The COVID-19 pandemic reveals gaping holes in locum tenens contracts

The ongoing COVID-19 pandemic brings to the fore many health system weaknesses that we always knew were there, but not too bothersome to be addressed. The media has focused on paid sick leave as a public health policy to permit infected workers to stay at home to avoid infecting their colleagues and clients. As many health workers crisscross the country to contribute to the pandemic response, my recent experience with physician locum contracting could be instructive to others.

As a pediatrician and health policy expert, every few years, I take time off my clinical practice to do locum contracts that enable me to do some writing and pro bono global health consulting. In November 2019, I surrendered my long term contract to focus on a book. By January 2020, I was itching to get back to work, and the book had advanced to a near-complete first draft; all that I had left to do was to work through several iterations of revisions between my writing coach, editors, and me.

I took up a locum ambulatory care position in Maine just in time for the identification of the first cases of COVID-19. As the disease spread in the community and to health care colleagues, I gave a second thought to my locum contract. That night, it was time for me to do a careful re-read of the contract.

As an employed pediatrician, one of the benefits of my long-term contract was a health insurance policy. When I terminated my long-term employment contract, I also lost my health insurance coverage. It was a little bit unsettling to be in Maine, far from home in North Dakota, without health insurance in the middle of a raging COVID-19 epidemic.

The contract said, “[Name of locum agency] does not pay for social security, workers’ compensation, unemployment, insurance of health and accident insurance.”

Oops, that’s not right, I thought.

I searched for a previous locum contract with another company. On their contract, beyond my basic remuneration, they didn’t even bother to say anything about protections or benefits for the contractor.

Both contracts were careful to phrase the locum doctor’s position as an independent contractor. I suppose my independence meant that they didn’t need to verify that I had health or disability insurance. They protected themselves by having a rigorous credentialing and onboarding process backed by medical malpractice insurance. But the health and wellbeing of the doctors taking the contracts was, at best, an afterthought.

I called the locum agency in the morning to air my concerns. To their credit, they admitted that the COVID-19 pandemic is an unprecedented event for which no one could have planned. They had developed a fund through which they could support health workers in need. If I took ill, I would have to call them for support. My health care will depend on the benevolence of the locum agency.

My other concern predates COVID-19, but the potential of getting sick helps to clarify all sorts of work-related risks. If I were to develop a cough with sniffles and unable to work around children, I wouldn’t have a timesheet to submit, and that would mean no income for the week to ten days while I am off sick.

Now that my locum contract is over, but the COVID-19 pandemic rages on, I’d be hard-pressed to take another locum contract without health insurance and income protections. Locum agencies must be as meticulous with asking that their contractors have health and disability insurance, with the protection of incomes, as they are with credentialing and malpractice protections. These benefits should be offered by the agency just as they provide medical liability coverage.

Koye Oyerinde is a pediatrician.

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