Dentists Taking To The Road as Locum Tenens

by Phillip Miller

About two years ago, Dr. Herbert Earnshaw, a dentist in Winchester, VA, had reached a critical stage in his career. A private practitioner for over 35 years, he had recently completed a contractual term as an employee of another dentist. He was not ready to take down his shingle, yet he was uncertain what to do next.

It was at this point that he received a call from Staff Care, a national company specializing in placing locum tenens physicians that had expanded its services to include locum tenens dentists. (Disclosure: The author is employed by Staff Care.) Dr. Earnshaw was vaguely aware that locum tenens dentists took the place of dentists who had to be away from their practices. He had never considered practicing as a locum tenens himself, but was intrigued by the idea.

Many assignments later, Dr. Earnshaw says he will continue practicing as a locum tenens dentist “until God lets me know it’s time to stop.”

Taking their act on the roadLike Dr. Earnshaw, a growing number of dentists are finding opportunities to take their act on the road by working temporary assignments in a variety of settings. The trend is being driven by a national shortage of dentists and mirrors a similar development in medicine, where tens of thousands of MDs work as locum tenens each year. In the field of medicine, private practices, hospitals, community health centers, correctional facilities, military facilities, and other providers are using locum tenens physicians to maintain services when permanent physicians can’t be found. This often takes place in federally designated Health Professional Shortage Areas (HPSAs) where the ratio of practitioners to the population falls below the standards set by the Health Resources and Services Administration (HRSA).There are over 6,000 HPSAs in the U.S. today where the number of primary care physicians falls below HRSA standards. At over 4,000, the number of dental HPSAs is not far behind. Companies like Staff Care, which for years specialized in the placement of locum tenens physicians, are being asked to find temporary dentists to fill openings around the country. Dr. Earnshaw, for example, worked as a locum tenens in a private practice, substituting for a doctor who was recovering from hip replacement surgery. He also worked temporary assignments at community health centers and correctional facilities that are chronically short of permanent dentists. Other dentists, such as Dr. Alton Walker of Rockport, TX, filled in for dentists who were deployed overseas by the military. He also substituted for a dentist who had to temporarily quit working due to injuries from a car accident.Benefits of locum tenensBoth Dr. Earnshaw and Dr. Walker agree that the primary benefit of practicing as a locum tenens is the stimulation gained from working in different settings, where the challenges, methods, and patients vary from place to place. Dr. Earnshaw says the downside of temporary assignments is being away from home. Dr. Walker is able to bring his wife with him on temporary assignments so is not concerned about the travel inherent to some locum tenens work. Both dentists agree that the pay, which typically includes a daily rate, per diem allowance, travel, accommodations, and licensure, is equitable and worthwhile, though not as much as they might make in private practice. The primary benefits that dental practices that use locum tenens dentists receive are continuity of care and uninterrupted revenue streams. Private practices and other facilities could lose patient goodwill or loyalty if patients have trouble scheduling appointments or services are chronically lacking. Also, when dentists are absent, revenue streams stop and support personnel can be left idle. Locum tenens dentists can maintain revenue streams and even profitability by keeping a practice near or at full production.How dentists are paidAgencies such as Staff Care provide two ways to pay for locum tenens services — a per diem option and a production option. The daily rate varies depending on the location and other variables of the temporary assignment, but usually range in the hundreds of dollars, rarely going into four-figures. In the production option, the practice pays a percentage of the revenue generated by the locum tenens dentist once an agreed upon baseline of revenue is reached. The rate typically ranges from 30% to 40% of production after billings exceed a base of $2,000 to $2,500 a day.Over the last two decades, locum tenens physicians have become a fixture at hospitals, medical groups, and other facilities. According to a recent Staff Care survey, 72% of hospitals and medical groups have used a locum tenens physician during the last 12 months. Locum tenens dentists, by contrast, are an emerging segment of the dental workforce and are still something of a novelty at many dental practices. As the shortage of dentists persists, however, it is likely that a growing number of dentists will be “getting their act together and taking it on the road.”Phillip Miller is vice president of communications for Staff Care, a national locum tenens staffing agency and a company of AMN Healthcare, the largest health care staffing organization in the United States. He can be reached at [email protected].