Traveling Doctors Help to Fill Vacancies in Underserved Rural Hospitals, Clinics

A growing number of doctors are traveling around the country to temporarily fill vacancies at underserved rural hospitals and clinics -- a trend that has allowed many small facilities to stay open, the New York Times reports. Some of these "locum tenens doctors," as they are known, find jobs on their own, but most are employed by companies that "recruit and place them, pay their salaries and cover their malpractice insurance, housing and travel." The companies then charge a fee to hospitals and clinics, which often need a temporary doctor to fill in for physicians who die, retire or take a vacation. One of the companies, the Salt Lake City-based CompHealth, says it has 5,000 doctors on its roster and recruited 865 traveling doctors in 2001, up about 200 from 1999. And surveys by the Irving, Texas-based Staff Care, another locum tenens firm, found that 15% of all U.S. physicians had taken temporary jobs at some point in 2000, up from 4% in 1987. Staff Care spokesperson David Faries said that the demand in small towns for doctors, especially radiologists and anesthesiologists, "far exceeds the supply." The traveling doctors have allowed many small rural hospitals to keep their doors open, the Times reports, because the loss of a permanent doctor often means "losing authority to admit patients" and therefore "cutting off a hospital's fees." But "[h]iring a single substitute ... can keep a hospital afloat until a permanent replacement comes along." According to the American Hospital Association, the number of hospitals with fewer than 25 beds fell from 2,999 in 1975 to 208 a decade later, but rose again to 299 by 1999 -- "even as the overall number of hospitals continued to drop."

The rising number of traveling doctors does raise some concerns. According to Don Neilsen, senior vice president for the AHA, the use of temporary doctors risks continuity of care for patients, and visiting physicians "unfamiliar with local diseases may diagnose them incorrectly." However, according to Dr. Yank Coble, president-elect of the American Medical Association, while traveling doctors were once viewed as "reckless vagabonds," they are now "rigorously scrutinized, in large measure because of malpractice concerns." He added, "They serve a very useful purpose." The need for temporary doctors has become even greater after the Sept. 11 attacks on the World Trade Center and the Pentagon, as the U.S. Department of Agriculture, citing security concerns, has pulled out of a program that allowed foreign doctors to work in underserved communities for three years. The pullback from the program, which placed more than 3,000 foreign graduates of American medical schools in rural communities, will force those communities to find a new source of physicians (Kilborn, New York Times, 4/16).