Month: May 2017

Locums…is it true what they say?  How do you choose the right company?

Usually by the time you’ve practiced for a while you will start to get emails from locums company representatives asking if you would be interested in locums work.  For residents, odds are at least one of your attendings has worked for locums company at one time or at least considered it.  The first time I heard of locums was during my third year of residency.  One of our attendings mentioned it as a good option to explore different practices before committing to a final hospital or location.  In my first year of practice, I received a random email from a larger locums company, I filed it away at the time.  I was happy and I didn’t have the time for additional clinical responsibilities.   But, when I decided to revisit locums, I went back to that email.  It was as good of a place to start as any.  Things to consider:

1. Big Company vs Small Company. There are a multitude of companies out there.  From my experience, the bigger companies are consistent, they have great support staff and usually work hard to maintain a favorable reputation with their facilities.  Their representatives are available 24 hours a day for any issues that may arise while you’re on assignment or traveling to an assignment. This  also means they have more standardized (and possibly lower) pay rates.  Small companies will have less support staff and therefore less overhead.  They may offer higher pay rates, but you may have to be a little more flexible.  As with anything else, each company may have local or regional preferences, may work with government facilities or be geared toward clients that are seeking temporary to permanent positions.
2. You are a contract employee of the locums company. You will have to complete credentialing application for each locums company, in addition to each facility you apply. As with any company, pay frequency may be weekly, bi-monthly or monthly.  You may receive paper checks or direct deposit.  Make sure you confirm with the company.
3. If you are seeking employment within a small geographical area, then you may want to research which companies place more physicians in that particular area and plan to sign up with at least 2-3 companies.
4. All companies generally offer to cover transportation to and from the site, including ground transportation to the airport, airfare and baggage costs. They cover or arrange lodging and rental car if needed.
5. They may or may not cover additional state medical licenses, DEA applications and/or controlled substances certificates.
6. They do not cover meals.
7. They do not cover health care benefits or other benefits usually associated with full-time employment: disability insurance, retirement investments or CME reimbursements.
8. Malpractice. They cover your malpractice while on assignment.  You will receive a copy of your malpractice coverage agreement when you start each assignment.  You will be responsible for your tail if you need it when leaving your current practice situation.
9. If you have the time, talk to a few companies and build a rapport with a representative in your specialty area before you commit. Explain your reason for pursuing locums, what length of assignment you prefer, where and how you would like to work. This relationship will be very important as you move forward.  Remember that the representatives talk with each other and facilities talk to multiple locums companies.  Your reputation is important.  It can help you get or keep an assignment, be asked to return to an assignment, be considered for a permanent position or negotiate a higher pay rate.
10. Be very clear with the representative if you would like to be “presented” to an organization. There are rules as to how often you can be presented to the same organization.  This detail can get tricky if you’re working with more than one company.  Once the company has your CV, it is possible that they can present you even if you’re not credentialed with them.  I now only send my CV to companies after I am confident that I plan to work with them.

I started with one company.  One of the larger ones.  For me it made sense to sign up with a company that had a solid reputation and great online resources.  Most locums physicians that you meet along the way, will tell you that if you do locums long enough you will add on additional companies.  One doc told me at one time he was up to 9!  I just added my second company, a smaller physician run company.  I imagine I will add a third next year.

Take homes:

• Ask around. See which companies have the best reputation in the area(s) that you want to work.  Forge a relationship with a representative before accepting your first assignment.
• Be clear about the type, location and/or length of assignment you are looking to find.
• Do not let the representatives talk you into anything you’re not comfortable with doing. There will be another assignment.  You are in control.
• Use this opportunity to build the life you want to live!

Resources:

https://www.nalto.org/

http://www.medpagetoday.com/KevinMD/41085

http://www.kevinmd.com/blog/2013/02/year-locum-tenens-physician.html

http://journal.practicelink.com/career-move/career-move-locum-tenens-physician/

Ways to Practice

There are multiple ways to approach locums work.  I decided to go the nomad route.  I signed up with one company and made myself available to go anywhere.   My only preference initially, was short-term assignments, typically 2-3 months in length.  That means I was covering gaps in time when hospitals were in the hiring process or maternity leaves, etc…  How you approach the type of assignment you want depends on your short term goals.  Questions to ask yourself:

1. 1. Are you supplementing your full time job? Is this a short term option to bridge your time between jobs or training?  Do you plan to continue locums for more than 2 years?
2. 2. Do you want to travel around the country or stay close to a home or family?
3. 3. Do you want full-time/full-scope practice opportunities? Would you like to work 2 weeks out of a month? Would you like shift work as a laborist/hospitalist?
4. 4. Do you want to work continuously or do you need to take breaks in between assignments?
5. 5. If you plan to continue a full-time job and work locums on the side, you can find weekend work in many practices.  Practices in small communities use locum physicians to round out their call schedules.  A “weekend” in the locums world usually means Friday 8 am to Monday 8 am.

If you need to stay close to home or family, I would recommend signing up with at least 2-3 companies to give you more options.  Try to find locums physicians in the area and find out what companies they use.  Another option would be to approach facilities that may be short staffed and offer your services in a locums capacity.

Things to consider when taking a position as a laborist: 1) Are you first call or second call? 2) Who is first call if you’re not?  I have now worked as 2^nd call for midwives or for family medicine physicians.  I have also been the laborist in academic programs that required residency teaching.   Taking positions as a laborist or hosptalist gives you the flexibility of shift work.  However, you will be only be doing inpatient work.  If you’re not ready to give up your generalist skills, I would suggest only taking laborist work to supplement a full-scope assignment.

If you don’t plan to take continuous, full-time assignments, I would suggest making your calendar at least 6 months in advance.  That way you can let your company(ies) know your true availability and plan accordingly.

When I first started, I was nervous that I wouldn’t be able to find enough work to keep me busy. And it is true, that I have had a few assignments fall through.  However, with proper planning, staying flexible and forging a good relationship with your locums representative(s) will usually prevent any unwanted gaps in work.

Lessons Learned:  Every Cloud has a Rainbow

1. Less is More. I still am not efficiently packing.  Because I often transition from a work assignment to leisure travel or a national meeting/conference, I tend to pack a variety of clothes and shoes.  As I continue doing locums, I hope to pare down my wardrobe to be able to carry all the basics for any occasion into a carryon bag.
2.  Eating well on the move. Short assignments are the most difficult.  Grocery shopping for 2-3 days can be challenging.  Most extended stay hotels have refrigerators and some have microwaves, but stovetops or ovens are uncommon.  On these type of assignments, I tend to eat out more which is not fiscally or health conscious.  Longer assignments, greater than a week, usually allow accommodations that include a stove and oven, which permits me to cook at home.
3.  Thankfully, most hotels have an onsite gym.  My fitbit has been a great addition in helping me to track my exercise but also to use pre-programmed fitness routines to follow in a crunch.  Depending on the location, I try to find local gyms, the YMCA or community centers that allow short term passes, memberships or class packs.  It has been a great way to spend my off time and allows me to interact with the community in a non-clinical capacity.
4.  Car rentals. USB ports and Bluetooth access are a must.  I spend a great deal more time driving than I have in the past.  Not driving during the course of the work week, but driving to assignments that are often 1-2 hours for the nearest airport.  This being the case, I use my car time to catch up with family and friends.  The USB ports allow me to charge my phone for both talk time and GPS utilization while driving.  Since I am driving alone, having the in car Bluetooth gives me one less device to keep up with and keeps me safe and hands-free!
5.  Health Insurance. Aaargh!  The greatest barrier for me to initially obtaining health insurance was my nomad status.  I now belong to a health share organization that I hope will cover my needs.  I’ll have to write a more detailed post on this issue later, especially as the policies around health insurance coverage are rapidly changing.