Clinicians turned to contract work to escape the grind. They’re finding the same challenges

Amanda Berg, DMS, PA-C , a physician associate, started taking on locum tenens jobs in October 2023 as a way to more quickly pay off her student loans.

Her specialty in urgent care is in high demand and she was able to schedule shifts around her full-time job. But the promise of flexibility has been elusive. Contract workers are not only covering staffing shortages — they’re filling in the gap for patients who do not have regular healthcare providers.

“I work almost everyday right now,” Berg told me when I asked how she balances her time. “So I don’t balance my time.”

Clinicians like Berg are part of a growing number of doctors and advanced-practice providers — at all stages of their careers — who’ve been gravitating toward contract work, either in addition to or even instead of full-time positions. But the tone is shifting since I first reported on the trend a couple of years ago.??

Berg recalls one place she worked that had 15 locum tenens providers but only two full-time employees. Locums providers are often resistant to starting a patient on a new drug or treatment regimen. But Berg said she still provides that follow-up care — even when it means putting in extra, unpaid hours.?

“It becomes really messy with getting patients their test results,” she said. “If everybody is per diem, then it could be a month before that same provider is going to be back in the clinic. So who's handling their task box?”

Staffing agencies tout the benefit of locum tenens for healthcare providers — and certainly there are plenty. But often they’re coming into hospitals or clinics that have struggled to retain staff, and accepting the challenges of treating patients who are caught in the middle.??

“A lot of the clinics that I service have patient populations that do not have primary care,” Berg said. “That's another level of complexity because here I am as a per diem provider that is only there a couple times a month at most. And yet now I'm their primary, essentially.”

The physician shortage has opened more opportunities for advanced-practice providers (APPs) — who hold one of the fastest-growing jobs in healthcare — to take on locums roles. Aya Locums , a staffing agency, said it saw a 66% increase in postings for nurse practitioners over the past 18 months. Staffing Industry Analysts , a trade publication, similarly tracked a 23.8% year-over-year increase in locums revenue for APP roles in the first half of 2024.

Clinicians too have been flocking to locums positions, seeking greater flexibility, more control over their schedules, higher pay and freedom from the business demands of healthcare.?

“If you are permanent, you're indentured in many ways,” said Lina Gallotto , an executive vice president at Barton Associates Inc. , which specializes in locum tenens placements. “You need to take those shifts, take those hours. You might even get paid by productivity. [Locum tenens] gives you control over your life.”

Staffing agencies cite surveys showing that job satisfaction is high in locum tenens; a 2023 report from CHG Healthcare , for instance, found that 81% of physicians had a “very” or “somewhat” positive experience working locums while only 5% had a “very” or “somewhat” negative experience.?

Yet peer-reviewed data is lacking, both when it comes to job satisfaction as well as the impact on quality of care. Even in surveys, fewer hospital respondents are calling locum tenens a solution to alleviate burnout: 42% saw it as a resource in 2023, down from 56% in 2021, according to the CHG report.??

Darla Talbott is a nurse practitioner who started working locums through Aya after her retirement six years ago. The assignments allow her to travel, and she enjoys immersing herself in the local culture. Calls have been increasing over the past six to eight months, she said, after a slowdown during the pandemic.?

Yet while she values the flexibility locum provides, there are some red flags she tries to avoid. She’s wary of positions in hospitals that have recently been through an acquisition— or any place that’s primarily staffed with temporary workers.?

“I understand locum doesn't go to the cream of the crop places,” she told me. “But I also know that you have to be able to be supported while you're there.”

The number of hospital mergers has been growing, with 72 takeovers last year, up from 53 in 2022, according to consulting firm Kaufman Hall . In a record 30.6% of cases last year, at least one of the parties was in financial distress. Acquisitions have a known impact on staff burnout, and it's common to see news reports of doctors and nurses leaving after a takeover.?

“You have to understand what your goals are and realize you're going into situations that might be difficult,” Talbott said. “[There can be] low staffing, people that don’t have a lot of clinical experience. It's not always an ideal world when you're traveling.”

Yet that same combination of factors is what’s likely to keep demand high. The population is aging, especially in rural areas, and there aren’t enough healthcare providers to keep up with patient volume. “Many times it’s domestic missionary work,” said Gallotto of Barton Associates.?

Patients themselves have become accustomed to seeing a revolving door of providers. Gallotto pointed to her mom, at 91, who sees a new clinician each time she needs a telehealth visit. It’s become part of aging, she said. The need is increasing faster than the supply of doctors and APPs.

Berg too has seen how hard it is to find a primary care provider — it took her eight months after she moved to Massachusetts for PA school. “It’s not that the patients are lazy,” she said. “You have to accept the reality that these patients still need care, even if it’s technically not something that you’re used to doing.”

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