My Life as a Locum Tenens

After practicing orthodontics for 30 years with only a few two-week vacations, I wanted to take some time off to smell the roses and spend more time with my family. For two years, I looked in vain for a locum tenens or an associate/partner. Not finding either, I decided to sell my practice, semi-retire, and offer my own services as a locum tenens. I figured there must be many orthodontists who want more time off to enjoy life and take stress-free family vacations, while maintaining patient services without the typical loss of office production.

You might be concerned about having an unknown orthodontist come into your practice. What will the patients think? How will the staff react? Can patients be started and debonded? These are all legitimate questions.

I had the same concerns when I became a locum tenens myself, only in reverse. Beginning with my first experience, however, I have had only positive results. In that first office, over four days, I performed 11 full bondings (new starts) and 10 debondings. The cost to the practice was about 10% of the four-day production, but for the first time, normal production and cash flow continued during the vacation week.

Prior Planning

The key to success is the orthodontist's advance preparation of the staff, communication with the patients, and discussion with the locum tenens about how patients are diagnosed and treated. I suggest you contact the locum tenens as far ahead as possible to arrange for dates of coverage, as everyone's calendar tends to get filled well ahead. I recommend scheduling patient appointments as usual during that period. The first time you have a locum tenens work for you will be the most time-consuming in terms of paperwork, but you should not have to repeat the entire process every time. This article and the forms provided are for informational purposes only. The author assumes no liability for them, and they should not be used without customization to fit each individual situation, after consultation with legal counsel.

The major items that must be addressed before bringing a locum tenens into your office are:

1. Contact the AAO malpractice insurance company carrier at (800) 622-0344 as soon as possible once you and the locum tenens have reached an agreement. The company will want to know the other doctor's AAO member number and how many days he or she will work. You will probably have to mail or fax this information on your letterhead. After you receive an endorsement in writing from your insurance carrier, mail or fax a copy to the locum tenens, who will be unable to work in your office without this endorsement (Fig. 1). AAO malpractice insurance will allow you to add the locum tenens coverage at no extra charge for the first 30 consecutive days. Coverage may be extended at a nominal charge for an additional 90 consecutive days during any 12-month period. If you have an insurance carrier other than the AAO, you will have to contact your carrier and arrange for similar coverage.

2. Notify your state board of dental examiners in writing of the doctor's name, license number, and expected dates of seeing patients in your office. Call before mailing this information; a fax is usually sufficient.

3. Notify your patients and parents as soon as possible so they have time to become comfortable with the idea of a substitute doctor. Send a letter to all active patients, and post a copy at the front desk for patients and parents to see (Fig. 2). If you don't use specific dates on the letter, you will not have to send out another mailing the next time. You may even want to add a sentence to your patient contract advising that you may have a locum tenens in the office at appropriate times. In addition, staff members should tell patients or parents in person when the locum tenens will be seeing them at their next appointments. There should be no surprises.

4. Coordinate a meeting with the locum tenens the day before the first patient day to acquaint him or her with the office and staff. Use this occasion to communicate doctor-to-doctor regarding diagnosis and treatment. Decide how you want to answer frequently asked questions such as, "When do you think I will be finished?" (You might have the locum tenens say, "Oh, that is for Dr. X to decide; you can ask him at your next appointment.") Every day the locum tenens is in your office, there should be a morning huddle to advise the doctor about the patients scheduled that day. To maintain quality of treatment and efficiency, direct the staff to guide the locum tenens where he or she is needed. Also remind the staff to introduce the doctor personally to each patient.

5. Send a letter to your referring dentists including the locum tenens's resume (Fig. 3). This has been warmly received and is good public relations.

6. Establish a short, simple contract between the two doctors (Fig. 4).

Reactions

Before my first week as a locum tenens, I was unsure how the parents and patients would see me as the fill-in orthodontist. Surprisingly, the most common statements were, "I'm glad Dr. X was able to get away for a vacation," and, "It was nice that Dr. X had you here for emergencies like this."

The orthodontist had this to say when here turned: "The locum tenens arrangement was a win-win situation for both of us and turned out better than I had anticipated. . . I enjoyed the time off without worry while maintaining production and income levels, rather than an overhead loss as in the past. No problems occurred, and you were there to see emergency patients. The feedback from patients and staff was very positive. Thanks again, and I am looking forward to having you here many more times."

Staff reactions included:

• "Dr. Grove made all of our patients feel very comfortable with him, and he was fun to work with!"
• "Dr. Grove made our staff feel very comfortable and made sure we had a good time. Thank you so much."
• "We really enjoyed having Dr. Grove here! He is very kind, and our patients really enjoyed him."

Conclusion

Making the decision to have another orthodontist in your office while you are gone is the biggest hurdle you will face. Once you have taken that step and have gone through the first locum tenens experience, you will wonder why you didn't do it before. Future vacations or time away from the office will go like clockwork and be even more stress- and worry-free.