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A profile in leadership: Greg Kurmadas, CTS-PRC

Greg Kurmadas, CTS-PRC, founding president, National Association of Locum Tenens Organizations, and president, Vanguard Health Solutions
"NALTO's credentialing standards have raised the bar of excellence within the industry and fostered a more communicative environment between organizations. As locum tenens practice becomes more popular, we must make sure that industry growth does not result in a dilution of quality. Locum tenens staffing firms should understand the market forces and seek and maintain quality in all that they do."

Adamantly against participants who approach the locum tenens industry from an uneducated or uncaring position, Greg Kurmadas, CTS-PRC, values those companies with the ability to maintain the culture of quality. This feat is especially crucial today, he maintains, when firms are faced with numerous challenges—from state agencies questioning independent contractor status of physicians, to rising medical malpractice premiums, to increasing patient load, to a dwindling pool of candidates and an inevitable physician shortage.

It was likely that this strong belief in quality won him the support of others in the locum tenens industry—and an invitation to become the founding president of the fledgling National Association of Locum Tenens Organizations (NALTO) in 2001. He recalls, "Many industry leaders had met in early 2000 in San Diego and were set to see each other again in Chicago in the fall of that year. Some of these individuals were members of the National Association of Physician Recruiters. We have always been in a like industry, with numerous agencies maintaining segments in both the permanent physician and locum tenens markets, but there was growing interest in becoming more autonomous.

"I attended the second meeting, as did executives from a few of the larger companies, some mid-sized agencies, and a number of smaller firms, representing $440 to $450 million in locum tenens-only business. After entering the room, I realized that nearly everyone present knew each other and had past history. Most of the companies in business then employed or were created by individuals who could trace their roots back to the few founding agencies. I believe the fact that I was a relative unknown—with no history with any of the players—and my willingness to be constructively objective, led the group to think that I might be the best person for the role."

What was NALTO's initial mission? The association's primary objective, Mr. Kurmadas notes, was to attempt to create a purchasing group that had some leverage in the medical malpractice insurance marketplace to counteract the skyrocketing premiums. Secondly, the organization was charged with increasing public awareness, educating clients and physicians about the viability of contingent staffing. "My most immediate goal as president was to bring a much greater acceptance of locum tenens practice to the healthcare community, as well as to patient populations. It was—and is—essential that quality service and competent professionals are associated with this industry. A number of company executives also wanted to use NALTO as a forum to improve quality and address how to prepare for the provider shortages that were approaching."

He adds, "The largest challenge facing the industry prior to establishing NALTO was maintaining standards for business practices. Today, members are audited and practices are evaluated, with any complaints being constructively handled by ethics and arbitration committees. The potential of being reviewed by peers helps to enforce proper standards and continuously strive for quality improvement. I would caution all who want to enter and participate in this industry to do so only with the right motives."

Has the organization's agenda changed over the years? "While educating the public and setting standards for business practices will continue to be worthy goals, I think the current agenda is focused more on immediate issues, such as the potential tax treatment of physicians as employees instead of independent contractors. And, although there has been a short respite in the market, the medical malpractice issue continues to loom ominously. Thanks to damages brought about by Hurricanes Katrina and Rita, the insurance markets likely will be adversely affected once again."

William (Bill) Yeaton, MD, has been a locum tenens physician virtually as long as he has been practicing medicine. After finishing medical school in his home state of New Hampshire, he set off for California to do a residency in family medicine with the United States Air Force. In 1988, after completing his residency, the Air Force sent him to Europe for 61?2 years, with 12 months in Sicily, 3 years in Germany, and 21?2 years in England.

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