Both students and physicians are increasingly using third-party student placement services (rotation agencies) to find external and rural clinical experiences.

You may already be aware of the growing need for clinical rotation sites, the significance of the IMG presence in medicine, and benefits (intrinsic and extrinsic rewards) to physicians becoming preceptors. But many physicians are outside of the normal academic medicine setting and may not wish to take on the responsibilities of setting up their own rotation site and managing students. For this, they often turn to a rotation agency.

These are organizations that will manage some of the task-management requirements for a physician, provide students a list of rotation sites, and schedule students according to the physician’s needs. Like any type of agency, they will attach a premium fee (up to several thousand per week) which the student is then liable for. 

 

 

This is currently a completely unregulated field,

which may leave students unable to complete proper due diligence before selecting an agency. As the physician is often put under a non-compete, sometimes for several years after the severance of their partnership, this can lead to great inequities for both the physician and the student. Here are a few red-flags that students may wish to be aware of, and best practices that physicians can ask about prior to signing a contract. *Alternatives and solutions at the end of this post!

For student protection, transparency is key. Many clinical rotation agencies will hide their locations availability, price fluctuations, and new openings from students until they have already locked-in their rotation (which they can then charge a “change fee” for). Some create false “categories” of rotations, allowing them to charge more for “verified” rotations while providing no additional service. 

On top of this, nearly none of the organizations out there provide an equitable cancelation policy. They require all payment up front and claim this to be a final sale even if they do not provide the product (I’ve personally experienced this). With no ability to fight these processes, students can, and have, been left with no alternatives but to forfeit time and resources while getting nothing in return.

 

 

Physicians are also often taken advantage of in these situations.

Not unlike certain locum tenens agencies, these rotations agencies are looking to make as much as they can on both sides of the transaction. Some physicians generously donate their time to teaching, while others try to negotiate reasonable compensation for their time. Either way, the agency is likely to minimize the preceptor financial gains while increasing student payments as much as possible. What could otherwise be considered a generous donation of a physician’s time now becomes a greater financial burden to the student.

 

 

Not unlike certain locum tenens agencies, these rotations agencies are looking to make as much as they can on both sides of the transaction. #medtwitter Click To Tweet

 

 

This isn’t to say that physicians shouldn’t be compensated for their time, nor that a company (such as an agency) shouldn’t be compensated for their services. However, with little competition and no regulation, these situations far too often lead to predatory practices. 

This can lead to unknowing students losing valuable time, educational resources, and finances as well as physicians unwittingly becoming purveyors of this system. For those interested in precepting outside of their institution, here are a few red flags that may help determine which organizations are on-the-level and which may be more prone to predatory practices:

 

1. Cancelation Policy- Assure that the agency uses a fair and equitable cancelation policy for its students. Often, their sales team will insist a student purchase multiple rotations all at once do to real or implied scarcity. These selling tactics are effective but can lead students to become financially obligated to stay with a company due to no refunds/cancelation policy being available. If the first rotation did not go as planned, but the student has already pre-paid for several others, they are now contractually obligated to stay with the same agency or forfeit their payments.
2. Arbitrary Classifications- Though there are obvious differences in an inpatient and outpatient rotations, or one’s through an ACGME-accredited site, some agencies will also add meaningless categories to their rotations. This is an upsell that usually provides no added benefit to students. Make sure any differentiation makes sense or provides added real (not stated) benefits to students.
3. Fees- Some agencies have been getting away from this in recent years, but it was not uncommon for them to add several different fees to a student’s application for any number of mundane reasons. These penny-pinching strategies are simply bad form and speak to the ethical mindset of such organizations. Make sure the student’s interest is placed first (as well as the preceptor’s).
4. Disputes- Assure there is a dispute process in place to protect both physicians and students. In a dispute, the physician may wish to walk away, and the student will likely be withdrawn from the rotation by the agency. However, though no rotation took place, the agency will both keep the student payment and not pay the physician their percentage. This could easily be avoided with a fair and equitable cancelation policy.
5. Non-compete Contracts- If you are going to sign on with an agency, make sure you are not signing away your ability to teach for the foreseeable future. Some agencies may try to ensure a preceptor doesn’t jump ship and register with a competitor. As physicians/preceptors are often too busy to run their education platforms independently, this may leave them unable to teach for a period of time which can lead them to give up completely! This doesn’t benefit the preceptor or the student. You are the “service.” Retain your autonomy.

 

 

If you were on the fence about precepting and have now been dissuaded, fear not! There are other alternatives to investigate! 

For example, if you have a small practice, consider allowing students into your clinic a few days per week. You can even contact the local medical (nursing, PA, etc.) school and see if their administration will handle the paperwork and scheduling for you. This is a great option for those in certain locations or with a school nearby. Though some physicians do run preceptor side-gigs from their private practice, this is not always feasible for those in community hospitals (which require more paperwork) or in more rural areas.

 

 

Preceptorship: Clinical Rotation Agencies vs Clinical Platforms Click To Tweet

 

 

The newest addition to the clinical education toolset is the rotation platform. Unlike agencies, platforms are crowdsourced online arenas for students and preceptors to connect while still being moderated through the platform. Think of this as an “Airbnb for clinical rotations”. 

Preceptors sign up their location, maximum students to be placed concurrently, compensation, and other factors related to their desired clinical experience. Students can also search by location, price, specialty, and other filtering criteria to find what they need and when they need it. The scheduling, payment, and much of the documentation is all handled within the platform with only a few clicks.

 

If you would like more information on any of the agencies or platforms described above, feel free to reach out. The environment is changing rapidly and most in clinical practice are unaware of these concerns and new arrivals. There is a great need for more clinical preceptors, more sites, and more transparency and protections for those actually participating in the clinical experience. As clinical education continues to shift in modern times, you can participate in making a great difference to the future of medicine!