positions to fill in as they await to find suitable personnel for a position. They are also using locums to meet increased patient demand, supplement staff in peak periods, and provide cover during vacations. 27% of them also said they use locums to reduce workload and mitigate burnout among staff.
Locum tenens could be the answer to physicians increasingly seeking a better work-life balance that enables them to deliver high-quality in-patient care while being present for their families, personal interests, and life outside of work.
It could also help healthcare organizations facing coverage gaps, address the growing burnout crisis, and deliver the highest-quality patient care on time.
