Table 4 Themes of deterrents and incentives of locum recruitment and retention reported by retained studies
From: Approaches to locum physician recruitment and retention: a systematic review
Author (year) | Financial incentives | Familial incentives | Educational/career-based incentives | Personal incentives | Mentorship and clinical back-up support | Deterrents to locum work |
|---|---|---|---|---|---|---|
2004 Supplement retirement income for older physicians and increase in income 2008 Increased remuneration, and reimbursement for travel and lodging, cover fees for state medical licensure, and supply malpractice insurance | 2004 NR 2008 Housing (unspecified) and family (unspecified) | 2004 Pre-permanent practice scouting. Career transition and easing into retirement when considered to be semi-retired or retired. Free from administrative responsibilities. Desire to practice on a part-time basis 2008 Pre-permanent practice scouting Facilitate hospital credentialling and verify medical licensure. Career transition and easing into retirement when considered to be semi-retired or retired. Free from administrative responsibilities Desire to practice on a part-time basis | 2004 Locum tourism, to travel and experience a different practice setting. Flexibility of work schedule 2008 Locum tourism, flexible work schedule, facility amenities (unspecified), work conditions (unspecified), overall quality of the facility (unspecified) | NR | NR | |
Rourke et al. (2003) [3] | OMA Rural Locum Program funds accommodation, travel and guaranteed income for locum physicians (unspecified). Payment assistance for CME | NR | Access to CME and provision of a cross-provincial locum physician medical license | NR | NR | NR |
Jenson et al. (2008) [15] | General remuneration for the purposes of recruitment (unspecified) | NR | NR | Flexibility of work schedule, work–life balance, and personal safety (unspecified) | Having known colleagues to work alongside | NR |
DiMeglio et al. (2018) [9] | Complimentary assistance with licensing costs, paid travel and lodging, and provision of malpractice coverage | NR | NR | NR | NR | Stress due to uncertainty regarding the requirements of the assignment shown to as a significant drawback for locum tenens physician |
McKevitt et al. (1999) [16] | Financial benefits (unspecified) | NR | Avoidance of commitment to a single practice. Allows for transition to retirement or temporary employment between permanent positions Practice task load and low administrative burden including paperwork, being on-call, and business management | Flexibility of work schedule, work–life balance, and locum tourism (ability to visit new places as a locum and travel) | Having familiarity with the practice | Poor job security, work unpredictability and exclusion from the National Health Service pension. Lack of career training opportunities. Perception of inferior professional status of locum by colleagues. Not enough patient continuity of care, as well as frequent travelling |
Woloschuk & Tarrant (2002) [17] | NR | NR | Pre-permanent practice scouting allowing the opportunity to assess suitability of the practice and community | Locum tourism | NR | Rural locum work can be demanding for new graduates in their early years of training |
Myhre et al. (2010) [2] | Financial benefits (unspecified) and the opportunity to increase income | Flexibility in accommodating family life | Increase clinical competence and skills. Pre-permanent practice scouting. Gain exposure to and develop understanding of running a professional practice. Flexibility in practice change and delaying commitment potential practice | Flexibility to accommodate lifestyle, work–life balance, and flexible work schedule. Time off to travel and participate in locum tourism | NR | Exhaustion. In addition, reasons for departure included the need for practice stability, continuity of care, and lack of patient volume, as well as being accepted by staff at the assignment were also downfalls |
Jenson et al. (2006) [14] | Financial factors for improvement of retention (not further specified) | Proximity to family and friends and schooling availability | Career advancement opportunities such as peer-facilitated educational support and help with education for keeping up to date | Post with flexible contracts, structured support (unspecified) and stress relief (unspecified) | Having access to a network of supportive colleagues | Isolation due to inadequate supportive network of colleagues and absence of sense of belonging. Difficulty remaining current as a physician and not feeling part of the ‘mainstream’ education system, including distance from postgraduate centres, and limited accessibility of different types of group education |
Rajbangshi et al. (2017) [18] | Increased remuneration for working in difficult conditions known as the “hardship allowance” | NR | NR | NR | NR | Low salary, and lack of equitable pay. Lack of career advancement, professional isolation, poor job security, and working conditions. Inadequate living conditions, difficulty in accessing leave of absences. Displeasure of administrative burdens |
Theodoulou et al. (2018) [8] | Hourly rates of locums higher than full-time contracted physicians and pay-centric doctors appear content with such enticing pay rates | NR | Originating from the reality that the early training programmes limit physicians’ exposure to certain specialities, locuming offers the opportunity to attain additional skills | Flexibility of work schedule and work–life balance, specifically logistical flexibility, compatibility with posts, and convenience of the locum assignment | NR | Lack of effective information sharing between physicians and managers to make informed decisions. Instability and desire to attain a secure position. Lack of care continuity. Professional isolation because of the need to adapt to new settings, no immediate “camaraderie” benefits, and native staff resentment about high locum pay. Uncertainty of where to go and who to report to, accessing buildings. Inadequate hospital onboarding practices reported as the most important deterrent to undertaking locum assignments |
Lagoo et al. (2020) [19] | NR | NR | NR | NR | Back-up or buddy physician available during the assignment to aid in understanding institutional workflow and culture. Intentional relationship building whereby seasoned colleague meets with the new LT physician several times to ensure comfort in the practice. Possibility of locum physician visiting the new hospital prior to assignment increases familiarity | Poor onboarding practices cause a lack of interpersonal relationship development. Inadequate time set aside to introduce key team members and foster relationships, leading to difficulties asking for help on shift. Information such as EMR basics, email access, and key team members not always provided. Lack of information on how home institution differed from locum assignment institution reduced welcomeness to the new team. Physicians described uncertainty and high stress in providing care in an emergency while in a new setting |