Rise of the MSP
Staffing for radiation oncology physics and dosimetry is constantly changing and evolving. It happens slowly, and someone working in one center their entire career may never notice the subtleties that ripple across the industry, but there are national trends. Privately owned centers come and go, largely driven by Medicare reimbursement rules. Hospitals get nudged to use consulting groups rather than hospital employees and then get nudged back in the other direction to insource as much as possible. A fairly recent trend in healthcare is the rise of MSPs.
Managed Service Providers (MSPs) became more prevalent during the nursing shortage created by COVID. As hospitals scrambled to find ways to get traveling nurses and other critical employees, MSPs stepped up to manage contingent workforce needs. An MSP acts as an intermediary: posting open positions to vendors, managing candidate submission to the hospital, and streamlining billing and payments to vendors.
The promise of an MSP is that they will manage multiple vendors on behalf of the hospital. At least for their contingent workforce, the hospital is only working with one entity, the MSP, while leveraging resources from multiple vendors. In most cases, the hospital agrees to work through the MSP exclusively for contingent workforce placements; the hospital will not contract directly with any vendors.
The MSPs usually take a percentage (e.g., 5-6%) of the bill rate. They will typically have a proprietary Vendor Management System (VMS) where they post open positions for registered vendors to see. This same platform can be used for managing candidates, and processing payments.
While this model may streamline operations for the hospital, it presents many challenges for vendors and locums. To gain access to place a locum at that hospital, a vendor will have to register with their MSP. Getting registered with an MSP can be difficult. The MSPs sometimes limit how many vendors they allow in certain specialties or geographic regions or simply say they are not taking any new vendors. If a vendor wants to be able to fill positions at many hospitals, they will have to register with multiple MSPs. Vendors have little to no leverage in negotiating the terms of registration, such as the percentage the MSP takes, or inclusion of protections like non-solicitation of the vendor’s employees.
Once registered, vendors are responsible for monitoring job postings and submitting appropriate candidates. They are often prohibited from communicating directly with the department that has the need. That can make it hard to submit a strong candidate, because the MSP doesn’t always post all the relevant information about a department. For example, is the equipment Varian or Elekta? Will HDR planning be expected? What treatment planning system is used? Routing all communication through a representative at the MSP can also slow down the process and locum candidates may decide to take other opportunities instead of waiting for a decision.
When MSPs are in place, bill rates tend to be lower. That happens not only because the MSP is taking their slice, but they also control the only path to filling contingent positions at this hospital. There is no possibility of negotiating rates with the hospital even when they’re well below market. The vendor may be trying to find candidates who will agree to 20% less than the typical rate or even lower. That may seem to lower costs for the hospital but makes it difficult for a vendor to submit high quality candidates when they could be making more money elsewhere.
These lower bill rates may also be kept artificially low to protect some postings from being filled by non-preferred vendors. Some MSPs bill themselves as vendor neutral, but that can hardly be the case when staffing agencies start MSPs or MSPs acquire staffing agencies. See https://www.whatisbluesky.com/blog/the-incestuous-nature-of-healthcare-staffing-vms-msp/.
All of this affects the locum physics and dosimetry market by adding another layer complexity and management. Radiation oncology is often a black box within the hospital. A department that identifies a need for a locum physicist or dosimetrist may not know that their hospital is contracted with an MSP and all locums will need to be routed through the MSP. As you probably know, physics and dosimetry are fairly niche fields. The MSPs generally don’t understand what physicist and dosimetrist positions are and try to fit them into the model they’ve created for nurses and physicians. They may not even have any registered vendors that staff physicists and dosimetrists. All of this means that the MSP can make it harder for a rad onc department to find a locum, not to mention that this system completely prevents direct hiring of an individual locum. A locum will have to work through a vendor, working through the MSP, to get to the department.
At Atom Physics, we have spent the past few years learning about the MSP landscape and getting registered with many of them. We have worked with these companies to educate them on why a physicist doesn’t have an NPI number, why we need to know more than the EHR to submit a good candidate for an open dosimetry position, and other intricacies of the rad onc department. If your department finds itself feeling hamstrung by having to work through an MSP, contact Atom Physics to see if we can still help. We pride ourselves on the professionalism and stability that a large national locum services company can provide, and we are confident that we can smoothly work through the process contracting with your facility directly or working through any number of MSPs.