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 me
to do both at the same time, and so did civilian life later on. When I
retired as a Navy pathologist last year, I put my uniform in mothballs
but kept my suitcase ready. I became a locum tenens or temporary

Small hospitals and practices often requie a skilled professional
to serve their patients in a regular physician’s absence. Agencies
like Comprehensive Health Systems of Salt Lake City employ physicians as
independent contractors able to provide temporary coverage on short

The call may go out for a locum tenens when doctors plan to
vacation or seek continuing education credits. Unexpected resignations,
retirements, or illnesses create a similar demand. And DRGs represent a
new opportunity for locum tenentes: Clinics and hospitals may want to
expand, yet hesitate because of uncertainty over the impact of
prospective payment. Bringing in a physician temporarily could be the
answer for these facilites, until they know they can afford another
full-time staff member.

Health care providers who have a sudden or short-term medical
vacancy contract with the agency to furnish a licensed physician. In
effect, 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 of
remote communities that were short on physicians. In recent years, it
has expanded its mission to include coverage of all sorts of temporary
medical needs. Now more than 250 itinerant physicians, including 40
pathologists, work for the agency. Among other companies providing
similar services are Kron Medical, Chapel Hill, N.C., and P-R-N, New
Braunfels, Tex.

My first assignment was in Williston, N.D., covering a solo
practice for three weeks in February 1983 so the regular pathologist
could bask in the Florida sun. In the process, I discovered that
patients and staff in isolated communities were far friendlier than in
large medical centers.

The position demanded a high degree of self-reliance. As the only
pathologist within a radius of 125 miles, I couldn’t show that
difficult 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 the
trappings of an affluent lifestyle. Physicians making house, car, boat,
and college tuition payments can’t take off on a moment’s
notice to a new assignment. Continually pulling up roots or leaving a
spouse and kids behind is out of the question for them.

For other doctors, however, a life of travel and varied medical
experience holds much appeal. Most of the time, locum tenentes
don’t know where their next assignment will take them, but
that’s part of the fun.

Some physicians make locum tenens work their post-retirement
career. One general practitioner fell in love with the western United
States during stints in which national parks served as his backyard. He
believes many older physicians mistakenly retire when all they really
want is more vacation and travel time. The locum tenens option would be
perfect for them. In fact, some retired physicians and their spouses
travel in their own recreational vehicles to new assignments.

Another candidate for locum tenens is the young pathologist wishing
to sample various practice settings before deciding on a particular one.

One young internist I spoke with saw his locum tenens tour as a
chance to sow wild oats before he settled down. He recently had
finished his residency and didn’t have any family or financial

A recent medical school graduate described some gratifying experiences she had as a locum tenens while learning first-hand about
the maldistribution of physicians in the U.S. She was impressed by the
respect she received and the friendliness of the patients in remote

The specifics of a locum tenens’ contract are fairly
attractive. Pay varies depending on the spceialty; for example, I
received $1,300 for every week I worked. Others, such as general
practitioners, receive less.

My contract with CompHealth guaranteed at least 13 weeks of work
per year or the company would pay the difference. For other
specialties, such as family practice, where CompHealth knows there will
be enough demand, the contract guarantee may run 26 weeks.

Thus, I had a minimum gross annual salary of $16,900 per year, and
I 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 two
assignments per year, CompHealth would have had the option to terminate
my contract.

Consider also that I didn’t have to absorb many expenses.
Once I was assigned to a job, CompHealth and the client physician or
institution took care of most costs. The client provided housing and
transportatin, for example. I drove my own car to a job in the East and
had to stay in a motel there, but eh mileage was reimbursed and I never
saw the motel bill. Sometimes a physician arranging for a temporary
replacement from CompHealth makes his own home available to the locum

CompHealth maintains a blanket malpractice insurance policy for all
of its physicians. It covered anything I did as a locum tenens for
which I migh be sued later.

The agency ran a complete initial check on me. It contacted all my
references to make sure I was qualified, and through this process
obtained copies of most of my professional documents. There were
necessary for hospital privileges and state licenses.

There’s no problem landing temporary hospital privileges. But
state licenses are another story because clients often do not give
CompHealth much lead time, and the bureaucracy never works as fast as
you would like. In North Dakota, I never even received a permanent
license. The state issued a locum tenens permit.

Colleagues treated me well in my different assignments, both
professionally and socially. I went from North Dakota to Dover, Del.,
where I served as an associate pathologist at 147-bed Kent General
Hospital for almost six months. I wasn’t the boss, but no one made
me feel like a substitute, either. During my stay in Delaware, the
pleasures of the seashore, boating, fishing, and hunting were available
to me. I hated to see th job end, but the jospital eventually found a
permanent associate pathologist.

My next assignment as a locum tenens was at 49-bed Woodlawn
Hospital in Rochester, Inc., which was once served by pathologists in
circuit-rider fashion. They would stop by once a week to provide
whatever services were needed. The hospital then contracted for
full-time pathology coverage. In time, the corporation providing the
coverage needed a new pathologist, and I assumed the position as a locum

Eventually, when the arrangement for coverage ended, the hospital
decided to take over operation of the laboratory. Thoroughly enjoying
the work, the institution, and the town, I accepted when they offered me
the position of pathologist.

CompHealth contracts require payment of a recruiting fee when a
practice or an institution lures away a locum tenens. The advantage of
such an arrangement, of course, is the opportunity both parties have to
check each other out prior to making a long-term commitment. That’s
exactly what happened in my case.

For pathologists just entering practice, considering retirement, or
somewhere in between but desiring a change of pace, working as a
rent-a-doc may just be the way to go.


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