Who is NALTO?
By Aaron Morgenstein MD
NALTO stands for The National Association of Locum Tenens Organizations. This organization refers to itself as the voice of the locums community. One of the locum companies founded it to advocate for the industry’s continued growth. Its members include approximately 90 locums agencies. Not all locums companies are members, nor is it required for independent locum agencies to be members. Although these locum companies are all competitors of each other, they are bound by a single purpose of growing the business of locums to profit off the services provided by practitioners. In essence, NALTO is an organization built by locums companies for locums companies, not necessarily for the practitioners.
This article discusses the relationship NALTO has with the locums companies and practitioners. The article highlights the aim of NALTO while also highlighting the lack of transparency from NALTO and throughout the locums industry.
NALTO seems to support a “financially symbiotic” relationship with locums companies and practitioners. Let’s face it, the money is excellent for all parties. Locums practitioners are making good money, as are the locums companies. This bond will continue as the locums industry continues to grow.
NALTO is an organization that, on paper, supports best practices for locums agencies. They have a code of ethics and best practice guidelines for their members. The organization aims to provide oversight to make sure locums companies play on a level playing field and do not mistreat the practitioners. Its mission is admirable, but from a 30,000-foot view, it seems that the organization promotes the well-being of its members over physicians and other medical professionals.
It is not apparent to observers that NALTO promotes transparency and fair practices toward practitioners within the locums industry.
- There is a lack of consistency across the industry regarding the quality of treatment its members provide to practitioners.
- It is unclear if NALTO listens to the practitioners about building guidelines that support best locums practices.
- NALTO advocates for its members to provide malpractice policies for practitioners, yet is not specific about ensuring these are the best policies to support practitioners.
- It remains unclear what NALTO is to do about its members violating federal telemarketing laws.
- NALTO has done little to protect practitioners from contractual items such as unfair non-competes and indemnification provisions.
- NALTO does not provide a limit to how much locums companies can charge for a buyout fee.
- There remains a significant lack of transparency with locums pricing and companies’ revenues and profits.
In reality, it is not clear how much oversight NALTO truly has and how much power they have to punish locums agencies that violate their code of ethics or best practice guidelines. There are times when NALTO is believed to have helped resolve disputes between locums agencies where it is unclear which one presented a practitioner first to a facility. Practitioners cannot be members nor board members, but they can submit complaints about the unfair treatment of locums companies toward practitioners. It is unclear how far these practitioner complaints are taken. Unfortunately, it is not uncommon to find locums companies and recruiters that do not follow the guidelines or ethics set by NALTO. From a practitioner’s point of view, NALTO does not always appear to promote practices that protect the practitioners. NALTO represents the locums agencies, not the practitioners. NALTO makes money from locums agencies, vendors, partners, and sponsors. They do not make their money directly from practitioners. Thus, the organization’s priority must be to keep its members happy. This only makes sense.
There is no requirement for locums companies to join NALTO. There are plenty of locums companies that are not members and have excellent business practices. NALTO does not always represent the best interest of practitioners nor defend them. NALTO can give the practitioner a false sense of hope as if they will resolve practitioner complaints. In reality, some questionable business practices from locums companies persist despite the oversight of NALTO. Many organizations promote their business practices by stating that they follow NALTO standards and guidelines. Practitioners must recognize that this may only be a false sense of security. Just because a company may have the backing of NALTO does not always mean that practitioners will be fairly treated.
Practitioners should recognize that not all standards or guidelines established by NALTO have the best interests of the practitioners. Practitioners should review their locums agreements carefully. Just because some recruiter tells you the language of a contract or a confirmation letter follows NALTO standards, you don’t have to agree to those terms. Instead, you should negotiate your terms with the locums recruiters that align with your comfort level, no matter what they tell you about NALTO standards.
In summary, don’t be misled about the purpose and aim of NALTO. Although, on paper, it appears that NALTO was formed to oversee the treatment of locums practitioners, they are only a place-holder for organizations to push their agendas throughout the locums community. We can be hopeful that NALTO will advocate for locums companies to provide greater transparency and better treatment of all practitioners in the future.