Hospitals are increasingly utilizing locum tenens physicians, advanced practice providers (APPs), and telehealth services to address staffing shortages.
The Innovation & Flexibility: Journey to Sustainable Healthcare Report reflects data from 129 healthcare administrators representing a range of facility types and sizes.
The COVID-19 pandemic exacerbated hospital staffing shortages as many clinicians faced burnout and mental health struggles, pushing them to leave the field. In addition, hospitals have struggled to recruit new providers to meet the growing care demands of an aging population.
The report found that hospitals’ top concern was attracting talent (25.8 percent), followed by avoiding burnout (20.6 percent) and retaining talent (19.4 percent). Respondents also said that controlling costs (15.2 percent), improving the patient experience (9.4 percent), and scheduling providers (9.05 percent) were areas of concern.
Around 90 percent of respondents said they use locum tenens physicians. Nearly 60 percent of those who do not outsource physicians reported that they will consider using locum tenens staff in the future.
Over half of respondents (52.3 percent) have been using locum tenens providers or outsourcing physicians for more than five years. Nearly a quarter have been outsourcing for three to five years, while 23 percent have recently turned to locum tenens staff within the past two years.
In the past, locum tenens coverage has been accompanied by negative perceptions regarding cost and patient experience. However, healthcare leaders said that using locum tenens providers helped increase patient access to care (68.8 percent), their ability to fill previously unfilled positions (60.9 percent), and staffing flexibility (55.6 percent).
For most respondents, using locum tenens providers did not affect patient satisfaction scores or the morale of permanent staff.
Facilities most commonly used locum tenens coverage for physicians only (56.9 percent). Almost 27 percent of facilities used both locum tenens physicians and APPs, while 9.2 percent of respondents reported using only locum tenens APPs.
Locum tenens coverage has historically been focused on physicians only. But hospitals are increasingly utilizing APPs, such as nurse practitioners and physician assistants, to fill staffing gaps and maintain patient access to care.
Healthcare leaders said that the greatest benefits of using APPs were the lower costs, their ability to provide safe and efficient patient care, and being able to meet staffing levels.
Over seven in ten facilities said they plan to expand APP coverage in the future. Patients often do not care whether their healthcare provider is an MD or an APP, the report noted.
However, 78 percent of respondents reported that APPs required supervision from an MD or DO at their facility. Relaxing these regulations could help facilities expand APP utilization and improve patient care access.
Some states, including Massachusetts and Delaware, have expanded the scope of practice for advanced practice registered nurses (APRNs). However, the American Medical Association (AMA) has voiced its opposition to expanding scope of practice for APRNs, stating that it could threaten patient safety.
In addition to locum tenens providers and APPs, telehealth services have helped hospitals manage staffing shortages.
Although hospitals use onsite locum tenens staffing more than three times as often as telehealth, more facilities are leveraging telehealth or hybrid care following the COVID-19 pandemic.
Sixty percent of respondents plan to expand telehealth, the report found. Nearly 80 percent of telehealth services for were for behavioral healthcare, but more hospitals have started to use telehealth for specialty care, such as oncology, cardiology, and physiatry.
However, the report noted that establishing telehealth reimbursement parity would likely increase the adoption of the care modality.