and earn enough money to begin paying off debts.
Physicians employed under such an
arrangement do not share in the HMO's profits
(or losses).
Group Member Position
In this case the physician members sign on as
partners and as such have a direct interest
in the success of the organization whose profits
they share. This arrangement is an
option for those physicians for whom salaried or
solo practices are not attractive
because they prefer fixed hours and wish to
avoid all the other burdens that a private
practice involves, even if it means possibly
having a lower income.
Affiliated Position
This is an arrangement where physicians who
belong to a group known as an
Independent Practitioners Association (IPA) are
contracted to serve a segment of an
HMO's patient load. The primary activities of
such physicians are outside of the HMO
and not involved in the organization's business
success.
Locum Tenens
After completing residency training, some
physicians, albeit a minority, have opted to
defer their decision for a while and have
elected a more mobile form of practice. They
have chosen to serve as substitutes in areas
where there is a shortage of doctors. They
are called locum tenens, the Latin name for
place holder. They usually obtain their posi-
tion through a placement agency, but some
freelance. The locum tenens concept was
developed to entice physicians to come to rural
areas and to keep them there. They were
used to substitute for physicians who wanted
time off for vacations and continuing edu-
cation, or who were ill. To replace them during
such intervals, a network of temporary
physicians was organized.
Currently, it is estimated that 12,000
physicians in every age group and specialty are
working as locum tenens. While the majority of
them are over 50 and semiretired, the
fastest growing group are recent residency
graduates. The reasons for engaging in this
work are the desire to travel and the
opportunity to explore a variety of different prac-
tices. In addition, since this is a way to keep
living expenses down, new physicians can
use their savings to more rapidly pay off their
medical school loans.
For some new practitioners this may prove to be
a good transitional phase but they
need to be aware of all of the ramifications.
An assignment may last for a few days or
several months and may vary from steady work in
one area to practicing in widely sepa-
rated locations. In addition, practitioners are
responsible for their own health insurance.
A major consideration is the impact of
relocating one's family, both in physical and psy-
chological terms, and it can prove costly in
view of the need to store some belongings
and ship others. Naturally, for single people,
these problems are less troublesome.
There are currently about 25 agencies placing
physicians, with CompHealth-Kron
being the largest, but some prefer the
freelance route. The key to success using this
approach is to arrange a steady flow of
assignments using an organized marketing plan.
In addition to this substantial challenge, the
freelancers must handle all the administra-
tive details, such as obtaining and paying for
medical licenses and malpractice insur-
ance, travel and housing arrangements, etc.,
normally taken care of by the booking
agency for a fee, which may be up to 40% of the
client's income.
Practicing Abroad
Physicians seeking opportunities to serve
overseas can contact the following
sources for information:
National Council for International
Health
1701 K Street NW Suite 600
Washington, DC 20006
(202) 833-5900
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