PEDIATRIC LOCUM TENENS PROVIDED BY AN ACADEMIC CENTER

Background. Locum tenens, the use of a substitute physician to replace a physician who must be temporarily absent from his practice, is wide ly accepted in the United States. Locum tenens has not previously been described or studied in pediatric practice. Objective. This article d escribes a locum tenens service for Colorado and Wyoming pediatricians provided by the Division of General Pediatrics and Pediatric Emergenc y Medicine at the University of Colorado School of Medicine and the Ch ildren's Hospital of Denver. An analysis and an evaluation of the prog ram are presented, and implications are discussed. Methods. All progra m data were prospectively collected and tabulated and later analyzed f or the period from July 1, 1994, through June 30, 1995. A survey of al l physicians using the Pediatric Locum Tenens Service was conducted wi thin 2 months of service to evaluate the program and to refine the ori entation, credentialing, and evaluation processes. Results. During the year, 35 pediatricians (14% of pediatricians in Colorado and Wyoming) made 97 requests for 398 days of locum tenens coverage. Coverage was used for vacation (85%), medical education (10%), medical leave (3%), and family matters (2%). Solo and rural pediatricians used the service at a higher rate than pediatricians in group or urban practices. Eigh ty-six percent had never used locum tenens coverage before because of either the expense (67%) or their unwillingness to trust their practic es to physicians or services with whom or with which they were unfamil iar (50%). The majority (83%) were willing to pay an amount for locum tenens equal to the net income derived from the locum tenens coverage in the practice. None indicated a willingness to pay more than that. R eferrals and admissions to the Children's Hospital from the pediatrici ans who used the service increased by 22% during the study period comp ared with the preceding year, whereas referrals and admissions increas ed by 9% among all other Colorado and Wyoming pediatricians. All pedia tricians completed surveys, and satisfaction with the locum tenens ped iatricians, charges, and program administration was high. Their sugges tions are described. Discussion. The following topics are discussed: ( 1) the economics of pediatric locum tenens; (2) the use of a locum ten ens service as a physician relations program by children's hospitals o r academic departments of pediatrics; (3) guidelines for orientation o f locum tenens pediatricians; and (4) a proposed evaluation and creden tialing process for locum tenens physicians.