As a locums physician or someone seeking part-time work, it is always best to know your options when searching for opportunities. Physicians that don’t know their options when doing locums may be disappointed later to find out they missed out on something special. Physicians are quick to run to locums companies and their recruiters when they need temporary, short-term, and/or high-paying opportunities. Many fail to recognize that you could consider looking for these opportunities without the locums agencies. Physicians may call this “contracting directly,” while those in the recruitment industry refer to this as “Direct Placement.” Whatever you call it, the goal is to eliminate the need for middlemen, staffing agencies, recruiters, and expensive job boards, allowing physicians to negotiate and contract directly with facilities.
Kathryn Judge, a finance professor at Columbia Law School, recently published the book, “Direct: The Rise of the Middleman Economy and the Power of Going to the Source.” The title alone says it all. Why the need for so many middlemen? Why not go directly to the sources? Or, in the case of medical physicians, why not go straight to the facilities and ask, “can we talk?”
Although Judge highlights the importance of the middleman in growing our global economy, she documents how they have become powerful players in our capitalistic society. She speaks of how the middleman has grown to profit from suppressing innovation and competition while using their power to persuade the minds of legislators and the general public. Instead of following the current ecosystem, Judge advocates for consumers to use “direct exchanges” while minimizing the need for middlemen. Rather than purchasing fruits from the grocery store, she encourages readers to get their food at the Farmer’s Markets directly from the source. Judge wants us to build personal connections between the source and the customer. In addition, she advocates for greater transparency and congressional actions to support “direct exchange” rather than help middlemen with impure motives.
Rather than highlighting the disadvantages of working through a middleman, we focus on the advantages of contracting directly with facilities.
#1: Build personal relationships with administrators and staff. Go direct to the administrators when problems arise rather than going thru a middleman.
#2: Get paid well while saving the facility from using a locums agency.
#3: Be a part of their family and grow with the facility as one of their own. You may or may not be considered an actual employee, but they will treat you like one when you contract direct.
#4: Find great job security when contracting directly vs. going thru a locums company.
#5: Set up a working arrangement that suits you.
#6: Have the facility reimburse for travel, malpractice insurance, and other items.
As Judge’s book suggests, there needs to be a cultural change where the medical industry and government agencies embrace “direct exchange” between physicians and medical facilities. Not only do physicians and facilities need to be educated about the option to contract directly, but there is also a need for industry-wide and legislative changes. Let’s look at some reasonable changes to consider in the industry to encourage facilities to contract with physicians directly.
#1: Open marketplace without barriers for facilities to directly communicate with available physicians.
#2: Advocate for transparency in the locums industry, especially when understanding what physicians are being paid and what facilities are being charged by locums agencies.
#3: Redefining fair market value for locums and part-time physicians so that physicians can get paid fairly without facilities being fearful of stark law violations.
#4: Congressional action to develop initiatives to promote the direct placement of physicians with facilities rather than going through expensive locums agencies.
#5: State and federal assistance in providing malpractice insurance and evaluating the need for tort reform.
#6: The healthcare industry takes a non-traditional approach to employing and hiring physicians rather than simply expecting all to work full-time.
The recent release of Judge’s book is timely as the power of the middlemen has grown since the start of the Covid-19 pandemic, especially in the medical staffing industry. In medicine, we must begin recognizing which middlemen are worth their value. Why not follow Judge’s lead and encourage more medical professionals and facilities to contract directly for locums, per-diem, part-time and non-traditional employment? There is great value in physicians fostering direct relationships with facilities to contract directly without needing a middleman. Developing a “direct exchange” of physicians and facilities looking to work together could alter the industry to benefit all parties, including the patients we treat. The next time you think of working with a locums company or speaking with a facility, consider having a conversation about contracting directly.