DIN White Paper #6
Institutional Cost Models for Cataract Surgery Program Staffing
How direct contracting, full-time hiring, and locum tenens compare for hospitals—and why a hybrid may be best
Authored and reviewed by the DIN team, July 2025
Executive Summary
Cataract surgery is one of the most common and critical procedures performed in U.S. hospitals. As demand rises—particularly in underserved and rural communities—hospital leaders must make strategic decisions about how to staff these programs effectively. This white paper compares three primary staffing models: full-time employment, direct contracting, and locum tenens.
Each option presents distinct cost structures, operational considerations, and trade-offs. Full-time employment offers stability but comes with high fixed costs (Medscape 2023; Today’s Hospitalist 2016). Locum tenens provides flexibility but at premium rates and with added agency fees (CompHealth 2024; AHA 2023). Direct contracting aligns costs with volume and avoids agency markups but requires careful management (Medical Economics 2007; Cohen 2024).
A hybrid approach—such as that offered by Doctors In Network (DIN)—combines the advantages of these models through coordinated, technology-enabled solutions that help hospitals meet both financial and operational goals (AHA 2025; Cross et al. 2024).
Introduction
This paper provides detailed analysis and guidance for hospital leaders seeking sustainable, cost-effective staffing for cataract surgery programs. It outlines the financial and operational implications of each model and demonstrates how hybrid solutions like DIN’s can support evolving program needs while optimizing cost and coverage.
Full-Time Hiring Model
Full-time employment delivers stability, continuity, and the ability to build referral networks and long-term program growth. A typical ophthalmologist salary is around $400,000 plus 20–25% in benefits, for a total cost exceeding $500,000 annually (Medscape 2023). This model is ideal for high-volume programs but can strain budgets during low-demand periods, as fixed costs remain constant regardless of workload. Recruitment and turnover amplify costs, with physician departures costing hospitals up to $500,000 or more when factoring in lost revenue, recruitment fees, and onboarding (Today’s Hospitalist 2016).
Locum Tenens Model
Locum tenens arrangements provide rapid coverage for vacancies or volume surges. Daily rates for ophthalmology locums typically range from $1,500–2,200, with agencies taking a 20–30% margin (CompHealth 2024; Medical Economics 2007). Locums are valuable for short-term gaps, but extended use is financially inefficient—studies show that after several months, locum costs surpass those of a full-time hire (Cross et al. 2024). Administrative burden is low, as agencies handle licensure, malpractice, and logistics, but continuity and team cohesion may suffer with rotating personnel.
Direct Contracting Model
Direct contracting provides a cost-aligned option, with surgeons typically receiving 50–70% of professional fees or a negotiated per diem (Medical Economics 2007). This model avoids agency fees and allows hospitals to pay only for work performed, enhancing cost efficiency for moderate volumes. However, hospitals must manage scheduling, credentialing, and legal compliance (Cohen 2024). When structured well, direct contracting combines flexibility with consistency, especially when the same surgeons return regularly.
The Hybrid Approach: DIN’s Model
DIN is a fractional staffing platform purpose-built for surgical specialists. We don’t do full-time placement. Instead, we combine the stability of employed models with the flexibility of locums—minus the churn, high costs, or one-and-done contracts. Our Rotating Surgeons return on a recurring basis, supported by smart matching and centralized logistics. It’s a modern way to staff surgical care that keeps ORs active, providers engaged, and patients connected to consistent, high-quality treatment.
Conclusion
DIN offers a distinctive and resilient solution for cataract surgery staffing, built on a fractional model that combines the best attributes of full-time and locum approaches while avoiding their downsides. This hybrid structure allows hospitals to align surgeon cost with case volume, scale capacity efficiently, and maintain program quality without the overhead of traditional employment or the churn of one-off locums. By embedding fractional staffing into a coordinated system, DIN helps hospital leaders achieve both financial sustainability and reliable patient access.
Works Cited
American Hospital Association (2023). Hospital Contract Labor Cost Analysis 2019–2022.
American Hospital Association (2025). 2025 Health Care Workforce Scan – Executive Insights.
CompHealth (2024). Locum Tenens Ophthalmology Opportunities – Rate Guide.
Cross J. et al. (2024). “The Cost of a Locum: A Simulation to Determine When You Are Paying Too Much.” Cureus 16(4): e58853.
Medscape (2023). Ophthalmologist Compensation Report 2023.
Medical Economics (2007). “Locum tenens: when you need one, how to get one.” Medical Economics.
Today’s Hospitalist (2016). “The Staggering Costs of Physician Turnover.” Today’s Hospitalist.
Cohen Healthcare Law Group (2024). Independent Contractor Physician Agreements and Compliance Tips.