Study: Emergency Doc Shortage Worsens In Rural America
(Edited from article by Jenna Hunt in Hi-Desert Star, September 25, 2020)
YUCCA VALLEY — Physician shortages across the country have left a growing number of rural areas like the Morongo Basin seeking solutions. Local healthcare experts say hiring qualified physicians to work in the Morongo Basin and set up long-term medical practices has always been a challenge. But COVID-19 has hoisted the hurdles even higher.
“Morongo Basin Healthcare District (MBHD) has engaged a staffing firm specializing in recruiting physicians to rural areas. The recruiter says physician applicants’ response has been slower these past few months than in previous years,” Morongo Basin Healthcare District CEO Jackie Combs said. The district operates medical clinics in Yucca Valley and Twentynine Palms. “We believe this may be related to COVID-19 and physicians’ not wanting to move during this uncertain time.”
Despite Americans’ heavy reliance on emergency departments, large parts of rural America are experiencing shortages of emergency physicians, according to a new workforce analysis in the Annals of Emergency Medicine.
“The number of emergency physicians is increasing but there’s a clear, unmet need for emergency physicians in rural areas,” said Christopher Bennett, assistant professor of emergency medicine at Stanford University School of Medicine and lead study author. “Policymakers and health leaders need to ensure emergency departments across the country are led by appropriately trained and certified emergency physicians.”
Shortage or Uneven Distribution?
The question of whether there’s a shortage of physicians or simply a distribution problem across the US has been debated for decades. Findings from LocumTenens.com’s June 2020 clinician survey adds fuel to that discussion.
Among 940 self-selected healthcare professionals responding to the survey (including physicians, nurse practitioners, physician assistants, CRNAs, clinical nurse midwives, clinical nurse specialists and psychologists in 35 specialties), more than half of those in emergency medicine, primary care and anesthesia reported their organizations faced layoffs, furloughs or both. Among them were 67% of responding emergency physicians, 63% of responding anesthesiologists, and 56% of responding primary care physicians.
In the midst of seeming shortages of physicians in certain specialties, why are so many being laid off or furloughed? Perhaps it’s because too few of them choose to live in areas where they’re needed most. This is why the locum tenens industry developed in the first place.
Of course, in the very unusual year that is 2020, this seemingly ironic trend most likely stems from the erratic spread of COVID-19 across the US, the postponement of most nonemergency and elective procedures, and the economic shutdown of most states during March and April. As we reported earlier this year, hospitals across the country are expected to lose approximately $323B as a result.
Meanwhile, the need for qualified clinicians in many rural areas across the country remains.
On its “locumstory.com” website, Comp Health indicates that because of high demand (particularly during the COVID-19 pandemic), emergency physicians willing to take locum tenens assignments can make between $160 and $300 hourly, depending on the assignment’s location and other factors. Typically these doctors work 12- or 24-hour shifts, covering an average 4-12 shifts per month for up to 6 months or longer, according to CompHealth’s specialty tracker.
CrossCountry Healthcare indicates demand for emergency physicians is high enough that “many facilities are open to hiring physicians who are board-certified in primary care,” although clients prefer those board-certified in emergency medicine.
Existing Shortage Will Worsen
Noting that one in five Americans lives in a rural area, the American College of Emergency Physicians (ACEP) “recognizes that action is needed to address emergency physician shortages and other challenges facing rural emergency care,” according to its August 12 news release. “This research underscores ACEP’s concerns and complements a developing analysis from its Emergency Medicine Workforce Task Force that will help identify best practices, site supervision requirements, and funding mechanisms to support research, cost savings, and promotion of residency training programs with more focus on rural emergency care.”
According to the “National Study of the Emergency Physician Workforce 2020,” the rural emergency physician shortage will worsen in coming years. Of the 48,835 clinically active emergency physicians in the United States, just eight percent (3,907) work in rural communities, down from 10 percent in 2008.
MBHD’s Combs said the local healthcare district has come close to finding the right fit a few times in its search, including an urban family physician who decided not to move after visiting the area. Earlier this month Combs said the healthcare district’s recruiter was starting to get some interest. “The potential candidates will need to be interviewed by the recruiter to determine if they meet our requirements and if they will be a good fit for our organization,” she said.
Aging Workforce Meets Urban Pull
The ‘Emergency Physician Workforce 2020’ analysis also shows the rural emergency physician workforce is aging. More than 70% of rural emergency physicians completed their medical training more than 20 years ago, according to the study. While the median age for an urban emergency physician is 50 years old, the median in large rural communities is 58 years old, and 62 in smaller rural communities.
Meanwhile, 96 percent of the emergency medicine residency or fellowship graduates within the last four years practice in more urban areas.
Still the specialty continues to grow. As older emergency physicians prepare to retire, the nation’s residency programs, which train doctors after they get their degrees, continue to expand: in 2008 there were 4,565 emergency medicine residents in 145 programs. Today there are 7,940 residents in 247 programs.
“There are reasons to be optimistic about the pipeline of residents and trainees,” Stanford’s Bennett said. “However, we need to encourage a larger percentage of them to work in rural America.”
All News Is Locums
How Has COVID-19 Affected the Anesthesiology Job Market?
“Anesthesia Success” podcast producer Justin Harvey recently interviewed LocumTenens.com Associate Vice President Kyle Hadley about the coronavirus pandemic’s effect on anesthesiologists’ employment picture. Harvey described their discussion as a “deep dive on some of the things impacting jobs for anesthesiologists.”
Here are highlights of that discussion:
- In his intro, Harvey noted that while job offers were rescinded for some, many physicians have been furloughed, and others haven’t been able to find jobs. Hadley responded, “I think, in the long run, you should be optimistic about your employability, (but it’s) not a bad idea to think about doing locums for a little bit while you’re waiting. If you’re willing to work some tough shifts, you could make a whole year’s worth of salary in just a few months.”
- Hadley noted that after COVID-19 hit, anesthesiology requests went from practically dominating the physician-search marketplace (as it has over the past few years) to almost ‘dropping off the radar screen,’ as elective surgeries were cancelled across the country.
- Private groups were affected pretty significantly by the downturn. A LocumTenens.com survey indicated that roughly 62% of CRNAs and anesthesiologists were furloughed, and 65% of anesthesiology groups said they had concerns about their practices’ futures.
- Hadley noted his firm has seen an uptick in requests for anesthesiologists recently, putting them at roughly five times the pre-coronavirus level. LocumTenens.com now has anesthesiologist job postings in some 36 states. However, there’s no specific site or geography looking for candidates.
- ‘In many locations electives are coming back slowly but surely, because without surgery, they have no revenue stream,’ Hadley said. “And some critical access hospitals in the rural United States have been impacted significantly.”
- The dearth of surgeries and the ‘glut’ of anesthesiologists looking for employment has put more employers in the so-called “driver’s seat” in permanent job negotiations. Harvey and Hadley suggested the possibility of a retention bonus (rather than a signing bonus, as was widely negotiated in the past). “That’s a way you can acknowledge today’s crazy situation and still show your desire to be a team player,” suggested Harvey, whose wife is an anesthesiologist.
- Considering the above, Hadley suggested that this is the perfect time for anesthesiologists to try working locum tenens: It’s a way to “try before you buy,” as well as to get malpractice insurance coverage at no cost to you while you earn what tends to be a better-than-average rate of compensation during your assignment. Hadley also highlighted greater flexibility in when, how and where you work as a “plus” of working locum tenens.
- Hadley illustrated his point by describing a physician who took a house-call OB shift for six months and paid off his student loans in a year.
- Hadley and Harvey emphasized that demand for anesthesia services will continue to be strong, considering the aging Baby Boomer population, the growing numbers of outpatient surgery centers, and the relatively stable numbers of medical school graduates specializing in anesthesiology. The two concluded that “newly minted” anesthesiologists have chosen a specialty that will remain in high demand.
South Florida Sun Sentinel’s “2020 Top Workplaces”
Includes Locums, Healthcare Staffing Companies
The South Florida Sun Sentinel, a leading news outlet covering Broward, Palm Beach, and Miami-Dade Counties, has named 71 employers across the state as “2020 Top Workplaces.” Several locum tenens agencies and at least one healthcare staffing firm made the top 10 list in each of three categories: large (400+ employees), midsize (125-399 employees) and small (fewer than 125 employees) companies.
Weatherby Healthcare, based in Fort Lauderdale with roughly 578 employees, ranked number 7 among large employers. In the midsize category Deerfield Beach-based All Star Recruiting, with 214 employees, ranked number 4 and CompHealth (based in Midvale, Utah, but with some 129 Florida-based employees) ranked number 10.
Among small employers, Therapia Staffing of Coral Springs, with 35 employees, topped the list. Therapia provides physical, speech and occupational therapists; psychologists; special education teachers; sign language interpreters and nurses in key specialties to hospitals, clinics and schools across the US.
“The Sun Sentinel surveyed nearly 30,000 employees in South Florida to find the best places to work. Nearly 13,000 employees responded to the survey. A record 134 employers agreed to take the survey,” according to a September 18 story by Alonso Alcocer. “Combined, they employ 55,605 people in South Florida.”
In a September 21 news release, All Star Recruiting noted that, “The anonymous survey uniquely measured 15 drivers of engaged cultures critical to an organization’s success, including alignment, execution, and connection.”
The Healthcare Staffing Story
17% Decline in Staffing Industry Revenue Forecast for 2020.
SIA Raises Growth Projection for 2021.
(Edited from SIA Daily News, September 15, 2020)
Two weeks ago SIA reiterated its July projection that US staffing industry revenue—temporary staffing, direct hire and retained search—will shrink by 17%, year-over-year, in 2020. However, analysts raised next year’s projections for US staffing revenue by one percent from its July forecast, to 12%. SIA also updated its forecast for several segments.
“As the US economy continues to reopen and recover, we are seeing positive momentum across many segments of the staffing industry,” said Timothy Landhuis, SIA’s director of research for North America. “We project that US temporary staffing revenue will be down 14% this year, a significant drop, but not nearly as steep as the 24% decline experienced in calendar year 2009.”
Revenue for 2020 is expected to decline by 35% in direct hire and by 30% in retained search.
Looking back at temporary staffing, revenue projections for 2020 were upgraded for some US temporary staffing segments compared to the July forecast. Travel nursing, for example, rose from 5% to 10%.
In addition, we project industrial revenue growth will decline by 20% instead of the 22% projected in July, and IT staffing revenue will fall by 9% instead of 10%.
While those segments rated an improved forecast, others deteriorated: for example, we expect locum tenens staffing to decline by 15% instead of the 5% forecast in July.
The report noted that the projected 12% overall growth in US staffing revenue for 2021 is based on three key assumptions:
- The spread of COVID-19 will continue downward.
- US gross domestic product will continue growing gradually but steadily.
- A COVID-19 vaccine will be widely available in the first half of 2021.
The full report, “US Staffing Industry Forecast: September 2020 Update,” with information on all staffing segments, is available to corporate members of SIA.
Precedence Research: Global HC Staffing Market
Could Surpass $47.5B (with 5% CAGR) by 2027
(Edited from Global Newswire, September 23, 2020)
In 2019 the global healthcare staffing market, then estimated at $30B, was expected to grow by 5%, compounded annually, between 2020 and 2027.
Precedence Research defines “healthcare staffing” as firms, partnerships, corporations or other business entities offering nursing personnel on a temporary basis. Among the most regulated business sectors, healthcare organizations are facing regulatory upheaval, an increasing physician shortage, constricted nurse staffing levels, and technology challenges.
Thus, staffing organizations require flawless execution of the credentialing and compliance processes required for healthcare operations. Travel opportunities, flexible schedules and broad clinical experience influence locum tenens and travel nurses to opt for a career in temporary healthcare staffing. In 2013 the World Health Organization (WHO) highlighted a shortage of some 7.2 million healthcare staff globally, a figure estimated to reach almost 13 million by 2035’s end. Precedence Research expects these factors to open new avenues for industry growth.
Get sample pages of, “Healthcare Staffing Market (by Service Type: Travel Nurse, Locum Tenens, Per Diem Nurse, Allied Healthcare) – Global Market Size, Trends Analysis, Segment Forecasts, Regional Outlook 2020 – 2027” report @https://www.precedenceresearch.com/sample/1013
Key Players & Strategies
A large number of market players means the healthcare staffing market is highly competitive. Therefore, market players are merging and collaborating to survive. For example, TeamHealth acquired Emergency Medicine Consultants (EMC), an emergency medical staff provider, in 2018. This initiative added EMC’s 330 physicians and 80 advanced practice clinicians to TeamHealth.
Key players in this market include Maxim Healthcare Services; Almost Family; Cross Country Healthcare, Inc.; Adecco Group; AMN Healthcare; Envision Healthcare Corporation; TeamHealth; CHG Management, Inc.; and inVentiv Health.
The locum tenens segment is projected to lead CAGR over the forecast period, primarily because of cost reduction offered in hiring temporary employees and physicians’ increasing preference for working locum tenens.
In 2019 allied healthcare held the largest market share in terms of revenue. It comprises physical therapists, occupational therapists, pharmacists, respiratory therapists, phlebotomists, and medical technologists.
The major players are adopting several marketing strategies such as collaborations, mergers, and acquisitions to gain maximum market share and expand their geographical presence.
Hospital leaders are also taking several important initiatives to overcome frontline staff shortages in current pandemic situations, which is expected to propel market growth.
In 2019, HNI Healthcare, Inc., announced acquisition of Martin Healthcare Group, a private company operated across the Midwest and in Florida, to spread its market reach.
Prominent players operating in this market include AMN Healthcare; Adecco Group; Envision Healthcare Corporation; CHG Management, Inc.; inVentiv Health; Cross Country Healthcare, Inc.; TeamHealth; Almost Family; and Maxim Healthcare Services, Inc.
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Precedence Research is a worldwide market research and consulting organization
News You Can Use
AAPS Seeks Less Regulation, More Patient Focus
We’ve all heard about the AMA, the American Medical Association. If you’re like me, you figured the AMA represented the views and interests of most physicians across the United States. Also, if you’re like me, you might not have heard about the Association of American Physicians and Surgeons “(AAPS).”
AAPS is “a nonpartisan, professional association of physicians in all types of practices and specialties across the country. Since 1943, AAPS has been dedicated to the highest ethical standards of the Oath of Hippocrates, and to preserving the sanctity of the patient-physician relationship and the practice of private medicine.”
AAPS’ motto, “omnia pro aegroto,” means “all for the patient.”
Under the “About” section of its website, AAPS questions, “as (our) government forces its power into every nook and cranny of our professional lives,” whether physicians serve the state or their patients.
“I once belonged to all the standard societies — my specialty society, my state and local medical society and — dare I admit this — even the AMA,” AAPS Executive Director Jane M. Orient, MD, said. “But I discovered that none of these societies stood on the principles I hold dear — individual liberty, personal responsibility, limited government, and the ability to freely practice medicine according to time-honored Hippocratic principles.
“AAPS has been fighting the good fight to preserve the practice of private medicine since 1943…The AAPS legal team defends doctors who have been mugged by Medicare, or railroaded by hospitals using sham peer review.”
Orient notes that the AAPS seminar entitled, “Thrive Don’t Just Survive,” has connected with doctors all over the country who wish to “leave the hassles of Medicare and the interference of managed care and start a cash practice. We have helped hundreds of doctors opt out of Medicare through information on our website and our limited legal consultation service. We challenged the HIPAA ‘Privacy Rule’ and got the government to acknowledge the ‘country doctor exemption’ for physicians who do not file claims electronically.”
Completely funded by membership dues and contributions, AAPS answers to and advocates for physician members, “not for big corporate donors or government funding sources. The AMA’s deal with HCFA [the Healthcare Finance Administration, the part of the US Department of Health and Human Services (HHS) that is responsible for administering Medicare and Medicaid] gave it a monopoly on the CPT codes, from which it derives at least $70 million in revenue annually. AAPS was one of the first to expose this conflict of interest,” according to the association’s website.
Delve into what the Association of American Physicians and Surgeons is all about here: AAPS Code of Medical Practice and Bylaws: http://www.aapsonline.org/AAPS_ByLaws.htm
Dues for MDs and DOs cost $375 per year. For physicians’ assistants, registered nurses, dentists (DDS and DMD), certified registered nurse practitioners and other advanced practitioners, the cost is $150/year.
Whether physicians are fresh out of residency, established in their mid career short-term physician jobs as a locum tenens can provide long-term benefits.— Locum Tenens (@locumtenens_usa) September 28, 2020
Here's a great article on The Long-Term Benefits of Short-term Physician Jobshttps://t.co/6C70rUIMy6
What’s it About?
Locumpedia is a free resource for the locum tenens community — from locum tenens physicians and advanced practitioners, to staffing firms and healthcare facilities that rely on locum tenens coverage.