COVID-19 reveals gaping holes in locum tenens contracts [PODCAST]

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“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.

He shares his story and discusses his KevinMD article, “The COVID-19 pandemic reveals gaping holes in locum tenens contracts.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. Today on the show, we have Koye Oyerinde. He is a pediatrician, and he wrote the KevinMD article “The COVID-19 pandemic reveals gaping holes in locum tenens contracts.” Koye, welcome to the show.

Koye Oyerinde: Thank you very much for having me.

Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and your journey to where you are today?

Koye Oyerinde: Yes. I am a pediatrician and a public health expert. I was trained in Nigeria and later on in South Africa, and then later on I came here to the States to do pediatric residency. I also obtained a doctorate in public health at the University of North Carolina at Chapel Hill. And for five years, I was a professor at Columbia University, the Mailman School of Public Health, a professor of global health.

Kevin Pho: And how has the pandemic affected both you and your practice?

Koye Oyerinde: Well, the pandemic has been a major issue in primary care pediatrics, not because the kids are the main victims of the virus. Parents don’t want the kids to get infected, and parents don’t want to get infected, so they avoid coming to practices. And so with a typical day of about 25 to 30 patients a day, it went down to maybe two to three a day. So even though it’s largely an adult, aging-population disease, the fear of contagion meant that we actually almost closed down.

Kevin Pho: Now, is telemedicine an increasing amount of your practice since the pandemic started?

Koye Oyerinde: Yes. For my colleagues who remained in practice, it became the major way they communicated with their patients. But I had taken time off work at the end of last year, and then the pandemic set in, and I’ve been off work since then, trying to do book writing.

Kevin Pho: OK. So let’s get into your KevinMD article, “The COVID-19 pandemic reveals gaping holes in locum tenens contracts.” Now, for those who haven’t read your article, can you walk my audience through it and share the story of why you decided to write it?

Koye Oyerinde: Because I have a background in public health, I’ve always taken time off clinical pediatrics to do some public health work. It’s mostly pro bono, but it’s part of why I enjoy doing what I do. I go off to consult with governments around the world about certain health issues from time to time. And so I’ve used locums to break my contracts, so I could go off and come back and keep the locum while I’m writing a report or something like that.

So for me, in November and December, I was writing a book. By the end of January, the shell of the book was already done, and I was spending time now more with book editors to correct and revise the book. So that was a good time to have a locum. So I took the locum in Maine, Bangor, Maine, a lovely locum. I enjoyed the practice.

And it was while I was on the locum that the COVID epidemic became an issue. I was just there in my hotel, thinking, OK, my health insurance was linked to my permanent contract, which I had surrendered in November or December. I didn’t have health insurance. Now I’m working in an environment where there’s a COVID-19 outbreak, without health insurance. I was based in Bangor, Maine, whereas my home is in North Dakota. I felt suddenly very vulnerable. I have no pre-existing conditions, and I’m generally fit. I have never slept a night in the hospital. Ordinarily, I didn’t consider myself a vulnerable person. But at that moment, with a COVID-19 outbreak, I just felt, “This is actually not sustainable. You shouldn’t be doing a locum in the middle of a pandemic without health insurance.”

So I went to read my locum contract, and there was nothing about health insurance coverage in case I fell ill. I went to my computer for an old contract with a different locum agency. Same thing, nothing there to suggest what they’ll do if I fell ill.

And for those who do locums, you have to submit the timesheet. So the number of hours you work is how much you get paid. So if you were to have the flu, simple flu, and you couldn’t go to work, I mean, I’m in pediatrics. If you have flu, you can’t take care of kids, right? So you’re healthy and strong, you can be in the hotel, but with your sniffles and cough, you can’t be around children. So you don’t get to work, and sometimes you don’t get paid.

So all of a sudden, I was now looking at two different things that affected my contract. One, if I fell ill, I couldn’t work, so I won’t be paid. Two, because I didn’t have health insurance, if I took ill, that should be a serious crisis for me.

And so the next day, I called the locum agency to ask what will happen. And in fairness to them, they were magnanimous. They said, “Well, COVID-19 is an unprecedented event, and so we have put aside a fund.” I call it the GoFundMe employee plan, a GoFundMe backup plan: If you fell ill, you could let us know, and we’ll review your situation and support you if we have to. I was grateful for the plan, but I didn’t think that was a good plan for me as an individual, to depend on the graciousness of the locum agency.

And so by the time I left the contract, I thought I had to write the article, because I’m sure that there are other people out there in my shoes who take these locum contracts from time to time. I think it’s important for us to think again. I mean, with the contracts, they pay attention to your credentials, and they pay attention to your malpractice coverage. Well, that’s protecting the locum agency, protecting the hospital. It doesn’t protect you, the provider of care. What I think should happen is that the locum agency should either require you to have health insurance before you take the contract, or they should at least provide access to insurance if you want to pay for it on your own. They should have some scheme by which you could pay for your own health insurance while you’re on their contract.

Kevin Pho: Now, as far as you know, is that a common situation among all the different locums agencies, in that very few of them, if any, provide health insurance coverage?

Koye Oyerinde: I am not aware of any that provide any health insurance. That’s why I felt the article was important. I have worked with at least two, and both of them don’t have insurance coverage for their positions. And I looked at others, and I said, “It’s just about the same thing everywhere.”

Kevin Pho: When working with locums companies, there are so many, and my inbox gets inundated with so many different companies. What are some things that you should look for if a clinician is interested in working with a particular locums company?

Koye Oyerinde: Well, I think it’s important to be sure that they are legitimate and they are credible. I think you should actually talk to somebody who’s worked with them before. The ones I’ve worked with have been very good. You know, you can rely on them to look out for you, because sometimes you get sent off to places where you’ve never been before. The times that I’ve worked with locum agencies, they called me to make sure I was safe, and called me to make sure the accommodation I had was good, the car rental service was OK, and so on. So you don’t want to work with a tiny agency that doesn’t have the resources to support you where you go to work.

Kevin Pho: And typically, how long is each contract when you start working for a particular hospital or clinic?

Koye Oyerinde: Well, the contracts vary. I, for one, don’t take anything less than a three-month contract, because if I’m going to ship myself from home to go live somewhere, then I want it to be long enough for me to know the local community, settle in, do my work, and then plan to leave when I’m leaving. I think it’s too short to go for a week or four weeks. So I always insist on a minimum contract.

Kevin Pho: Now, you talked about the lack of health insurance in a lot of these contracts. What are some other red flags that clinicians should look out for when reviewing potential locums opportunities?

Koye Oyerinde: I think one of the red flags is how you get compensated. Sometimes when you read the contract, they state per-hour compensation, and they avoid telling you that your lunch break is not compensated. And I think if I’m right there for 10 hours of the day, I’m not going home in the middle of lunch break to go and cook or to buy food or something. I think the whole 10 hours should include my lunch break; that should be compensated. Whereas most of them don’t cover you for your lunch break, so your hour there, you don’t get any pay for that hour.

Kevin Pho: We’re talking to Koye Oyerinde. He’s a pediatrician, and he wrote the KevinMD article “The COVID-19 pandemic reveals gaping holes in locum tenens contracts.” Now, how has the pandemic affected the locum tenens industry? Do you find that there are more opportunities out there since the pandemic started?

Koye Oyerinde: Yes and no. I’ll say in certain areas. So I do only outpatient pediatrics, and that’s been badly affected by the COVID-19 epidemic. One, because the daily census of patients in the outpatient practices and centers has gone down dramatically since the epidemic. Because it’s so low, most practices can handle what they have. They don’t need an extra hand.

Whereas on the side of the hospitalists, the diversion of all the hospital-based physicians into critical care and emergency practices means there is a need for locum doctors to cover for the roles that they’ve left behind while they’ve moved to critical care and emergency medicine. So I think for the hospitalists, it’s a good time; there are more opportunities for locums. Whereas for outpatient practices, this is really not a very good time.

Kevin Pho: And my final question: Do you have a take-home message that you want to share with the KevinMD audience?

Koye Oyerinde: Locums are good. I think it’s a good thing to be able to leave a full-time contract and go off somewhere and spend some time, and it’s helped me see the country. I think it’s a good thing to do locums. But I think it’s important that we advocate that the health of the physicians doing locums should be protected. At the minimum, either they buy their own health insurance, or the agency should factor that into how they write the contracts and how they pay for the contracts.

Kevin Pho: All right. Well, thank you so much for sharing your time and insight. Thanks again for being on the show.

Koye Oyerinde: Thank you very much.

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