Alternate Model of Providing Cardiovascular Care: Locum Tenens

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EP LAB DIGEST. 2024;24(9):18-19.

Kelly Airey, MD, FACC, FHRS
Mason City, Iowa

Newer models of employment are emerging for physicians, and electrophysiologists are not immune. There is a critical shortage of health care providers, particularly in cardiovascular (CV) medicine. Electrophysiology (EP) services are in high demand with a low volume of providers available due to a dwindling supply of CV physicians. This workforce crisis has limited patient access to care, delayed necessary treatments, and threatened clinical outcomes.¹ Smaller communities are particularly affected by the shortage of electrophysiologists for many reasons, including remote location, fewer amenities, less support for call and coverage, etc. EP locum tenens coverage by board-certified EP physicians can help mitigate this shortage by providing high-quality care to areas in need when hiring a full-time EP physician is difficult. From the EP physician perspective, it can be difficult to balance between work and rest, leading to burnout in smaller communities with a high demand and low supply of physicians. Although very rewarding, EP practice comes with some drawbacks such as long hours, particularly in the laboratory, where catheter ablations or complex device implantations and lead extractions can take hours. In smaller communities with high service demand, this can accelerate burnout when physicians have little or no relief from providing service. 

A newer model in these communities is to provide locum tenens coverage to assist existing EP physicians with work volume and provide vacation/continuing medical education coverage. Relatively unheard of, even a few years ago, part-time coverage is becoming more widespread, particularly post pandemic. I have been providing EP locum tenens services for a year and share my experience here. 

There are several benefits to the EP locum tenens model. First, this model offers the physician an ability to carve out work hours that are likely more predictable. As many locum physicians do not work full time, they are able to handle long workdays for short periods. They can be dedicated to working long hours the entire week, since they are often taking weeks off during the month. Frequently, there is no call involved. There are also fewer administrative responsibilities and less meetings to attend. The ability to participate in leisure activities allows for a better work-life balance. It is easy to schedule vacations with less stress. 

Being employed as a locum physician means managing your business as a self-employed health care provider. I created a professional limited liability company (PLLC) with an S corp tax classification. I am responsible for paying my own social security and state and federal taxes, as well as health and dental premiums. I contribute to my 401K with both employer and employee contributions. I pay myself a salary and am responsible for quarterly tax payments. The hospital covers my malpractice and tail insurance, as well as hotel and car rental charges.

I am presently performing a permanent locum position at MercyOne Hospital in Mason City, Iowa. I adopted this work model just over 1 year ago. I work Monday to Friday, 1 to 2 times per month. There are 2 full-time EP physicians and a locum as of July 1st. Prior to that, there was 1 full-time electrophysiologist and 2 locum physicians. MercyOne has a cardiovascular fellowship program with 9 CV fellows and 1 interventional fellow; under the direction of Dr Michael Spooner, the permanent EP physician, our fellows have a robust commitment to research. There are presently 3 fellows interested in EP fellowships. My daily routine includes attending rounds and fellows conferences at 7 AM followed by either a full lab or office day. There is 1 EP laboratory and another hybrid room in which devices can be implanted. I typically work in the EP laboratory 2-3 of 5 days. Anesthesia is assigned depending on the types of cases scheduled. We perform typical catheter ablations and device implant cases except for extractions, which are referred out. We are typically finished by 5 PM daily. As I am consistent with my presence in the practice on an ongoing basis, I see patients in clinic and then schedule them for procedures during the future work weeks, which provides some continuity of care. I also work from home, reading electrocardiograms (ECGs) and monitors on an hourly payment schedule.

For emergencies and add-on cases, temporary pacemakers are placed after-hours by the interventional cardiologists. The physician in the laboratory is responsible for performing any emergency add-on cases. The fellows rotate through EP and assist in cases and inpatient consults. Cardioversions are performed by the cardiologist on hospital service. 

I have found the physicians are very pleasant and work well with locum physicians to divide work and function very well as a team. We participate in fellows teaching sessions during morning rounds. I have been integrated into the group and feel like a valued asset to the system. I provide continuity of care by working from home a few hours per day and continuing to engage with staff regarding patients I have cared for. Along with reading monitors and ECGs from home, the workload on the EP physicians in clinic is decreased, allowing them to focus on direct patient care. 

However, there are some challenges to providing locum tenens coverage. This includes having monthly travel, being away from home frequently, and staying in hotels for prolonged periods. The loss of a stable routine and eating schedule can be trying at times. Although less meetings and administrative responsibilities can be beneficial to practice, it also makes advancing in leadership less of a reality, and for some, may diminish a sense of belonging. Becoming self-employed and learning a new business model for doing taxes and providing health insurance has been a challenge. However, I continue to learn about new business models and alternate taxation methods with excellent mentoring. 

In terms of reimbursement, locum pay varies across the country. Hourly pay is typical. For EP, hourly rates range from $250 to $375 per hour, with the average annual salary of $637,000 per year according to various locum sites. Typically, malpractice insurance, travel, and hotel stays are covered. 

In summary, EP locum tenens coverage is an alternate model of practice that is becoming increasingly popular, particularly in smaller communities across the country where demand for EP physicians far outweighs supply. The benefits to small communities with high demand for quality EP care in this era of dwindling CV workforce are tremendous. The locum tenens model involves the EP physician to become self-employed and manage an LLC. This can be a very satisfying method of practice for those physicians who are flexible and wishing to improve work-life balance while providing high-quality service. I have found the experience very rewarding. Although my income is somewhat less, I find balance in the increased rest and relaxation as well as now have the ability to engage in more social and leisure activities. EP locum tenens coverage has been the right choice for me and could offer an ideal solution for others. 

Disclosure: Dr Airey has completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest and report no conflicts of interest regarding the content herein. 

Reference

1. Maddox T, Fry ETA, Wilson BH. The cardiovascular workforce crisis: navigating the present, planning for the future. J Am Coll Cardiol. 2024;83(3);466-469. doi:10.1016/j.jacc.2023.12.001