So you may ask why doesn’t the facility/group just hire their own locums and bypass the agency all together? The main problem behind this is that it creates 2 different competing interests. The facility/group’s primary focus is to hire full time employees. The locum agency’s primary focus is to fill temporary staffing needs. The types of providers who fill full time positions are usually not the same people who fill locum positions. The reasons really just boil down to goals and interest of the provider. Although I have seen a few providers convert over the years from a Locum position to a full time permanent position at a specific facility, this is not usually the case. Most locum providers have a little nomadic blood in them and they desire change and mobility. Most providers who settle down in an area and take full time permanent positions are looking for more stability in their job. They may have children in school, families living nearby etc.. It is hard for a locum company to sell a permanent job to a locum provider who is looking for a higher hourly rate and travel opportunities. At the same time a facility/group pushing their own permanent jobs are not going to be paying the higher hourly wage. They are pushing salaries that are more in line with the long term. It has the appearance of a conflict when you say here is a job for 200k plus benefits or we can give you a locum contract for 200/hr.

The locum agency can also serve as a buffer between provider and facility/group. In the event a provider is not working out for whatever reason, the responsibility of counseling and possibly terminating that provider falls on the agency and not the facility/group.

Finally, there are laws to be concerned about. Larger groups with multiple 1099 providers risk being put under the microscope since they are not paying the payroll taxes that are paid from w2 employees. When there were only a handful of 1099 providers out there it probably did not warrant a whole lot of interest from the IRS. Now that this is becoming more common, groups are putting themselves at risk by hiring 1099 workers directly, especially if those workers end up being there for years. To counter that risk, many companies are creating new management corporations to handle these types of providers to prevent the CRNA from working “directly” for them.

My advice is to find a locum agency you are comfortable with and can trust. While there has been an onslaught of new agencies out there with many bad actors, you can still find competent and honest recruiting firms. That can help you navigate the process effectively.