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Some doctors have very long commutes, by choice

FARGO - Haena Kim faces a daunting commute to get to work at an ear, nose and throat clinic here where she's one of several temporary physicians filling in.

Dr. Haena Kim, an ear, nose and throat doctor from the San Francisco Bay Area, flies in for a week at a time to staff Sanford’s ENT clinic in Fargo. Dave Wallis / The Forum

FARGO – Haena Kim faces a daunting commute to get to work at an ear, nose and throat clinic here where she’s one of several temporary physicians filling in.
She flies in from the San Francisco Bay area where she lives, with a layover in Minneapolis-St. Paul, a trek that takes the better part of the day.
Her clinical rotations last seven or eight days at a stretch, a schedule she’s been keeping at Sanford Clinic since last August and plans to continue through the spring or early summer.
For Kim, who is launching her own specialty clinic in Walnut Creek, Calif., the opportunity for regular, temporary stints in Fargo helps financially and also to keep her skills sharp, with a flexible schedule.
“You keep your hands busy,” she said. “It’s very, very helpful.”
Jennifer Exo, a pediatrician, is working two weeks on, two weeks off, at Essentia’s walk-in clinic here, commuting from the Kansas City, Mo., area.
After working at a pediatric intensive care unit in Denver, Exo was looking to return to general pediatrics and found the opportunity in Fargo.
“I like the pace,” she said. “It’s always a pleasure to see kids who are well.” In a critical care setting, she was dealing with very sick, sometimes dying, children.
Sanford and Essentia have long relied on using outside doctors and other providers to temporarily fill vacancies or provide “call relief,” a common practice in hospitals and clinics.

At any given time, Sanford Clinic Fargo has between six to a dozen locum tenens, a Latin phrase roughly translated as “place holder,” to fill provider vacancies, often while recruiting to fill the position permanently.
Similarly, Essentia has about 10 temporary providers filling in at a time in its west region, with Fargo the hub.
While the number of temporary doctors hasn’t changed significantly over the years, administrators at both health systems said, the need for backups often fluctuates with demand, especially for specialists – positions that often pose recruiting challenges.
“The use of locums probably isn’t different than it used to be,” said Dr. Richard Marsden, senior executive vice president for Sanford Clinic Fargo. “It’s just different specialties. That changes with the marketplace.”
Nationally, the use of temporary physicians has risen sharply over the past decade, according to a survey by Staff Care, a health care staffing firm.
An estimated 26,000 physicians worked as locum tenens in the U.S. in 2002. By last year, according to Staff Care’s survey, the number had mushroomed to 40,000, or more than 5 percent of the active physician workforce.
North Dakota, which is experiencing rapid population growth, is one of the five top states where doctors plan to work in temporary roles over the next five years as more doctors embrace alternatives to traditional hospital- or clinic-based practices, the Staff Care report said.

Vital bridging role

The credentialing and vetting standards for physicians and other providers hired temporarily is the same as it is for permanent hires at Sanford and Essentia, according to administrators.
Both often use firms that specialize in temporarily placing physicians and other providers.
Sanford’s ear, nose and throat clinic recently had several physicians leave within a short time span, creating the need for backups, Marsden said. A couple of replacements have been recruited, and will fill positions this summer.
Locums, meanwhile, serve a vital bridging role, said Marsden and Kris Olson, Essentia’s vice president for physician and professional services.
“They do serve a really good purpose,” Marsden said. “We’re trying to keep our physician group as much full time, living in the community as we can.”
Besides ear, nose and throat physicians, Sanford is temporarily filling specialties that include cardiovascular surgery and pediatric intensive care.
Locums work is a good opportunity for younger physicians who are just starting out to gain experience and sample a variety of settings, Marsden and Olson said. It’s also convenient for doctors who are winding down their practice or ready for semi-retirement.
Essentia and Sanford have hired doctors who came to them as temporary replacements.
“We have signed quite a few into permanent practice,” said Olson. Many doctors who come from other parts of the country find they like Midwestern hospitality and patients who generally are compliant, Olson said.
“People really enjoy coming into Fargo,” Olson said. “They really truly come from all over the place,” including one physician who is a U.S. citizen who travels from Israel for temporary work assignments.

‘Warm, welcoming’


That’s been Kim’s experience. The Ohio native’s medical training was in Chicago and Miami before she settled in the San Francisco Bay area.
“Everybody’s been so warm and so welcoming everywhere,” she said.
Exo’s temporary position at Essentia allows her to keep working through January, when she will take a break because she is expecting her first child to be born in March.
“It’ll be hard to leave,” she said. “It’s been pretty good here.”
Kim agrees. She’s had time to explore Fargo-Moorhead’s shopping venues and parks. “Honestly, I think Fargo’s a wonderful town. I wouldn’t say there’s a lack of anything in Fargo.”
She’s still getting used to the weather, though. On her last visit, in early October, the high temperature was around 70 degrees. When she flew in Sunday evening, the ground was covered with snow and the overnight low plunged well below zero.
The store clerk in California thought she was crazy when she bought a pair of winter boots for her last trip.
“I said they’re not for here,” Kim said. “They’re for Fargo.”

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