I joined the boomer wave of “retirees” at the end of 2019, but for multiple reasons, have continued to work on a part time basis as a consultant and direct patient care provider. By the end of 2020, I concluded that carrying even part-time liability insurance was an excessive cost given the limited amount of direct patient care work I was doing. Subsequently, I’ve discovered Locum Tenens work minimizes my business costs while providing an opportunity to help colleagues in the PALTC space, who need coverage for vacations or acute illness. Locum Tenens is a model that allows a physician to temporarily assume the duties of a colleague’s practice during the agreed time of service. This means that when I work exclusively for a colleague on vacation, I’m covered by their medical liability insurance and use their billing system for the patients I see. At the main facility where I’ve provided this service, I’m familiar with their physician’s EHR and use that EHR for patient care documentation. At other facilities with a different physician EHR, I activate my old EHR and use that system for documenting patient care and for turning the documents into my colleague’s biller, for later reimbursement. Besides this reimbursement, I generally negotiate an incentive fee from the facility to cover the added work of picking up patients I don’t know, many of whom are medically complex. I have maintained my Medical Director Certification (CMD), so I also negotiate a fee for Medical Director services if I’m covering their Medical Director duties.

Locums by their very nature are temporary relief positions. In my experience, each medical liability company allows their insured physician up to 30 days of Locum Tenens coverage. In addition, some liability companies like NORCAL limit the number of days a retired physician can provide locum services under their insurance to 30 days per year. At the primary facility where I provide these services, I request confirmation of liability coverage for each time I provide vacation coverage, which I save and also forward to facility management. My colleagues at this facility have different liability carriers so I can provide each up to 30 days’ coverage per year. To extend the coverage time, they generally just request coverage for weekdays, since it’s easy for them to cover calls over Saturday and Sunday when they are home.

In late April, the MBC (Medical Board of California) e-news reported on new legislation that permits an e-prescribing exemption if a provider writes less than 100 prescriptions per year. The AB 852 legislation provided other specific exemptions to the specific e-prescribing requirements for physicians, but this one applies to the PALTC space, where most Rx’s are done by the facility through its order system, limiting new Rx’s to new controlled substances Rx’s, which are uncommon during a locum’s stint. An E-Prescribing Exemption form has been created by the CA State Board of Pharmacy, which is easily completed online. For part-time workers, this exemption removes the frustration, added time, and costs of e-prescribing.

In my area, the number of physicians working in the PA-LTC space has dwindled as private practice has shrunk and Boomers have retired. Vacation and illness coverage for facility Medical Directors and key physician providers have become more challenging and may contribute to provider burnout and thoughts of seeking other employment venues.

For recently retired physicians with geriatric expertise, the locums option may be a way to support good medical care in our space, but on a limited basis. As a clinician, much of the joy of my medical practice has occurred at the bedside. I suspect there are other Boomers out there who might want to consider the Locum Tenens option.

AB 852 Link: https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202120220AB852 E-Prescribing Exemption Request Form:

https://www.pharmacy.ca.gov/webapplications/apps/exemption_request/index.shtml