Rent-a-doc: pathology goes on the road Essay

Leave the Navy and see the world.

I enjoy pathology and like to travel. Military practice allowed meto do both at the same time, and so did civilian life later on. When Iretired as a Navy pathologist last year, I put my uniform in mothballsbut kept my suitcase ready. I became a locum tenens or temporaryphysician. Small hospitals and practices often requie a skilled professionalto serve their patients in a regular physician’s absence. Agencieslike Comprehensive Health Systems of Salt Lake City employ physicians asindependent contractors able to provide temporary coverage on shortnotice. The call may go out for a locum tenens when doctors plan tovacation or seek continuing education credits. Unexpected resignations,retirements, or illnesses create a similar demand.

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And DRGs represent anew opportunity for locum tenentes: Clinics and hospitals may want toexpand, yet hesitate because of uncertainty over the impact ofprospective payment. Bringing in a physician temporarily could be theanswer for these facilites, until they know they can afford anotherfull-time staff member. Health care providers who have a sudden or short-term medicalvacancy contract with the agency to furnish a licensed physician. Ineffect, they rent a physician. It’s the old “Kelly girl”office temporary concept, transplanted to the medical profession. CompHealth began as a non-profit foundation addressing the needs ofremote communities that were short on physicians.

In recent years, ithas expanded its mission to include coverage of all sorts of temporarymedical needs. Now more than 250 itinerant physicians, including 40pathologists, work for the agency. Among other companies providingsimilar services are Kron Medical, Chapel Hill, N.

C., and P-R-N, NewBraunfels, Tex. My first assignment was in Williston, N.

D., covering a solopractice for three weeks in February 1983 so the regular pathologistcould bask in the Florida sun. In the process, I discovered thatpatients and staff in isolated communities were far friendlier than inlarge medical centers. The position demanded a high degree of self-reliance. As the onlypathologist within a radius of 125 miles, I couldn’t show thatdifficult biopsy to anyone but myself.

Many physicians seek out and are happy with permanent practices.They enjoy the intrigues of hospital staff politics and relish thetrappings of an affluent lifestyle. Physicians making house, car, boat,and college tuition payments can’t take off on a moment’snotice to a new assignment. Continually pulling up roots or leaving aspouse and kids behind is out of the question for them.

For other doctors, however, a life of travel and varied medicalexperience holds much appeal. Most of the time, locum tenentesdon’t know where their next assignment will take them, butthat’s part of the fun. Some physicians make locum tenens work their post-retirementcareer.

One general practitioner fell in love with the western UnitedStates during stints in which national parks served as his backyard. Hebelieves many older physicians mistakenly retire when all they reallywant is more vacation and travel time. The locum tenens option would beperfect for them. In fact, some retired physicians and their spousestravel in their own recreational vehicles to new assignments. Another candidate for locum tenens is the young pathologist wishingto sample various practice settings before deciding on a particular one. One young internist I spoke with saw his locum tenens tour as achance to sow wild oats before he settled down.

He recently hadfinished his residency and didn’t have any family or financialobligations. A recent medical school graduate described some gratifying experiences she had as a locum tenens while learning first-hand aboutthe maldistribution of physicians in the U.S. She was impressed by therespect she received and the friendliness of the patients in remotecommunities. The specifics of a locum tenens’ contract are fairlyattractive. Pay varies depending on the spceialty; for example, Ireceived $1,300 for every week I worked.

Others, such as generalpractitioners, receive less. My contract with CompHealth guaranteed at least 13 weeks of workper year or the company would pay the difference. For otherspecialties, such as family practice, where CompHealth knows there willbe enough demand, the contract guarantee may run 26 weeks.

Thus, I had a minimum gross annual salary of $16,900 per year, andI could earn about $65,000 in a single year. I could not be too choosy,though, about when and where I worked. If I refused more than twoassignments per year, CompHealth would have had the option to terminatemy contract. Consider also that I didn’t have to absorb many expenses.Once I was assigned to a job, CompHealth and the client physician orinstitution took care of most costs. The client provided housing andtransportatin, for example. I drove my own car to a job in the East andhad to stay in a motel there, but eh mileage was reimbursed and I neversaw the motel bill.

Sometimes a physician arranging for a temporaryreplacement from CompHealth makes his own home available to the locumtenens. CompHealth maintains a blanket malpractice insurance policy for allof its physicians. It covered anything I did as a locum tenens forwhich I migh be sued later. The agency ran a complete initial check on me. It contacted all myreferences to make sure I was qualified, and through this processobtained copies of most of my professional documents.

There werenecessary for hospital privileges and state licenses. There’s no problem landing temporary hospital privileges. Butstate licenses are another story because clients often do not giveCompHealth much lead time, and the bureaucracy never works as fast asyou would like.

In North Dakota, I never even received a permanentlicense. The state issued a locum tenens permit. Colleagues treated me well in my different assignments, bothprofessionally and socially. I went from North Dakota to Dover, Del.

,where I served as an associate pathologist at 147-bed Kent GeneralHospital for almost six months. I wasn’t the boss, but no one mademe feel like a substitute, either. During my stay in Delaware, thepleasures of the seashore, boating, fishing, and hunting were availableto me. I hated to see th job end, but the jospital eventually found apermanent associate pathologist.

My next assignment as a locum tenens was at 49-bed WoodlawnHospital in Rochester, Inc., which was once served by pathologists incircuit-rider fashion. They would stop by once a week to providewhatever services were needed. The hospital then contracted forfull-time pathology coverage. In time, the corporation providing thecoverage needed a new pathologist, and I assumed the position as a locumtenens. Eventually, when the arrangement for coverage ended, the hospitaldecided to take over operation of the laboratory. Thoroughly enjoyingthe work, the institution, and the town, I accepted when they offered methe position of pathologist. CompHealth contracts require payment of a recruiting fee when apractice or an institution lures away a locum tenens.

The advantage ofsuch an arrangement, of course, is the opportunity both parties have tocheck each other out prior to making a long-term commitment. That’sexactly what happened in my case. For pathologists just entering practice, considering retirement, orsomewhere in between but desiring a change of pace, working as arent-a-doc may just be the way to go.

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