A family of physicians originating in Holland. 3,000 miners and ranchers. A “ski bum.” Yellowstone National Park. A U.S. Naval shipyard surgeon with a lacerated thumb tendon.
What do they have in common?
They played roles, large or small but each significant in its own way, in shaping an idea into a multi-billion dollar industry affecting millions of lives. That industry is locum tenens. The force it is today was over 40 years in the making, but its inception, consisting of these and other puzzle pieces, set the stage for locums’ ground-shaking impact on healthcare.
Rural physician burnout
In the mid-1970s, Health Systems Research Institute (HSRI) was created by the University of Utah’s College of Medicine and Intermountain Healthcare, with funding by the Robert Wood Johnson Foundation. HSRI wanted to stem the tide of rural physician burnout and subsequent abandonment of practices. Many hadn’t the means or resources to take time off for CME courses, vacation, or even sick days or simple downtime.
HSRI offered a program called ROPE, Rural Outreach Physician Education, whose purpose was bringing rural doctors to the University of Utah for courses to help them run their practices efficiently. But at the same time HSRI had to address the rural physician’s ever present concern: “What am I to do about my patients? I can’t leave my practice unattended.” The program assembled a network of doctors to cover practices while the rural physicians went to ROPE programs.
A family of physicians – Therus C. Kolff
One of the covering physicians was Therus C. Kolff, who immigrated to the states from Holland with his parents. His was a family of physicians. His grandfather, father, uncle, and two brothers were all physicians, and Therus took the same route. In the 1970s, between finishing his internship at the University of Utah and starting residency, Therus decided to take time off and try something different. That’s when he volunteered with the HSRI to cover for rural doctors attending ROPE.
One assignment brought him to Hanna, Wyoming, where he said, “I worked with a nurse practitioner caring for about 3,000 coal miners and ranchers. There was not another physician for 60 miles.” He recalled the experience being “great fun.” It was also transforming. He continued to work with HSRI for two years.
The “Ski Bum” physician – Alan Kronhaus
Alan Kronhaus was Kolff’s good friend and fellow physician. Kronhous said when he finished residency, “all I wanted to do was ski.” A painfully empty bank account, however, reminded him “that in order to do that, I needed money.”
He, too, signed up with the HSRI. He treated patients in a small mining town in Nevada for six months, after which he took off for the ski slopes. When ski season wound down and he was broke again, he approached the HSRI for another assignment. He loved treating patients who otherwise might have gone without a physician’s care. He ended up working with them for two more years.
One of his assignments tapped into an aptitude that was recognized by his colleagues: his mastery of the organizational workings of healthcare delivery systems. Kronhaus was tasked by HSRI with setting up and operating a healthcare system in Yellowstone National Park. One of his team members was his friend, Therus Kolff. Their program rotated senior surgery residents and attending physicians from the University of Utah so that park rangers and visitors had quality surgical care in the event of traumatic injuries.
The origin of locum tenens
The program’s physician rotation was so successful that Kronhaus was approached to become the institute’s medical director. Kolff joined him as associate medical director. The two worked diligently for permission to carve out of the HSRI programs a stand-alone service of locum tenens. They cobbled together a fledgling network of doctors interested in part-time work, and they started serving communities in the West that HSRI wasn’t. Hospital administrators from around the country began taking notice.
Kolff, Kronhaus, and their team thought they we were building a small company around providing primary care replacements for vacationing or CME-attending doctors in western states. Kolff said, “I realized there was nationwide demand when we suddenly got a call from the naval shipyard in Philadelphia asking if we could cover them with an orthopedic surgeon.” Their surgeon had lacerated the tendon on the back of his thumb and was incapable of performing surgeries for eight weeks. “After filling that need, we were no longer just western and primary care.”
Comprehensive Health Systems is born
Kolff was so motivated by what they’d created, he left Utah in 1978 to attend Harvard for health policy and management studies. He returned to Salt Lake City a year later with his master of public health degree and a vision of a locum tenens organization he was planned to create. He named his organization Comprehensive Health Systems, Inc. It would later change to CompHealth and eventually become CHG Healthcare.
Kronhaus became a visiting scholar with the University of North Carolina. There he focused his research on the economics of physician temporary placement. Analyzing the data from his HSRI days, he concluded that it cost a physician less to leave his or her practice temporarily with coverage than to leave with no coverage. He said, “I was knocked out by the results and thought that, if the service makes that much sense economically, what client would not want to have it?”
Kronhaus starts KRON Medical
He then set out to create his own locum tenens organization, called KRON Medical, started in his bedroom – because, he jokes, it wasn’t large enough for his garage. Placing an ad in the Journal of the American Medical Association, he was pleasantly surprised, if not outright shocked, by the number of physicians interested in working part-time assignments. He began with internal medicine and family practice placements but within a year added radiology and anesthesiology coverage.
KRON and Comprehensive Health become CompHealth
Comprehensive Health Systems and KRON Medical grew exponentially. The need for medical temps proved so ubiquitous and far reaching, dozens of competitors — some generalists, others niche players — sprang into existence. In the rough and tumble of any new environment, there are winners rising to the top, casualties falling by the wayside. There are also those with niche strengths, organizational muscle, or talent depth so valued, one company acquires another to bolster its marketplace position. Such was the case in 1993 when the companies created by two old friends, Doctors Kolff and Kronhaus, became one, with CompHealth purchasing KRON Medical.
The growth and flux of the locum tenens market required a stabilizing and unifying influence. The industry itself recognized the need of professional standards and ethical guidelines. It found them in the 2001 creation of the National Association of Locum Tenens Organizations (NALTO).
NALTO’s members work hard to ensure that the reputation of locum tenens is held in the highest regard by the healthcare industry nationwide. Testament to that respect is the degree to which the healthcare industry uses locums.
Locum tenens is now used throughout the country
Ninety-four percent of healthcare facility managers surveyed in 2017 reported using locum tenens physicians in the previous 12 months. Family practice, internal medicine, general surgery, psychiatry, and anesthesiology physicians are consistently the most in-demand locum physician specialties.
NALTO estimates that three-quarters of all hospitals augment their permanent medical staff with locum tenens physicians. Temporary physicians provide patient care for more than 600,000 days per year. The locum tenens business is projected to end 2017 as a $3.6 billion industry.
More importantly, however, is that the ultimate beneficiaries of the locum experience — the patients — are confident they are receiving the finest care possible when the healthcare provider treating them is a locum tenens provider.
No higher aspiration or greater goal could have been hoped for when an idea germinated just 40 years ago into the powerhouse called locum tenens.