Locum physicians’ professional ethos: a qualitative interview study from Germany

Abstract

BackgroundIn contrast to other countries, the appearance of locum physicians as independent contractors constitutes a rather new phenomenon in the German health care system and emerged out of a growing economization and shortage of medical staff in the hospital sector. Locums are a special type of self-employed professionals who are only temporally embedded in organisational contexts of hospitals, and this might have consequences for their professional practice. Therefore, questions arise regarding how locums perceive their ethical duties as medical professionals.MethodsIn this first qualitative study on German locum physicians, the locums’ own perspective is complemented by the viewpoint of permanently employed physician colleagues. Eighteen semi-structured interviews were conducted in 2014 to explore the professional practice of locum physicians from both groups’ perspectives with respect to doctor-patient-relationship, cooperation with colleagues and physicians’ role in society. The data were analysed using qualitative content analysis, including a deductive application and an inductive development of codes. The results were related to key tenets of medical professionalism with respect to the question: how far do locums fulfil their ethical duties towards patients, colleagues and the society?ResultsThe study indicates that although ethical requirements are met broadly, difficulties remain with respect to close doctor–patient contact and the sustainability of hiring locums as a remedy in times of staff shortage.ConclusionsFurther qualitative and quantitative research on locum physicians’ professional practice, including patient perspectives and economic health care system analyses, is needed to better understand the ethical impact of hiring independent contractors in the hospital sector.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3118-6) contains supplementary material, which is available to authorized users.

The quality and safety of locum doctors: a narrative review

“…Other papers examined locum medical practice in settings such as anaesthesia, 23 primary care 24–26 and hospital medicine, 22 and some explored doctors' attitudes to and experience of locum working. 27,28 Overall, there was some limited empirical evidence to suggest that locums may have a detrimental impact on quality and safety. 22–25,27,28 This was attributed in part to locum doctors being less likely to be familiar with patients and less aware of local policies and processes, 25 which had a number of consequences, including delays in discharging patients 26 and safety procedures being less likely to be carried out.…”

“…27,28 Overall, there was some limited empirical evidence to suggest that locums may have a detrimental impact on quality and safety. 22–25,27,28 This was attributed in part to locum doctors being less likely to be familiar with patients and less aware of local policies and processes, 25 which had a number of consequences, including delays in discharging patients 26 and safety procedures being less likely to be carried out. 23 There was some qualitative evidence to suggest that working with locums was viewed unfavourably by other doctors as their lack of familiarity could be burdensome for other healthcare professionals, who reported having to work outside of their scope of practice in order to compensate for locum unfamiliarity with local contexts.…”

“…26 Locum working was sometimes regarded as a problematic solution to staffing problems that had potential quality issues. 27…”

‘You're just a locum’: professional identity and temporary workers in the medical profession

“…2011), less ethical (Salloch et al . 2018), or untrustworthy ‘outsiders’ who lack commitment and have poor intentions towards the organisation (Chan et al . 2013).…”

Nurses' tension-based ethical decision making in rural acute care settings

“…19 The RNs shared some of the difficult ethical issues and conflicts that they had experienced. Ethical conflicts had the potential to occur when the nurses were working with locum physicians, 20 working with limited resources to care for patients and families, 21,22 dealing with dual or professional-personal relationships, 23,24 and maintaining patient confidentiality. 25 Some ethical issues were very similar to ethical issues reported in the nursing literature.…”