From Hackensack, N.J., to Boston, and several places in between, Gauderer has plied his skills as a child-development specialist where they are needed—and then moved on.
He is one of a small but possibly growing number of physicians opting to work locum tenens—Latin for "holding a place." In exchange for wages, travel costs, and other expenses, locum tenens doctors work for a defined period, filling staff shortages at hospitals, corrections facilities, clinics, and community health and mental health centers. When their time is up, they move on to fill a vacancy in the next town—or sometimes the next state.
Physicians who don’t want the hassles of owning a practice or being employed, who have the freedom to travel, and who want to see both the medical world and the real world before settling down are drawn to locum tenens work.
"I liked the possibility of doing temporary work and getting myself inserted into a new context to see if I like it, instead of being committed and stuck with it," Gauderer said.
He has settled now into a permanent position as an attending psychiatrist specializing in child development at Hackensack University Medical Center. But Gauderer has traveled a long way to find his home.
Born in what was then East Germany, he graduated from medical school in Rio de Janeiro, Brazil. He came to the United States in 1971 to pursue postgraduate work at the University of Tennessee, Harvard Medical College, and the Mayo Clinic. He is board certified in general psychiatry, pediatrics, and child psychiatry.
In 1978 he returned to Brazil, where he ran his own clinic until the end of 1999. By that time, Gauderer said, he had had enough of administration. "I was sick and tired of running things and paying bills while trying to stay up to date," he explained.
Wanting to return to America, Gauderer found an online locum tenens company, LocumTenens.com, that placed him at several sites in the United States. He was pleased to fill a vital need without shouldering the burdens of responsibility. "All of a sudden, the only thing I had to do was show up, do my work, and go home," he said.TBL1
The weariness with administrative hassles that drove Gauderer from his practice in Brazil is likely to resonate with American physicians beleaguered by managed care, financial concerns, and paperwork. And it is one reason why some people say the numbers of doctors opting to work locum tenens may be increasing.
Yet accurate numbers are hard to come by. Neither the American Medical Association nor the American Medical Management Association keeps up-to-date records on numbers of locum tenens doctors.
And some administrators who make use of locum tenens say that the special hardships of working locum tenens counterbalance the benefits, and that journeymen physicians like Gauderer will always be a unique breed.
"The idea of having to live in a hotel for three months 2,000 miles from friends and family has appeal only to a very limited number of individuals," noted David Brody, M.D., director of behavioral health services at Arden Hill Hospital in Goshen, N.Y., who has used locum tenens doctors. "In my judgment these are unique people who can put up with that kind of lifestyle. I don’t see it as a growth market."
"You may escape some of the hassles, but you get a whole different set of them," pointed out Stephen Sears, M.D., senior vice president for medical administration at Maine General Medical Center in Augusta and Waterville.
Yet surprisingly, the image of the young doctor just out of medical school trying to pay off debt does not fit the reality of the locum tenens market. Both Brody and Sears said the locum tenens doctors they have worked with are predominantly older and retired or semiretired psychiatrists.
"Modern psychiatry is very different from what it was in the beginning for the person who is now in their retirement years," Sears said. "It’s not surprising that people are retiring and doing locum tenens for a short period."
Sears said he has used locum tenens psychiatrists to fill various positions "almost continuously" for the past three years.
"I think it reflects the fact that there are fewer people going into psychiatry but a greater need for psychiatrists," Sears said. "I know we are not the only hospital struggling to maintain our program."
Companies providing locum tenens docs to hospitals and clinics see a growth market. A recent article in American Medical News quoted a survey by Staff Care, a locum tenens company in Irving, Tex., showing that 15 percent of physicians today say they have worked locum tenens at some point in their career, compared with 4 percent in 1987. A recent survey of 8,000 physicians and 16,000 administrators by Locum Tenens.com found that 41 percent of responding physicians were looking for permanent positions, but that 64 percent were willing to take a locum tenens placement. Moreover, 59 percent of health care facilities use locum tenens physicians to staff for vacations and vacancies.
"Absolutely," replied Scott Webb, vice president of the psychiatry division of Staff Care, when asked if he sees a growth market in providing temporary docs to hospitals in need. "It’s growing every day."
Webb said that while the difficulties that come with temporary work are real, so are the benefits. Physicians are usually paid on an hourly or daily fee, equivalent to an annual salary of $115,000 to $120,000, he noted, and that’s with no call or overtime.
Physicians are paid out of the fee charged to clients, which runs between $750 and $1,000 a day. At Staff Care, Webb said, the fee also includes transportation, housing, and malpractice costs. At any one time, Staff Care may be placing 500 to 700 physicians, including 60 to 80 psychiatrists, he reported.
A handful of locum tenens companies compete with Staff Care to provide temporary physicians nationwide. These include CompHealth, Medical Doctors Associates, Vista, Locum Tenens.com, and J&C Nationwide. But hundreds of smaller companies provide locum tenens physicians in specific geographic regions or specific medical specialties.
Webb believes that hospital and clinic administrators benefit from the services provided by locum tenens companies. Vacant positions mean lost revenue—sometimes thousands of dollars a day when the unfilled position is a high revenue-producing one such as anesthesiology or radiology.
But administrators are more reserved in their enthusiasm. Sears said the fierce competition among companies to place doctors—as well as the time constraints administrators are under to fill vacancies—provides the conditions for a rat race that can lead to cutting corners.
Sears said he has had physicians who he was led to believe had no blemishes on their record. "But when we did all the credentialing, they were clearly problematic. When the need comes up, the challenge is to find companies that will provide physicians who are not of marginal capabilities. The reality is that sometimes the time frames you have to work in are very abbreviated."
And it is clearly a sellers’ market, making hiring locum tenens an expensive proposition for administrators. "It’s been a mixed blessing," Brody said. "The costs are double what it would be to have someone full time."
But Brody and Sears said that for the most part the system works well enough to meet patient care needs. And the often urgent needs of a clinic or hospital are an attraction for the locum tenens doctor, who gets to play a "heroic" role helping out in what may be a desperately short-staffed situation.
"The advantage from my point of view is that it does provide access to a very large pool of psychiatrists," Brody said. "I can usually bring these people in very quickly."
Today, Gauderer appears to be done with his days as a journeyman. But he looks back on his work as a locum tenens psychiatrist with pleasure and recommends it to administrators and physicians. "It’s a win-win situation," he said. ▪