Locum tenens: A type of practitioner, not a type of privilege
When reviewing credentialing documents, I frequently see locum tenens privileges as a subset of temporary privileges. As the title of this column states, locum tenens is a particular type of practitioner, not a valid type of privilege, temporary or otherwise.
When you review The Joint Commission’s standards on temporary privileges, you see that they recognize only two circumstances in which temporary privileges may be granted:
- To fulfill an important patient care, treatment, and service need
- When an applicant for new privileges (who has a complete application that raises no concerns) is awaiting review and approval by the medical staff executive committee and the governing body
In fact, we have seen locum tenens physicians appropriately be granted temporary privileges for either of these circumstances, or regular privileges.
Most commonly, locum tenens physicians are interim physicians that are needed urgently because of anticipated need (vacation) or for unanticipated need (e.g., absence due to a health reason; unfilled slots in a rotation, such as ED or anesthesia; or emergent patient need for a specialist). Even with anticipated events such as vacation, it may be difficult to get a replacement and it only comes together at the last moment. Some medical staffs may argue that the inability to fill the absence would create an important patient care need necessitating the use of temporary privileges. In these circumstances, limited time is available to complete the credentialing process and The Joint Commission allows an abbreviated process (current licensure and current competency verification) that includes the CEO and the medical staff president granting a practitioner privileges. Most medical staffs, if time allows, choose to do as much verification as possible to ensure patient safety.
Less commonly, locum tenens physicians episodically return to the organization over a period of time. Maybe these locum tenens are covering for different radiologists as the radiologists take time off; maybe they fill in periodically to work ED shifts. In these circumstances, it is appropriate to have them apply for and to grant them regular privileges (although they still may need temporary privileges the first time they are there, except for in circumstances in which the application is complete, there are no red flags, and is awaiting approval. When the medical staff believes that a practitioner will likely be returning, it is more efficient for the medical staff to recommend regular privileges for these individuals. In this way, a fully complete and verified application must go through the credentialing process like the application of any other practitioner on the medical staff.
The take away here is that you must credential and privilege these individuals through the approved manners noted above. Keep it simple; do not create a third pathway of temporary privileges with alternate criteria or alternate approval. You can still get these individuals who are necessary to deliver care approved in a manner that is appropriate, timely, and compliant with regulations.
Mary J. Hoppa, MD, MBA, CMSL, is a senior consultant with The Greeley Company, a division of HCPro, Inc. in Danvers, MA.