Physicians who have been out of circulation for a year or more and wish to re-enter the workforce as locum tenens providers are advised to consider what is involved in becoming established as bona fide candidates for temporary opportunities. This group can include doctors who have practiced in management, academic, or research positions where they did not provide direct patient care. The starting point is to gather the necessary paperwork to complete the credentialing or re-credentialing process, as well as adhere to other qualifications for locum tenens practice.

CREDENTIALING

As standard policy, most physician recruitment firms require locum tenens providers to be fully credentialed before accepting contract engagements—and re-credentialed every other year thereafter.

EVIDENCE OF CLINICAL COMPETENCE

One of the most important considerations in re-entering the workforce is to establish current clinical competence. Whether the doctor serves in government or commercial practice settings, it is essential that the physician documents the clinical skills needed to capably perform the responsibilities associated with the position.

One form of documenting clinical competence is verification of recent continuing medical education (CME) credits. Honoring CME obligations can involve tested knowledge of industry trends, classroom instruction on new medical techniques, presentations at conferences, participation in medical research and publications, and similar means of remaining clinically current.

For physicians who have been out of the practice arena for an extended period of time, another means of attesting to clinical competence is to serve in a 3-month unpaid proctorship. This involves teaming up with a practicing physician to observe and be observed, and to assist in certain procedures to build up competence and confidence. Presenting a fresh reference from an attending physician following a proctorship is helpful in establishing clinical competence. It is critical to document the proctorship, note the procedures performed (type and volume), and obtain references from the proctor.

CERTIFICATION AND LICENSURE

Board certification is officially granted by the professional society or academy of the medical specialty with which the physician is associated. Typically, certification lasts 7 to 10 years. "Lifelong certification," once an attractive option, is phasing out. Even doctors who previously have obtained this certification are looking to get re-certified in their medical specialty once their current certification expires.

To re-enter the workforce, it may be necessary to obtain updated board certification or licensure. Many state medical boards have implemented a "10-year rule" that stipulates if doctors have not been certified or licensed in the last decade, they need to take licensure exams again to be re-licensed.

REQUIREMENTS FOR GOVERNMENT CONTRACTS

Accepting locum tenens opportunities in the government sector involves adhering to even more stringent qualifications.

Employment gaps. Some government medical treatment facilities are stricter than others in specifying what is acceptable in terms of explainable gaps in employment history. Certain organizations permit a 3- to 6-month gap, as long as it can be properly explained. Other government facilities allow for no break in hands-on clinical involvement. For example, contracts for medical services at a Veterans Affairs hospital stipulate that "there should be no gaps in employment history."

"No gaps" means just that. Other than short timeframes between locum tenens opportunities, doctors presented to VA facilities must show continuity of hands-on clinical involvement since they began their practice. Any time periods for vacation or traveling should be, of course, reflected on the CV.

Hospital privileging. Maintaining uninterrupted hospital privileges is equally important for physicians wanting to serve at government medical facilities. Once again, stringent guidelines state that contract requests will be refused if a physician "has had his or her clinical privileges limited, suspended, or revoked by any healthcare facility" within the last 5 years. However, this restriction does not apply if clinical privileges "were subsequently fully reinstated by the healthcare facility."

Whereas some commercial medical facilities might be more flexible in adhering to similar requirements—especially if their temporary staffing need is urgent—government institutions do not have such liberty. Doctors re-entering the workforce certainly need to be aware of this stipulation and make sure they are not ruled out for locum tenens consideration because of it.

Physical history and immunization. Particularly at the federal level, physicians who accept government contracts must have a physical exam within the past 10 to 90 days and current immunizations such as PPD, Tetanus, MMR, Hepatitis B, and Varicella. This requirement is becoming increasingly prevalent on the commercial side as well.

Background check and security clearance. Doctors wishing to practice at certain government facilities are required to have completed a comprehensive background check within the past 5 years, especially if the provider will be caring for patients under the age of 18. Practicing medicine prior to completing the review does not negate its importance. It simply means that the given medical facility may grant privileges pending the provider’s successful completion of the background check.

Some government locum tenens contracts—such as those with Department of Defense installations and correctional facilities—require stringent security clearance to enter the facility and treat patients. Physicians interested in opportunities in these practice settings should carefully consider anything in their background that might be a "red flag" and prevent them from obtaining such clearance.

Again, we have seen the number of commercial healthcare sites requiring detailed background checks and drug screening climb as well.

OTHER PRAGMATIC CONCERNS

In order to complete recruitment agency credentialing and hospital privileging, it is helpful to have on hand notarized originals of credentialing documents. Some medical facilities and licensing boards insist that medical professionals present copies of notarized originals as part of their application packages.

Besides keeping a file of letters of reference to use whenever needed, it is also helpful to line up clinicians (colleagues, supervisors) who can supply verbal references upon request. Rather than rely on the same people all the time, it is advisable to rotate the names of individuals offered as reference contacts. Keep in mind, most facilities require references that have directly observed clinical competence within the last 12 to 24 months.

Taking these pragmatic steps will help physicians in any medical specialty prepare for being considered as fully credentialed candidates for locum tenens opportunities.

NECESSARY DOCUMENTATION

In order to complete in-house credentialing of prospective candidates, credentials verification personnel at locum tenens firms require the following information:

• An updated, polished curriculum vitae (CV) with detailed professional history
• Copy of wallet-size state medical license and specialty board certification
• ECFMG certificate (if required) to verify education for foreign medical graduates, or certificate from Fifth-Pathway Program
• Health & Human Services/Office of Inspector General query to identify any Medicare/Medicaid sanctions or exclusion from federal programs
• Verification of Life Support Skills (BLS, ATLS, ACLS, PALS, NALS, etc.)
• Verification of all medical education and training
• Federation of State Medical Boards' (FSMB) verification of licensure history and presence of past or current sanctions
• National Practitioner Data Bank (NPDB) report
• NPI (National Provider Identifier) number
• Copy of current DEA and state controlled substance certificates, as applicable
• Recent professional references from colleagues or supervising physicians who can attest to current clinical competence