Differences in Productivity and Clinical Care Between Permanent Staff, Employed Travel, and Locum Tenens Emergency Physicians

Abstract

Study objective: Emergency department (ED) staffing shortages have increased reliance on locum tenens physicians (locums). We compared productivity, quality, utilization, and clinical practice measures between permanent staff, employed travelers, and locums during their first 100 shifts at a site.

Methods: We performed a retrospective cohort study comparing outcomes between the 3 physician types with linear regression, using data from a national ED group from January 2021 to July 2023 from sites that used travelers or locums. Covariates included patient characteristics, case mix, ED volume and boarding, date and time, count of prior shifts at the site, shifts in the prior 30 days at the site, and site-fixed effects.

Results: We included 67,400 shifts worked by 1,195 staff, 37 travelers, and 266 locums at 126 sites. Mean patients per hour was similar between staff and travelers (1.8 vs 1.8, adjusted coefficient [ß] 0.003, 95% confidence interval [CI] -0.051 to 0.057) but modestly higher for staff vs locums (1.8 vs 1.7, ß 0.101, 95% CI 0.052 to 0.150). Mean relative value units per patient was higher for staff vs locums (4.7 vs 4.4, ß 0.127, 95% CI 0.097 to 0.157). We observed no statistical differences in 72-hour returns, admissions or transfers, coagulation testing among discharged chest pain patients, brain computed tomography (CT) orders for syncope, D-dimer with CT pulmonary angiogram, overall CT orders, ED length of stay, or discharge opioid prescriptions.

Conclusion: Locums were less productive than staff during their first 100 shifts. Other measures were similar among groups.

Keywords: Clinical competence; Emergency service; Locum tenens; Physician staffing; Productivity; hospital.