The Board of Regents of the American College of Surgeons (ACS) approved the following Statement on Maintaining Surgical Access with a Locum Tenens Surgeon at its October 2017 meeting in San Diego, CA. The statement was prepared by the Board of Governors’ Surgical Care Delivery Workgroup and is supported by the Advisory Council for Rural Surgery.
The practice of using locum tenens spans across multiple medical specialties—from dentistry, to primary care, to surgery. Although this practice is a commonly employed option for hospitals to address a workforce shortage, the ACS needs to take a leadership role in defining standards for successful engagement of a locum tenens surgeon.
This statement provides a framework for guidelines and standards in the appointment and assessment of locum tenens surgeons. Such guidance will ensure quality and safety during coverage transitions in surgical patient care while protecting the interests of both the locum tenens surgeon and the host practice or institution.
This statement does not replace existing regulatory and hospital credentialing processes nor state licensure requirements.
Guidelines for locum tenens surgeons
The locum tenens surgeon should meet the following criteria:
- Must have the appropriate state medical licensure.
- Must be board certified or board eligible to practice in the surgical specialty or subspecialty for which he or she is being hired. This criterion includes any necessary work visas for surgeons who are not U.S. citizens. Must be in good standing with the American Board of Surgery or other American Board of Medical Specialties (ABMS) Specialty Board, and should participate in Continuing Medical Education activities as required by the relevant ABMS Specialty Board.
- Must satisfy the credentialing process of the host practice and hospital. This criterion includes background checks for prior criminal activity, as well as any pending or ongoing investigation into the surgeon’s standard of care.
- Should maintain an up-to-date log of his/her surgical experience and references for review by the host practice or institution. The ACS Surgeon Specific Registry is an excellent online option for this requirement.
- Should provide adequate handoff of all patient care activities resulting from his/her tenure on the service to the host practice.
Guidelines for the host practice group
The host practice should have the following procedures and processes in place:
- An established procedure for patient handoffs, transitions of postoperative care, and long-term follow-up of patients seen and managed by the locum tenens surgeon should be developed.
If available, a physician extender or mid-level health care professional associated with the host practice should be available or is strongly encouraged to assist the locum tenens surgeon while providing continuity of care for long-term patients.
- The hospital and host practice should provide the necessary tools for successful entry into the locum tenens position, including but not limited to: a comprehensive orientation to the facility; introductions to operating room, inpatient, and office staff; shadowing of practice partners and proctoring as possible and as needed; adequate training and 24/7 access to assistance for the hospital electronic health record, radiology, and laboratory systems.
- The hospital and host practice should coordinate coverage of all expenses related to locum tenens physician credentialing, contracting, and compensation.
- The hospital and host practice should provide adequate medical liability coverage with an indefinite period tail endorsement paid by the institution. If the locum tenens surgeon is hired through an agency, the responsibility for malpractice tail coverage may be the responsibility of the locum tenens agency.
- The hospital and host practice should provide the locum tenens surgeon and agency with a fair evaluation of his or her performance and have a mechanism for due process review if the surgeon feels that the evaluation is unjust.
Principles for consideration by the locum tenens agency
The locum tenens agency should abide by the following principles:
- In addition to managing and coordinating the locum surgeon’s employment, the agency is responsible for choosing surgeons who meet training, experience, and professional affiliation criteria (such as membership in the ACS) necessary to offer high-quality surgical care.
- Individual performance, available practice and/or institutional practitioner quality measures, and measures of both patient and practice satisfaction should be maintained by the agency for a defined period and subject to periodic review by the locum tenens surgeon.
- Individual surgeon performance, quality, and satisfaction measures maintained and disclosed to hiring institutions by the agency should be:
- Spelled out in contract language between the agency and the locum tenens surgeon
- Securely stored and protected as privileged information
- Fairly representative of his or her practice
- Transparent and readily accessible to the individual locum tenens surgeon for comment, personal performance assessment, and performance improvement