ACS Guidelines for Locum Tenens Surgeons
What should surgeons expect from a locum tenens assignment?
The American College of Surgeons (ACS) recently released standards for surgeons planning to accept a locum tenens position, practice groups hiring locum tenens surgeons and locum tenens agencies to help maintain access to care, provide quality care and ensure continuity of care for patients.
“This is for making sure a surgeon considering locums has all of the things to look at and ask for when negotiating a contract,” said Nancy Gantt, MD, a member of the American College of Surgeons (ACS) Board of Governors and author of the guideline statement.
Gantt and the ACS recognize the need for locum tenens, particularly in rural communities, where local surgeons are feeling worn out due to heavy demand. Locum tenens are also hired to cover short-term vacancies, while permanent surgeons are being recruited and during other times of transition.
Gantt indicated the college had learned of challenging locum tenens situations, where the surgeon, the employer, or the locum tenens agency had not held up its end of the deal.
“It seemed opportunities were missed, where quality wasn’t getting delivered and the surgeon did not have a voice,” Gantt said.
Gantt and others pulled together information about best practices.
“We wanted to make sure everything was written down, so the employer would think of these things, and the person considering a locum position would ask about [the standards],” Gantt said. “We wanted to make sure everything was in one place.” While the ACS guidelines are specific for surgeons, some of the more general recommendations could benefit any physician considering a locum tenens position.
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“Doing locums is an attractive concept at multiple stages in a physician’s career when they first get out of residency if they need a break if they feel compelled to serve the underserved but financially cannot go on a prolonged mission trip,” Gantt said. “There are so many opportunities to improve our surgical workforce.”
The guidelines for locum surgeons cover basics, such as having a medical license in the state where the assignment is located; being board certified or board eligible in the specialty he or she is being hired for, and being in good standing with the American Board of Surgery or other American Board of Medical Specialties Specialty Board.
The locum tenens surgeon also should go through the credentialing process at the host practice or hospital, and maintain a log of his or her experience and a list of references.
In most cases, locum tenens agencies like AMN Healthcare will assist surgeons with the credentialing process.
When a locums surgery assignment is ending, the surgeon should also be able to hand off all patient care to someone else. Mid-level providers, such as nurse practitioners or physician assistants, could be able to fill that need and are one of the standards for the hiring practice.
“The physician extender could be the one familiar with the social environment the surgeon is stepping into and the patients,” Gantt said. “If you have a physician extender, that person can be like a navigator for the patient.”
Guidelines for the hiring practice
The host practice should provide a process for handoffs and transitions of care, according to the ACS guidelines. It also should provide tools for entry into the position, such as orientation, introductions to people, proctoring as needed, and access to someone who can provide assistance for questions about the electronic health record and other hospital or practice systems.
Additionally, the hospital or host practice should provide medical liability coverage with tail endorsements, unless the agency is paying for tail coverage.
[AMN Healthcares’ locum tenens benefits include medical malpractice insurance, or professional liability coverage, for all of its locum providers.]
RELATED: A Guide to Locum Tenens Malpractice Insurance
At the end of the assignment, the practice should provide the surgeon and the agency with an evaluation of performance and a process for the surgeon to dispute anything considered unjust.
Principles for the locum tenens agency
The ACS guidelines recommend the locum tenens agency select candidates for an assignment who have the training, experience, and professional affiliations to provide high-quality care.
“The agency should be [the surgeon’s] advocate,” Gantt said.
The agency should maintain quality measures about the surgeon, including patient satisfaction for a set period. Those quality measures can be disclosed to the hiring practice if it is in the contract, they are securely stored, accurately represent his or her practice on medicine, and be transparent and accessible to the surgeon.
“This is for ensuring quality, ensuring the employing hospital gets what it wants, and ensuring the surgeon gets what is appropriate,” Gantt said.
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