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 Patients were no more likely to die within 30 days of arrival at the
hospital when they were treated by so-called locum tenens
physicians, who temporarily fill in for staff physicians,
researchers found.
Hospital reliance on locum tenens physicians has surged in recent
years, driven in part by regional physician shortages and by
increasing demand for care by patients who have recently gained
insurance.
Researchers examined data on more than 1.8 million Medicare
beneficiaries hospitalized between 2009 and 2014 and found 8.8
percent of patients treated by locum tenens physicians died within
30 days of being admitted to the hospital, as did 8.7 percent of
patients who had staff doctors. The difference was too small to rule
out the possibility that it was due to chance.
“Our work indicates that locum tenens physicians caring for patients
hospitalized for treatment of general medical conditions likely
deliver equivalent quality care to non-locum tenens physicians,”
said lead study author Dr. Daniel Blumenthal, of Massachusetts
General Hospital and Harvard Medical School in Boston.
“While it is unlikely that patients would ever know whether or not
their physician was a substitute physician, our work indicates that
patients should not worry about whether or not their physician is a
locum tenens,” Blumenthal said by email.
Locum tenens doctors generally do not have any previous relationship
with their patients, are not familiar with the local community, and
may never have worked with the hospital’s electronic health records
system, hospital staff, or with the local network of facilities
where patients may be discharged to after hospitalization, the
researchers said.
Overall, about 38,000 patients in the study, or roughly 2 percent,
were treated by locum tenens physicians, researchers report in JAMA.
Slightly more than 9 percent of all the general internists in the
study had a locum tenens physician cover for them at some point.
Patients were hospitalized for a variety of reasons typically
handled by general internists in hospitals such as pneumonia, kidney
infections, lung disease, and gastrointestinal disorders.
There were no meaningful differences in patient characteristics,
including reason for admission or other medical conditions, between
those seen by staff doctors and substitute physicians.
Yet there were some small but statistically significant differences
in other measures. Patients treated by substitute physicians had
somewhat higher spending and slightly longer hospitalizations.
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Patients treated by locum tenens doctors had average total charges
of $1,836, compared with $1,712 for patients seen by staff doctors,
the study found.
With locum tenens doctors, patients remained in the hospital an
average of 6.64 days, compared with 5.21 days for staff physicians.
Readmissions, or repeat hospitalizations, occurred for about 23
percent of patients with locum tenens physicians, compared to 24
percent with staff doctors.
The study wasn’t a controlled experiment designed to prove whether
or how the employment status of physicians might influence patient
outcomes.
“I suspect most would hypothesize that outcomes would be
significantly worse for locum tenens physicians compared to staff
physicians, as the locum tenens docs are not as familiar with the
hospital, local practices and policies, and how to get things done
locally,” said Dr. Karl Bilimoria, director of the Surgical Outcomes
and Quality Improvement Center at Northwestern University’s Feinberg
School of Medicine, in Chicago.
“Thus, this study provides findings that may be counterintuitive to
many people,” Bilimoria said by email.
Because Medicare requires locum tenens physicians to provide at
least 60 days of coverage, however, these doctors may be reasonably
familiar with the practices and culture of the hospitals where they
fill in, Bilimoria said. Results from this study don’t offer insight
into outcomes for doctors who substitute only for a day or week at a
time, he noted.
It’s also possible that there are subtle differences in outcomes
that the study didn’t detect.
“But just because the patients did not die more frequently under the
care of locum tenens docs, does not mean that their disease-specific
outcomes are equal,” Bilimoria added. “There may be more nuanced
outcomes that could show a difference.”
SOURCE: http://bit.ly/2Ax83MB JAMA, online December 5, 2017.
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