When doctors in the department of psychiatry met Christian Gauderer, they couldn't help wondering what mysterious circumstances had brought their new colleague to Brooklyn's Woodhull Medical and Mental Health Center. They thought he might be running from something.
There was nothing in the doctor's mien or method to suggest adark past, though the guy did come from East Germany and (after a residency at the Mayo Clinic and a fellowship at Harvard) had run a psychiatric clinic in Brazil. No, the truly suspect thing about Gauderer was that he had come to Woodhull as a locumtenens physician. "Holding a place," for those of you who ducked out on Latin in high school. "Temp doc" to the rest of us.
"Among colleagues, there's a certain stigma," says Gauderer. "They kind of wonder, Why is this person doing temporary work? What's wrong with him?" An attitude which might explain the previous reluctance among doctors to take up temporary medical work.
Class stratifications that separate staff doctors from roving replacements notwithstanding, an increasing number of docs have been tempted -- by the fluctuation of budgets, the pressures of managed care, and the needs of both hardscrabble rural and hard-core urban areas that are begging for physicians -- to become latter-day guns for hire: Have stethoscope, will travel. Of the more than 600,000 doctors in the U.S. working with patients, 15 percent of them, according to industry estimates, have worked or are working as temps; in 1987, the figure was just 3 or 4 percent.
Twenty years ago, temps were deployed almost exclusively to cover for vacationing docs. "Now it has morphed into an industry that is used to deal with full-time losses," says Pamela McKemie, senior vice-president of the Atlanta-based LocumTenens.com, which supplies doctors for New York hospitals. "If a physician has left a practice, generally it takes six to nine months to find a replacement." Obviously, no one involved is eager to lose referrals or revenues -- so they dial a doc.
"You know what the public thinks of doctors to start with," says a supplier of temporary medical personnel. "For a hospital to reveal they use temporary doctors is a step worse."
More to the point, they're useful for hospitals focusing on the bottom line.
"When you're looking to cut costs," says Don DeCamp, chief operating officer for the Salt Lake City-based CompHealth, a health-care-staffing company that does business in New York, "the way to keep quality high and costs low is to use locum tenens doctors. You can add staff and subtract staff very quickly. It moves your costs from fixed to variable."
A hospital or a clinic with nine primary-care physicians on staff may want to cut back to five or six and use temps during peak periods like flu season, says DeCamp. Locum tenens docs are paid for their time and receive no benefits beyond free lodging, malpractice insurance, and transportation. Which might be enough to make up for the occasional sniping from colleagues. "At one place, I was called 'rent-a-shrink,' says a psychiatrist.
Locum tenens physicians tend to fall into three categories. There are retired doctors, like72-year-old radiologist Dogan Kizilay. "For a while, I did woodworking," he says. "I made a butcher-block table and some shelves. But how many things can you make?" So, following a career in Queens and New Jersey, he's now doing temp work at NYU Downtown Hospital.
Then there are the doctors in transition. Louis Keehn, for example: The 42-year-old anesthesiologist is now temping at Jamaica Hospital. He recently immigrated to Israel with his family but spends half the year back in the U.S. doing spot work to pay the bills. When Gauderer, a 55-year-old divorcé, remarried and had a baby, locum tenens work allowed him to make a fresh start in his professional life as well.
"I thought being a locum tenens would give me the flexibility to look around, to get back to the American mainstream in psychiatry," says Gauderer, who did stints in rural Massachusetts and Westport, Connecticut, before arriving at Woodhull (where he was paid $500 a day and $100 an hour for overtime). Eventually, he returned to a full-time job, at Hackensack University Medical Center.
The locum tenens industry is experiencing its most impressive growth with doctors in the third category, those just out of residency programs. Some may do temp work for a year while waiting for a spouse to finish school; some just want to check out their options, like dating before marriage. That was the case with Rajesh Parekh. The psychiatrist had three goals after medical school (at Mount Sinai) and residency (University of California, Irvine). He wanted to drive around the country for a few months with his new wife, he wanted to end up in New York, and he wanted a situation that would let him establish long-term relationships with his patients." Locum tenens helped me get some money and get me time to look around," says Parekh, who after six months in the emergency room at Woodhull ($65 an hour, time and a half for overtime) landed a permanent position as a staff psychiatrist at Columbia Presbyterian.
But it isn't only psychiatrists. The bulk of locum tenens work in New York City is in pediatrics, family medicine, radiology, pathology, and oncology, frequently in clinic settings. "For all those people who think New York is a great place to visit but wouldn't want to live here," says Don DeCamp, who recently sent a shipment of cardiologists to Executive Health Systems, a midtown medical practice, " locumtenens work lets them do it."
Though Lenox Hill has used locum tenens anesthesiologists, according to Daniel & Yeager, a staffing firm for medical personnel, the hospital did not return calls about the matter. CompHealth recently placed a psychiatrist at Payne Whitney, part of New York Presbyterian, but a spokesman there insists the hospital doesn't use temporary doctors. CompHealth placed a radiation oncologist at Mount Sinai, whose spokesman says that the hospital doesn't use temporary doctors either.
John McKeon, personnel director at Brooklyn's Kingsbrook Jewish Medical Center, pretty well put his finger on it when he said the hospital just didn't like the idea of having anyone temporary on staff -- doctors, nurses, anybody. "We want people who are fully committed to patients and the hospital," he said.
"There tends to be a fear about how the public is going to react to certain bits of information," says David Faries, a spokesman for Staff Care, Inc., an Irving, Texas-based supplier of temporary medical personnel. "You know what the public thinks of doctors to start with, and for a hospital to reveal they use temporary doctors is a step worse."
Beth Israel Medical Center has no such qualms, acknowledging the deployment of locum tenens physicians in its critical-care units.
"We needed high-level coverage in intensive care, and in many cases the locum tenens doctors are better than residents because they have more experience," says Mark Rosen, chief of pulmonary and critical-care medicine. "We looked at having full-time attending doctors versus the temp model and this way turns out to be just as good and much cheaper for the hospital.
"These people are different from the mainstream, but they do the job," he adds. "Everybody has a right to their own motivation. For whatever reason, this is the life they've chosen."
Louis Keehn's reasons are really quite simple. "As a locum tenens, I don't have to worry about billing,"he says. "I don't have to put any political chips on the table and say to anybody, Do me a favor? I only have to take care of the patient. Anything I have to argue for or against is for the good of the patient. To me, this is the purest form of medicine."