Poole S R, Efird D, Wera T, Fox-Gliessman D, Hill K
Department of Pediatrics, University of Colorado School of Medicine, Denver 80218, USA.
Pediatrics. 1996 Sep;98(3 Pt 1):403-9.
Locum tenens, the use of a substitute physician to replace a physician who must be temporarily absent from his practice, is widely accepted in the United States. Locum tenens has not previously been described or studied in pediatric practice.
This article describes a locum tenens service for Colorado and Wyoming pediatricians provided by the Division of General Pediatrics and Pediatric Emergency Medicine at the University of Colorado School of Medicine and the Children's Hospital of Denver. An analysis and an evaluation of the program are presented, and implications are discussed.
All program data were prospectively collected and tabulated and later analyzed for the period from July 1, 1994, through June 30, 1995. A survey of all physicians using the Pediatric Locum Tenens Service was conducted within 2 months of service to evaluate the program and to refine the orientation, credentialing, and evaluation processes.
During the year, 35 pediatricians (14% of pediatricians in Colorado and Wyoming) made 97 requests for 398 days of locum tenens coverage. Coverage was used for vacation (85%), medical education (10%), medical leave (3%), and family matters (2%). Solo and rural pediatricians used the service at a higher rate than pediatricians in group or urban practices. Eighty-six percent had never used locum tenens coverage before because of either the expense (67%) or their unwillingness to trust their practices to physicians or services with whom or with which they were unfamiliar (50%). The majority (83%) were willing to pay an amount for locum tenens equal to the net income derived from the locum tenens coverage in the practice. None indicated a willingness to pay more than that. Referrals and admissions to the Children's Hospital from the pediatricians who used the service increased by 22% during the study period compared with the preceding year, whereas referrals and admissions increased by 9% among all other Colorado and Wyoming pediatricians. All pediatricians completed surveys, and satisfaction with the locum tenens pediatricians, charges, and program administration was high. Their suggestions are described.
The following topics are discussed: (1) the economics of pediatric locum tenens; (2) the use of a locum tenens service as a physician relations program by children's hospitals or academic departments of pediatrics; (3) guidelines for orientation of locum tenens pediatricians; and (4) a proposed evaluation and credentialing process for locum tenens physicians.
临时替班医生，即使用替代医生来替换因事必须暂时离开其执业岗位的医生，在美国已被广泛接受。此前儿科执业中尚未对临时替班医生进行过描述或研究。
本文描述了科罗拉多大学医学院普通儿科学与儿科急诊医学科以及丹佛儿童医院为科罗拉多州和怀俄明州的儿科医生提供的临时替班医生服务。文中对该项目进行了分析和评估，并讨论了其意义。
前瞻性收集并整理了该项目的所有数据，随后对1994年7月1日至1995年6月30日期间的数据进行了分析。在服务结束后的2个月内，对所有使用儿科临时替班医生服务的医生进行了一项调查，以评估该项目，并完善入职培训、资质认证和评估流程。
在这一年中，35名儿科医生（占科罗拉多州和怀俄明州儿科医生的14%）提出了97次临时替班医生服务请求，共计398天。这些服务用于休假（85%）、医学教育（10%）、病假（3%）和家庭事务（2%）。个体执业和乡村儿科医生使用该服务的比例高于团体执业或城市执业的儿科医生。86%的人以前从未使用过临时替班医生服务，原因要么是费用问题（67%），要么是他们不愿意将自己的业务托付给不熟悉的医生或服务机构（50%）。大多数人（83%）愿意为临时替班医生支付与业务中临时替班医生服务所产生的净收入相当的费用。没有人表示愿意支付更多费用。在研究期间，使用该服务的儿科医生转诊至儿童医院和入住儿童医院的人数比上一年增加了22%；而在科罗拉多州和怀俄明州的所有其他儿科医生中，转诊和入院人数增加了9%。所有儿科医生都完成了调查，对临时替班医生、收费和项目管理的满意度很高。文中描述了他们的建议。
讨论了以下主题：（1）儿科临时替班医生的经济学；（2）儿童医院或儿科学术部门将临时替班医生服务用作医生关系项目；（3）临时替班儿科医生的入职培训指南；（4）针对临时替班医生的拟议评估和资质认证流程。
