I like the Locum Tenens system
After finishing another successful assignment as a Locum doctor, I have to say that I find the system very appealing. Most of the time, the physician can choose the duration of the assignment, the clinical setting and the location, among the many offered by the companies that manage this system.
The physician turnover in hospitals all over the nation is very high; I recently read that it was 20% per year; different sources may probably disagree on the exact figure, but they will surely agree that it is above what you would usually expect. That strongly denotes a problem in the industry. Although financial incentives for physicians are good motivators to accept job offers, there is need for more to keep the new employee. What forces clinicians to leave the institutions? I speculate that it is quality of life.
For example, physicians are usually considered “exempt employees”, meaning that they have a variable daily schedule and are not required to punch time cards. This is supposed to be a privilege. The concept looks progressive because of its apparent flexibility and may probably apply very nicely to workers like programmers, writers or artists; you may come to work and leave at different times without being micromanaged, as long as you complete your projects in time and fulfill your duties. The physician, however, despite being an exempt employee, is required to be in the hospital at a specific time, usually 7:30 or 8:00 in the morning; what is really variable is the finish time, which is usually well beyond that of other employees; personally, I seldom left the hospital before 6 PM and met colleagues who would never leave before 9 PM. That obviously means that the “exempt employee” status is a sleight of hand to avoid having to pay the physician overtime.
Working hours are just one aspect of many that make current hospital jobs unattractive in the long run. But I think it is the administrators’ job to do their homework and figure it out by themselves. I don’t think it is as much a matter of insight as it is a matter of decision; I believe they know that it would be a lot cheaper to improve the permanent doctors’ conditions (and hire more of them) instead of getting a continuous flow of Locum physicians; I also believe that they somehow sense what has to be done to improve efficiency, decrease their department overhead and increase the workers’ satisfaction; it is not rocket science. What actually stops them from carrying out the necessary changes is probably fear to angry the establishment, since such changes would entail treading into the terrifying land of the unconventional. In the meantime, I believe that the Locum companies are going to keep flourishing during the following years, providing care for the areas with no permanent physicians.
The Brain Shop 
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