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Contract Doctors a Risk in New York Hospitals

To reduce expenses, some New York hospitals contract with outside doctors. These doctors, who are not full-time staff members, can save a hospital thousands of dollars in benefit costs. But they come with their own set of risks— including an increased chance of medical malpractice.

When you think of temporary workers, you likely don’t think of doctors. Though temporary doctors may not be as common as other contract personnel, they are a growing presence in New York hospitals. Unfortunately, there are reports of doctors working on a locum tenens basis who have committed malpractice in another state and then relocated. A report from New York Magazine estimated approximately 15% of the 600,000 working U.S. doctors have worked as temps at some point. Back in 1987, that number was just 3 or 4%.

A Doctor Shortage Means more Temporary Opportunities

There’s a shortage of physicians in rural areas and in large urban hospitals. That means that doctors who are willing to travel and contract on a temporary basis can truly reap the (financial) rewards of temp work.

Even as hospitals and health care facilities experience cuts in government funding, they are seeing the need to increase the number of temporary doctors. The reason? Demand is increasing. Americans are using hospitals more often, in part because of an aging population. The increased demand and shortage of licensed physicians creates a market for temporary doctors.

Forbes Magazine reported in 2012 that the nation’s largest physician staffing firm, Staff Care, had 181,834 temporary days filled by its temp doctors in 2010, which climbed to 183,252 in 2011. The trend is growing.

Temp doctors are no longer just used to cover for vacationing physicians. Now they are a constant presence in many hospitals and practices, particularly in emergency rooms. Temporary doctors, who are independent contractors, may be hired because an emergency department’s staff is stretched thin and straining under the demand of too many patients.

Hospitals also have a financial incentive to use temporary doctors. Hospitals want to reduce their liability exposure for any malpractice claim brought against a non-employee doctor. The principles of vicarious liability ordinarily prevent a hospital from being held liable for the negligence of a doctor who is not a direct employee of a hospital. There are several exceptions that apply in New York and are referred to as the Mduba Doctrine (Mduba v. Benedictine Hosp.).

More Temp Doctors Means More Risk for Error

While it’s true that doctors will face some of the same patient concerns wherever they practice, the procedures can be dramatically different from one hospital to another, even from within the same city.

The chain of command is different from hospital to hospital, as is the protocol for decision-making. Does the doctor have to get approval before admitting a patient or dismissing someone who sought emergency care? The triage system for handling patients in emergency departments may vary. For a temporary doctor, these are things that can’t be learned in a single shift or even a handful of shifts.

The layout and equipment may differ. While one hospital may use one manufacturer for all of their monitoring and complex machines, another may rely on a different vendor. Unfamiliarity with medical equipment that temp doctors encounter increases the risks of a serious emergency room error.

An employee knows the ins and outs of their job. It comes with the experience of working at a specific facility with a particular set of rules and group of people. A temp worker doesn’t have that benefit. Many preventable medical errors occur because of a breakdown in communication or poor communication between doctors and nurses at critical moments.

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