Table 3 Study and sample characteristics in the 12 studies included in the review
From: Approaches to locum physician recruitment and retention: a systematic review
Author (year)/country | Aim | Design | Setting | Population (specialty breakdown, practice experience) | Sample size (n) | Strategies and tools used for locum recruitment | Main findings |
|---|---|---|---|---|---|---|---|
Simon & Alonzo (2004, 2008) [7, 13] USA | 2004 To characterize the profile of locum tenens (LT) and the motivation driving the decision to choose this type of practice 2008 To analyse who accepts LT assignments, when in their career they do so, variations in LT practice and what dimensions of satisfaction are important to LTs’ in the context of contingent, nonstandard employment | Cross-sectional | Hospital, clinic, single and multispecialty group practice | Primary care (26.9%), specialist (53.2%), and subspecialist (19.8%) physicians with a mean of 22.6 years practice experience | 776 | 2004 Respondents had been placed exclusively through LT placement agencies 2008 Placed through LT agencies; arranged for assignments through informal means (unspecified) | 2004 Female LTs were motivated by a flexible work schedule (31%) and were more likely to report locuming as their sole source of income (64%). Male LTs’ primary (62%) motivation was to work part-time and used locum income to augment retirement and pension resources (38%), and as a secondary income (33%) 2008 Locum positions were often sought as an initial position after residency, during a career transition when semi-retired or fully retired. The main reasons for accepting assignments were to: practice part-time (31.5%); obtain a flexible work schedule (21.1%); increase income (15.5%); travel (9.5%); experience new practice settings (8.3%); and avoid administrative responsibilities (2.9%). LT assignments of longer duration were associated with greater problems, including working conditions, transportation, remuneration, and housing |
Rourke et al. (2003) [3] Canada | To determine how family medicine residents and practising rural physicians rate potential recruitment and retention solutions for rural practice | Cross-sectional | Broad healthcare settings in rural communities | FM staff physicians (56.8%) and junior and senior FM residents (43.2%) | 486a | The OMA Locum Program contains a repository of registered physicians to supply locum services in rural areas | Residents rated an alternate payment plan that provides allocated CME time and comprehensive payment plans with guaranteed locum income as the most important recruitment solutions. Rated as “very important” by half or more in at least one of the groups (physicians or residents) included that of practice solutions related to locum provincial licenses, specifically the provision of locum licensure that allows rural physicians to cross provincial borders and provide their services as a locum |
Jenson et al. (2008) [15] UK | To calculate the rate of retention of locum GPs and the highest rated recruitment and retention factors | Cross-sectional | PCTs | Primary care physicians (100%) with a mean of 10.4 (SD: 11.5) years practice experience, ranging from 0–49 years | 13 | NR | Locum recruitment was influenced by work flexibility, availability, environment, and remuneration. Seventy-three (73%) of locum respondents agreed that they would prefer to arrange locum assignments independently. Less than half of locums (46.2%) felt adequately supported with professional development |
DiMeglio et al. (2018) [9] USA | To identify clinical duties and remuneration of anesthesiology LT positions using content analysis of recruitment emails | Cross-sectional | Hospitals, surgical and trauma centres | Anesthesiologists (100%) | 241a | Staffing agencies included the following information about assignments: payment information; licensing requirements; travel reimbursement; case load; and mean daily hours | Most opportunities came from five staffing agencies and information surrounding qualification and licensing was not consistently provided in emails. Majority of emails lacked information for the physician to make an informed decision to accept or decline the assignment. Locum anesthesiologists in the sample had an hourly rate significantly larger than the national average. Some staffing agencies covered licensing expenses (28%), travel (23%), and accommodation costs (20%) |
McKevitt et al. (1999) [16] UK | To characterize the motivation behind and experiences of physicians locuming in general practice | Cross-sectional | General practices | Primary care physicians (100%) with a median of two years of practice as a locum | 111 | Personal network was used to contract physicians | Reasons for pursuing locum assignments included short-term work between posts, experiencing a variety of practices before committing, work–life balance, and becoming part-time after retirement. Drawbacks of LT work included frustration with low status, lack of job security, and difficulty accessing structured training and education |
Woloschuk & Tarrant (2002) [17] Canada | To determine the influence of background, gender, and rural educational experience on students' willingness to locum rurally or engage in rural permanent practice | Pre–post study | Rural-based practices | Medical students (100%) with prospective interest in FM training | 254b | Rural educational experience for students increases likelihood of pursuing a rural locum assignment | Rural educational experiences in clerkship increased the chances of medical students choosing to take on rural locums and cemented novel rural connections |
Myhre et al. (2010) [2] Canada | To understand the demographics of family medicine residency graduates choosing locum work, their reasons behind choosing and leaving locum work, and its shortcomings and rewarding aspects | Mixed-methods | Hospitals, general practice, family medicine residency training programmes | Family medicine residency graduates (100%) | 155a | NR | Most (46.7%) cited practice exploration to increase experience and competence as the main reason to locum. The main reason for leaving a locum post was starting permanent practice (52.1%). Other reasons included desires for stability and patient continuity, and the impacts of personal life changes, financial considerations, and an end of need for exploration. Downsides to locum practice included negotiating contracts, low patient counts, lack of continuity, and working with difficult staff. Rewards of locum practice included flexibility and freedom in practice, increasing experience, and awards associated with seeing patients (unspecified) |
Jenson et al (2006) [14] UK | To gain an understanding of the role of a primary care trust (PCT) educational support group in the recruitment and retention of locum physicians | Focus group | Urban PCTs | GPs with a range of 2–40 years practice experience | 9a | Locum bank arrangements providing administrative support | GP (general practitioner) and locum retention factors included a supportive network of colleagues, assistance keeping up to date, and financial factors. Access to an educational support group was the most impactful factor influencing retention, especially for locums |
Rajbangshi et al. (2017) [18] India | To gain insight to the motivation and challenges of rural recruitment and retention of doctors and nurses in India’s states of Meghalaya and Nagaland | Semi-structured interviews | Urban and rural-based district and maternity hospitals, primary and community health centres, and general government service | Generalist (90%) and specialist physicians (10%) | 10 | NR | Rural background and community ties were strongly associated with decisions to join rural facilities regardless of the type of contract worker (locum physician or nurse). Poor working and living conditions, poor job security, lack of professional development and recognition, low salary, and lack of incentives deterred contractual locum physicians from rural service. Lack of pay parity and job security were unique challenges faced by contractual locum physicians |
Theodoulou et al. (2018) [8] UK | To explore the locum doctor landscape, and secondarily to evaluate the implementation of a novel software platform for temporary staff recruitment in the healthcare industry | Content analysis | Workforce planning in British healthcare system | Industry experts (15%), regional based strategy consultants in digital healthcare (15%), executive trust directors (8%), specialty managers (15%) and physicians (46%) | 13c | Key information (e.g., hourly rates, hospital maps) about locum assignments were shared between hospitals and prospective locums via point of contact. Use of internal staff bank and external agencies. Use of novel software termed “ABG” | Locum physicians were imperative to covering physician shortages, but current recruitment practices were inefficient, lacking transparency and consistency. The financial remuneration of the locum assignment has been said to be a motivator for “pay-centric” physicians. Locum physicians highlighted that this line of work does not allow for career progression and is dissatisfying because of lack of patient continuity of care. Lack of information made available about the LT assignment creates some professional isolation and logistical issues that prevent smooth completion of shifts. Mobile first solutions such as the secure third-party communication (ABG) software was more convenient, transparent, and cost and time effective. Findings enabled the development of an Information Exchange System to compare recruitment methods in healthcare |
Lagoo et al. (2020) [19] USA | To (1) better understand the potential areas of risk when a physician is first working in an unfamiliar setting; and (2) develop a tool for surgeon onboarding that can also be further refined to meet the needs of different specialties for the purposes of physicians who are recruited to work at hospitals outside of their home institution, through professional service agreements (PSA) | Semi-structured interviews | Academic medical centres and community hospitals | Family medicine (5%), emergency medicine (5%), OB/GYN (20%), general surgery (45%), anesthesiology (5%), and internal medicine (15%) physicians with most (50%) having greater than 20 years of practice experience and few (15%) with less than 10 years of practice experience | 20a | NR | Key findings from the aspect of travelling physicians detailed that logistics of providing care in a new setting are not usually integrated into onboarding practices which can limit the ability of the physician to provide efficient and effective care. Lack of interpersonal connections impacts the physicians' ability to acquire help with working in new settings |