COMMENTARY

Advice for Anyone Contemplating Locum Tenens Work

Melissa Walton-Shirley, MD

Disclosures

December 18, 2018

Soon, I will join the almost 50,000 physicians who make up the expensive team of medical temp workers in the United States,[1] a physician "placeholder" with all the perks and inconveniences attached.

I last did locum tenens work in the 1980s; as a green intern, I occasionally staffed emergency departments (EDs) in the Southeast. I worked long hours and slept in a recently refurbished call room down the hall from the ED. I made quick cash at a rate of $100/hour—that felt like hitting the lottery for a financially strapped newlywed. And the room was large enough for my husband to accompany me on weekends. The downside was that anything and everything could and did roll through the door of that ED. Back then, I thought everything was my specialty. I've lived and learned. Perhaps these pointers might help anyone considering the locum approach to life.

Get Reacquainted With Your Printer

I'm amazed at the amount of coordination it required to become urgently credentialed. Between the facility where I'll be working and the agency I'm with, a team of five was assigned to secure me hospital privileges and an out-of-state license.

For those who have been pampered with a staff secretary and/or an office manager, locum work will be quite a culture shock. I've become intimately acquainted with my printer and fax machine and have made fast friends at the local post office and FedEx dropoff points.

Documentation: Get Snap Happy

If you are even remotely considering locum work, photograph and screenshot every document and certificate on your office wall. I had forgotten words like "FLEX" and "National Board of Medical Examiners." Dig around in your attic for copies of your first board certifications. Don't just nod your head and thank someone when they give you a flu vaccine or a tuberculosis skin test. Whip out your smartphone and snap the documents you signed to prove you received them. No one is going to simply take your word for it.

Locate and photograph copies of all Drug Enforcement Administration (DEA) and state license numbers. Be prepared for a request to "transfer" your current DEA registration to another state. Apparently that's a thing. I'd never heard of transferring a DEA registration, and though I  prescribe narcotics only for inpatient cardiac pain, it made me uncomfortable. I don't like undoing anything that has worked well in the past.

If you've had any medical-legal wranglings, be prepared to provide detailed documentation. Thanks be to God, I was involved in only one such issue back in the 1990s. It was a frivolous threat, but I was still asked to provide the plaintiff's name (it took me forever to even think of her last name), the attorneys involved (yeah, right), and a copy of the original claim (I had no idea where to start—apparently it's at the county court clerk's office).

If you have a history of medical claims, you need to be ready with all of that information and an explanation.

Avoid Clickbait and Be Tech Savvy

The more you click on locum agency sites, the more phone calls you will receive—each click equates to blood in a shark tank. A reputable agency rep wisely advised me to pick a couple of agencies and deal with them; otherwise you'll have to put a call blocker on your phone just to get a moment's peace.  

Be prepared to deal with another electronic health record (EHR). I'm more comfortable making intensive care unit rounds or coding a patient than I am signing onto a new EHR system (I'm not kidding). For locum work, you'll train for a few hours one morning on the EHR system and be expected to go live that afternoon. That timeline has me contemplating turning down work if I don't know the EHR system. If you aren't tech savvy, this is a huge consideration no matter how fantastic a clinician you are.

Be Flexible

Though many locum jobs are scheduled well ahead of time, there are occasional urgent needs. As long as my elderly parents are stable with backup options for their care, and it's not more than 7 to 10 days per month, I'm good with that. My husband, less so. He requires that I gradually acclimate him to the idea that I will be away. Better yet, it's a great opportunity to tack on a few days before or after a job to see the sights and enjoy downtime together.  My company provided arrangements for a companion ticket (at our expense, of course), but avoiding the hassle of booking travel separately was a great perk.

I've learned a lot about myself from occasional travel inconvenience in my life as a blogger. There was that time the Icelandic volcano extended my stay beyond clean clothes and I killed a hair dryer in a motel drying my socks (lesson learned: one cannot attach socks to the end of a hairdryer without choking it to death). I'm okay with that kind of stuff. You just have to roll with the punches. If you can't, then I wouldn't sign up for urgent needs locum work.

Ask Yourself: Are You A Risk Taker?

I did crazy stuff in my past locum life, like suturing multiple family members who decided to carve themselves instead of a turkey one Saturday night. While the elder member became vagal staring at his own blood, I was about 30 sutures into a 200-suture job on one relative as another bled beside him. Eventually, I decided to transfer one of them given that it was just me and an LPN on duty. I worked in hospitals without a neurologist or a CT scanner, so transferring patients became a subspecialty.

I'm more risk-averse now. Thus, I'll be doing locum and PRN work only as a cardiologist. As for malpractice insurance, make certain the agency provides coverage from a reputable carrier with tail coverage.

Don't Sell Yourself Short

I'm hoping that locum tenens will fulfill my need to continue some medical practice in what I have deemed my "semi-retirement." If you're contemplating the same, do your research. Talk to a few agencies and see what they are offering. If it's not worth your time, shoot them a higher salary. The worst they can do is say no. Remember, everything is negotiable except patient safety, your happiness, and your integrity.

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