Does patient care suffer with substitute doctors?

By Sally Robertson, B.Sc.Dec 6 2017

When a regular doctor is not at hospital due to illness or vacation, for example, patients are not treated by the doctor’s colleague or other hospital physician, but by a locum from outside of the hospital. This use of “locum tenens” physicians represents a growing, multi-billion-dollar industry that is being driven by a shortage of physicians and changing employment patterns.

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Researchers from Harvard Medical School have now asked whether these temps provide the same level of care as the doctors they are filling in for – the answer to which appears to be yes, at least in terms of death rates in the month following treatment.

As reported in JAMA, a review of 1.8 million Medicare hospital admissions between 2009 and 2014 showed that death rates in the 30 days following hospitalization were similar between patients treated by locums and those treated by regular doctors.

However, authors of the study Anupam Jena and colleagues warn that they did observe some small but statistically significant differences in other measures, with patients treated by the locums spending more money and more time in hospital.

Our findings so far are reassuring, but some of the trends we found demand that we look more closely at how the system works in a more granular way,"

Anupam Jena, Harvard Medical School

The substitute doctors do not usually have any relationship with their patients, are not familiar with the local community and may not have ever used the hospital’s electronic health records system or worked with the facilities patients may be sent to after leaving hospital.

The study showed that nearly 40,000 of the 1.8 million people admitted to hospital received care by substitute doctors and that those doctors replaced a regular doctor in one in ten cases.

Patients treated by locums were no more likely to die within a month of hospital admission than those treated by regular doctors. However, analysis of different sub-groups within the study population showed that hospitals that used substitutes less often had worse patient mortality outcomes.

Co-author Daniel Blumenthal suggests that this could be due to the remote location of these hospitals, limited financial resources or to a lack of robust support systems to help locums plug in to the hospitals' systems.

"As the market place shifts and employment patterns fluctuate, we owe it to our patients to make sure that the way we cover for doctors who are out of the office is safe and effective," Blumenthal warns.