COMMENTARY

A Locum Tenens MD Works During COVID: Eerie, Empty Hotels, Desolate Airports

Sandeep K. Aggarwal, MD

Disclosures

June 17, 2020

In January, I threw my old career to the winds.

After much deliberation, I left my job as a hospital-employed neurologist and cast my lot in locum tenens work. Instead of going to the hospital each day, I now work in 1- or 2-week stints at different healthcare facilities around the country.

Barely a few months into my new job, the COVID-19 pandemic hit, and that changed everything. Here is a reflection of some of my personal impressions of this time.

The Airport Is Desolate

I arrive at O'Hare from my home in Chicago to fly to my new locum job. Once a beehive of activity, the airport is a ghost town now. When I started traveling at the beginning of COVID, I actually enjoyed walking through the empty corridors, as though I owned the place. But now my echoing footsteps bring a feeling of unease.

I snap on my mask, step up to the check-in counter, and receive my boarding pass and receipt for my checked bags, packed full for a 2-week stay. O'Hare is so easy now. As I whip through security, the TSA staff are uncharacteristically eager to help.

Navigating the cavernous halls with my carry-on in tow, I proceed to the gate at the far end. Most restaurants and stores are closed, although some Starbucks shops and bookstores are open still. Battalions of airport staff are sanitizing seats where few people will sit, and mopping floors where few people will walk, but it makes me feel safer.

As I sit and wait to board, a constant flow of pandemic news spews from the TV monitor above. The public is learning more about medicine than it probably ever wanted to know. I am reminded that I play a part in this unfolding drama. Even though I'm not in the front lines fighting COVID, I will be flying to a place where my care will be needed, and that makes me feel useful.

Now it is boarding time. Just a few of us are waiting, but the announcer goes through all the boarding groups, as if it were a full plane: the first-class passengers, then people who need special assistance, then families traveling with children. I exchange smirks with the few other passengers as we line up, show our tickets, and go down the gangway.

On board, we spread out across the plane and find seats far away from each other. The plane reeks of disinfectant that has just been applied to all surfaces here. Just in case, I clean my seat table and arm rests with sanitizer, then adjust my mask. The flight crew thanks us for flying, and silently I thank them for making my work possible. They're probably content just to have a job.

As the COVID emergency unfolds, airlines have canceled a lot of flights and have consolidated the rest. Now there are more people on each flight. The crew has stopped handing out beverages and snacks, especially on the shorter flights, and the longer flights don't serve hot beverages or alcohol any more.

We are permitted to change seats once the airplane door closes. There's still enough room to keep middle seats open. One passenger tells the flight attendant that he wants to sit further forward. But he is told that if he moves, it would affect the plane's balance. I didn't realize our plane was this precarious, but then, everything is precarious these days.

With the new, stripped-down flight schedules, I have to fly at inconvenient times or make multiple stops, which can make my trip a lot longer. For example, one trip from Chicago to Montana involved a layover in Seattle, almost 600 miles farther to the west.

Hotels Have a Different Feel

Arriving at my hotel, I'm in another place that is practically devoid of people. The long hallways are eerily empty, and I feel like I'm in the movie The Shining. The hotel restaurants are closed, so room service is the only option.

Outside of work, I spend almost all my time in my hotel room. Housekeeping is no longer permitted to clean the rooms until the guests leave, so I do my own cleaning and even change my own bed. "Finally picking up after yourself?" my wife would probably say, if she were here. I smile and realize I miss her.

I used to work out in hotel gyms, but they're all closed now. I do some exercises in the room to maintain some degree of physical fitness, but I still feel out of shape and sluggish. It's still too cold outside to run.

To maintain sanity, I go down to the lobby with my mask on and talk with the people at the front desk, keeping 6 feet away, of course. I ask them about what this area of the country is like, and I find out about their lives, their kids, their grandkids.

Hotel guests tend to be at work in healthcare or government. I can always spot them, but sometimes I see other people who seem out of place: a woman with two small kids, then a young couple. I make up stories about what I think they're doing here. The airlines have limited nonessential travel for everybody.

My wife, also a doctor, was planning to fly out to join me on one of the weekends in which I don't return home. I was looking forward to renting a car and tooling around the area with her—the two of us discovering a part of America we wouldn't have seen otherwise. But my plan is defeated by new rules at the hospital where she works: Any employee who leaves the state has to be quarantined for 14 days upon return. She can't come to see me.

To lower the threat of contracting the virus, I have been keeping isolated in my hotel room. In the evenings, I call my wife and two adult sons. I use the time to cultivate my hobbies, which include writing plays and studying the German language.

Being shut in a room sounds lonely, but I have to confess that I often find it welcoming. The solitude gives me a chance to reflect on the past and on the future. It's probably not that much different from being cooped up in your home.

Work Is Still Rewarding

My clinical work is fairly routine, but it provides me with a sense of purpose and stabilizes this peripatetic life I lead. I mainly treat patients with central and peripheral nervous system disorders, including testing the nerves through electromyography. Using a different electronic medical record system is challenging at first, but it works when I learn the ropes.

Though I don't treat patients with COVID, I'm always aware that I could contract the virus at any time. I wear a mask when interacting with patients, and I'm thankful that most of them wear masks, too. Patients are screened for fevers or recent illnesses before seeing me, which provides some protection, but it's not fail-safe. At one of my locum sites, I can treat all of my patients via telemedicine, which I now embrace as a very useful alternative.

And the patients appreciate my care. Some of them tell me they never got a proper diagnosis before. It's very fulfilling when patients feel comfortable with your care and are eager to follow your recommendations and return for a follow-up visit. This motivates me to get through these times.

I get my assignments through a locum tenens company that contacts employers and facilitates my licensure applications for out-of-state assignments. This process can take several months, including an intensive interview with my prospective employer to make sure we are a good fit.

My immediate supervisors are clinical operations managers at the hospitals. They make sure I get what I need and that I'm following hospital protocols. They grouse to me about having to attend endless meetings grappling with the financial and logistical impact of the COVID crisis on their institution. No sooner are they finished with one round of downsizing or redeploying staff than a new round commences.

I chat with the other locum tenens providers at work. I learn about their experiences at various sites and the issues they have with providing care. Socializing after work is a little harder. I start a dinner with one locum provider, but he is called away to see a patient.

Working a second time at the same locum employer, I finally get to know the full-time physicians, but getting together after work is also difficult. I ask one of them if he'd like to grab a drink, but he has to return home to help take care of his kids. However, I do manage to have a pleasant lunch with a colleague and her husband.

What Will the Future Bring?

As the pall of the pandemic lifts a little bit and we try to figure out what comes next, the future looks murky—not just for me, but for all physicians.

At my old job, administration interceded to an unprecedented extent. We doctors were basically on a treadmill, seeing more patients in less time, and the scheduling centers weren't able to customize time slots for appointments.

One alternative for me might have been to go back to my old work as a solo practitioner, but that no longer seems financially feasible. I had heard that locum tenens work is flexible and provides some autonomy, so after some careful planning, I decided to give it a shot.

I immediately knew I made the right decision, and I was even more convinced after the pandemic hit. Hospitals and practices are not great places to be right now, because patients are staying away and they are hemorrhaging money.

Locum tenens seems like the best alternative for me, at least for the foreseeable future.

Yes, the COVID crisis has made everything more difficult, but I am able to help my patients and make a difference.

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