Are You Underusing Your Locum Workforce?

Temporary. In and out. No strings attached. These are some of the descriptors that healthcare leaders use to portray locum work. They’re also the conditions that those leaders set for locum physicians. And yet locums themselves sing a very different tune, seeking meaningful impact not just on patients, but on the hospital and community as a whole.  

Little research exists on the workplace interests of locum tenens physicians, but those who hire and manage large groups of them are increasingly finding that short-term doctors crave the same sorts of impact and meaning as staff physicians—and are not attempting to shirk responsibility. “They’ve gotten a bad rap,” says former hospital CEO Jennifer Cano, national practice director of the healthcare interim solutions practice at Korn Ferry. “People assume that they’re not engaged and aren’t the best at what they do. I’ve not necessarily found that to be the case.”  

To be sure, locums vary in skill and ability. Roughly 5 percent of the physician population have worked as locums, according to 2019 AMN Healthcare estimates. But as a group, locum physicians are undeniably quick learners and nimble employees who can parachute into an organization, hit the ground running, and swiftly absorb procedures and culture. Yet healthcare organizations often treat locums as second-class citizens—the hired help, not colleagues—despite their holding the same credentials as staffers. “Executives hardly ever talk to locums about long-term strategy,” says Cano.  

C-suite expectations of locums are low: show up, provide the standard of care, go home. Today’s healthcare executives are not asking locum physicians to serve as agents of change. “The expectation is not that locum physicians will come in and lead major change or drive quality initiatives,” says Charles Falcone, M.D., director of the Physician Leadership Institute at Korn Ferry. “There has traditionally been an assumption that physicians choose locum work to get away from broader organizational expectations, but that’s not always the case.”  

Typically, hospitals end up in a holding pattern with locums, who commonly become essential to services like surgery and emergency medicine. Once locums are on the payroll, employers are often unable to find long-term hires, and therefore need locums on an ongoing basis. “Sometimes there’s no end in sight, because who knows when the permanent replacement is going to come,” says Cano.

Much of the low-expectations attitude toward locums derives from longstanding assumptions: for decades, locum physicians were seen as transient, uncommitted job hoppers who couldn’t secure a staff position. While some truth to that may have existed 30 years ago, in today’s job market nearly all locums are choosing part-time work—especially millennial physicians, who tend to opt for work-life balance, and empty nesters seeking a change of pace. Some simply want to work six months a year or enjoy fresh experiences. “Many want to feel that they are part of the team and are contributing beyond simply covering a shift,” says Falcone.  

There’s a healthcare precedent for engaging and developing temporary employees: interim executives were once looked down upon and are now widely respected, with many seen as turnaround specialists. In the case of locum physicians, “the opportunity lies in appreciating them as a great potential source of knowledge transfer,” says Lauren Glaccum, senior leader in the health systems and academic practice at Korn Ferry. A substantial proportion have worked in a variety of health systems and can thus objectively spot needed improvements in everything from patient flow to standards of care. “Many have the capacity to be much more than someone seeing patients while a staff physician is on maternity leave,” says Glaccum.  

The biggest opportunity awaits in developing and engaging locum teams to turn around struggling units. A hospital looking to rebuild a surgical team with poor quality metrics might deliberately hire locums with experience at top medical centers and task them with critiquing existing norms and procedures, and then mentoring others.  

Cano suggests beginning by engaging locums with meaningful work. “Deep down they do want to connect to purpose—they do care!” she says. That purpose might be creating the best surgical center in the region, or turning around a department, or offering top-notch care to a community that has gone without it. Word choice matters, she says. “Don’t call anyone locums.” Try “Turnaround Team” or “Interim Physician” or something similar.  

And all locum physicians can be treated as potential permanent employees. A locum-to-permanent hiring option signals commitment, whether or not they take it. “There’s a good chance that if you make a locum feel at home, they may want to stay on long-term. I’ve seen it happen a number of times,” says Glaccum. “If you treat them as a temp worker, you’re not going to retain them.”

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