Can Nephrologists Afford to Take Time Off?

The mental and emotional importance of taking time away from work is widely accepted as an essential component of a healthy lifestyle, yet why is it so difficult to do so?

Whether it’s the hassle and time involved in organizing your patient appointments before and after the time off, or finding another physician to cover any emergencies that happen while you’re away, you may feel like taking a vacation is more work than it’s worth! And perhaps you feel that a vacation isn’t worth the loss of revenue that results when you are away from the office.

These are valid concerns. With the population aging, increased incidents of diabetes and hypertension and increased life expectancy, forecasts indicate that by 2015 end-stage renal disease will increase nationwide by 85 percent. What will this dramatic increase in the number of patients and the mounting healthcare staff shortage mean for you and your business? Without making some critical business decisions to preserve your business and your own personal well-being, you face longer hours, easier burnout and less personal time for yourself and with your family.

Coverage Options for Nephrologist

Taking time off requires a lot of effort. But if planned properly, physicians can avoid making the simple business mistakes that result in revenue loss. Consider some of these options as well as the advantages and disadvantages of each.

Reciprocal Coverage: Reciprocal coverage is probably the most common practice when scheduling time out of the office. Physicians who don’t have access within their group for coverage will often have a competing physician cover for them while they are away. While this is beneficial for covering hospital responsibilities and call, reciprocal coverage may also mean giving competing practices access to potentially new patients and sources of revenue. In addition, if you ask a local nephrologist to provide you with reciprocal coverage, there will be an expectation that you will reciprocate coverage when it is needed. If your time is already in short supply, you may run into additional time burdens when it is time to reciprocate.

Scheduling Around Time Off: Scheduling patients around time off can help your practice maintain monthly revenue to some extent. However, even with diligent micromanaging this option may still result in long working hours before and after taking time off. Additionally, it may still be extremely difficult to achieve your practice’s maximum revenue potential. Even when other arrangements are made to accommodate time off, for every day the physician is not in the office, your practice loses revenue.

Hire a Permanent Physician: Adding another full-time physician is another option. Depending on the office location and the daily patient traffic, this may be a smart business move. However, if the location has peak seasons (e.g., a destination that attracts snowbirds during winter), the cost of maintaining a full-time physician through the off-season may get expensive. Additionally, the practice would have to shoulder the additional cost of a new employee with salary, benefits, malpractice insurance, and other overhead expenses.

Another Option: Staffing a Locum Tenens Nephrologist

Locum tenens, or temporary physician staffing, has become an increasingly popular alternative. A nephrologist in Illinois recently considered the locum tenens alternative when he lost a physician in his practice. After researching locum tenens he was amazed by what he found: “I realized that there was a whole other universe out there for physicians and this has actually been around a long time. Nephrologists have not really had to use locum tenens in the past, but with the increasing patient population, I think there is definitely going to be a stronger need for this service.”

For years healthcare systems have budgeted for temporary staff because with high peak periods, it makes more business sense. Locum tenens only work the time requested, which helps lower their labor costs and also reduce staff burnout during peak periods. In the big business picture, why give up a piece of your practice if you don’t have to?

Concerned about the costs, credentialing, insurance and other issues of working with a locum tenens nephrologist? Here’s a closer look.

Cost Benefits: The first half of this article discussed the different practices physicians use when taking time off of work. Each option involves a cost each and every time the physician takes time off. While there is an initial cost in hiring a locum tenens nephrologist, when compared to the costs of your other options, practices may actually be able to make a profit by fully utilizing a locum tenens physician.

With a locum tenens nephrologist, a practice can maintain a full schedule of patient visits to fully maximize reimbursements. A locum tenens nephrologist can also help maximize capitation rates. For example, physicians who oversee multiple dialysis practice often don’t have time to visit all of them in the same week because of the distance required to travel between clinics. Not being able to achieve the maximum four visits can result in lost revenue. Also, in order to administer certain drugs such as Procrit to dialysis patients, a physician must be on site. Having access to a locum tenens nephrologist means the clinic can continue to provide the services that are a core part of its business.

Based on a recent physician revenue survey, a nephrologist in a practice will typically generate over $16,000 in gross revenue per week. Meanwhile, the weekly cost to bring in a locum tenens nephrologist is around $7,700 (inclusive of all fees including physician compensation, housing, travel, car rental, etc.), which still leaves $8,300 for the practice—compare that to the lost revenue of not having a physician on staff.

Fully-Credentialed: It is always difficult to entrust your patients to someone with whom you don’t have a professional relationship. Staffing firms ensure that physicians have all the necessary credentials and experience. They contract to cover the malpractice insurance of their locum tenens physicians and go to great lengths to find reputable physicians to avoid potential money loss and maintain their relationships with the practicing physician and practice.

Additional Perks: A locum tenens physician is also a great resource to fill the need for a permanent physician. It takes time to find a good employee and a busy schedule makes it very hard to find time to do so. Hiring a locum tenens physician will help you find more time plus it’s an excellent opportunity to consider the locum tenens physician as a permanent placement if the candidate is interested. RBT

Kyle Rampey is division manager at Foundation Physician Staffing, which provides temporary placement of nephrologists around the U.S. For more information about locum tenens, visit www.foundationphysician.com; or contact Kyle at (866) 292-2190; kyle.rampey@foundationphysician.com.

Becoming a Locum Tenens Physician: 24 Questions You Should Ask

Interested in considering a career move as a locum tenens physician? Do your homework by considering various staffing companies and remember to ask the following questions as you evaluate a company’s services:

1. Do they offer work in only one region or across the country?

2. How many opportunities do they have in your specialty?

3. What type of practice setting is provided?

4. How many physicians are currently working with them?

5. Who are their clients?

6. Do they understand the specific requirements and certifications that apply to your specialty?

7. Do they have representatives dedicated to placing physicians in your specialty?

8. Do they coordinate new licensure?

9. Do they cover physicians under a comprehensive policy? If so, is there a charge to you for coverage?

10. Do they have risk management professionals on staff, ensuring that you are placed in a safe, ethical work environment?

11. Are they available to help you resolve problems or concerns with a practice’s policies, procedures, equipment and more?

12. Do they coordinate your travel to assignments?

13. How are expenses handled?

14. What type of housing is provided?

15. Do they offer services for your personal travel as well as professional?

16. How will you get paid—hourly, daily, weekly?

17. Will you be paid extra for overtime and call duties?

18. Will you be paid on a regular cycle or only after the company receives payment from their client?

19. Do they credential physicians according to recognized national standards?

20. Is their credentialing service certified by a recognized agency?

21. If you have questions or encounter a problem, do they offer 24-hour support services, including weekends?

22. How long have they been in business?

23. Will they provide references from other physicians who have used their services?

24. Will they offer you the option of converting a locum tenens assignment into a permanent position?

At-a-Glance: Selecting a Physician Staffing Company

Ready to consider locum tenens physicians? Here are some important considerations to take into account as you research staffing companies.

Services. Do they offer travel, housing, hospital privileges, credentialing and licensing? These are essential to making sure the physician arrives ready to work. Does the company provide malpractice insurance for the physicians they place? Are they concerned with whether the client has coverage?

Specialization. Are they familiar with your specialty? Do they have resources available to fill your needs? They should also have a representative available 24 hours a day to answer your questions or address concerns.

Location. How well established is the staffing company in your particular geographic area?

Experience. A good firm can provide you with a brief history, expertise and business practices as well references from other clients.

Financial stability. What is the company’s payroll history? Do they have the financial resources to pay their physicians regularly?