Hospitalized patients treated by locum tenens physicians had similar rates of 30-day mortality and greater Medicare Part B spending compared with patients treated by non-locum tenens physicians, according to an analysis published in JAMA.

Investigators examined 30-day mortality, inpatient Medicare Part B spending, hospital length of stay, and hospital readmissions at 30 days among a random sample of Medicare fee-for-service beneficiaries hospitalized between 2009 and 2014 who were managed by locum tenens and non-locum tenens internal medicine physicians.

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Of 1,818,873 admissions managed by general internists, a total of 38,475 (2.1%) received treatment by locum tenens physicians. Hospitalized patients had a variety of illnesses, including cardiovascular disease, endocrine disease, cancer, chronic pulmonary disease, renal failure, depression, liver disease, and neurologic issues. Investigators found that differences in reason for admission were not clinically relevant between locum tenens and non-locum tenens physicians.

There was no significant difference in 30-day mortality between patients managed by locum tenens physicians and those managed by non-locum tenens physicians (8.83% vs 8.70%, respectively; adjusted difference, 0.14%; 95% CI, -0.18% to 0.45%). Treatment by locum tenens physicians was associated with greater Part B spending compared with treatment by non-locum tenens physicians ($1836 vs $1712; adjusted difference, $124; 95% CI, $93 to$154) as well as longer length of hospital stay (5.64 days vs 5.21 days; adjusted difference, 0.43 days; 95% CI, 0.34-0.52). Additionally, patients treated by locum tenens vs non-locum tenens physicians were less likely to be readmitted to the hospital at 30 days (22.80% vs 23.83%; adjusted difference, -1.00%; 95% CI -1.57% to -0.54%).

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In this study, the investigators did not obtain data on training, board certification, or other characteristics of the locum tenens physicians, which may have influenced treatment outcomes.

Overall, the absence of a significant mortality difference between treatment by locum tenens and non-locum tenens physicians, “argues against the presence of systematic differences in the quality of care administered by these 2 groups of physicians.”


Blumenthal DM, Olenski AR, Tsugawa Y, Jena AB. Association between treatment by locum tenens internal medicine physicians and 30-day mortality among hospitalized Medicare beneficiaries.  JAMA. 2017;318(21):2119-2129.