How locum tenens can solve physician burnout

In early 2004, I was at the height of my career as a neurosurgeon in solo practice, but I was also well on my way to clinical depression. I was angry and couldn’t relax, and I was always irritated. Even a few days off didn’t help because of the mountain of phone calls and paperwork waiting for me upon return to work.  I asked myself, is this burnout?

Coincidentally, I happened to meet a neurosurgeon practicing locum tenens who was happy with his work-life balance. I signed up for a weekend trial as a locum neurosurgeon, then a week trial, and then I looked at my wife who was also my office manager, and asked, “Why are we doing this?” A month later we closed the office.

Stress and burnout are often lumped together, but they are distinct processes. Unlike stress which is associated with over engagement, burnout is characterized by disengagement, blunted emotions, depression, exhaustion which affects motivation and drive, and demoralization. Stress produces a sense of urgency and hyperactivity, while burnout produces a sense of helplessness and hopelessness.

This country is losing the experience, skill and wisdom of senior physicians because of burnout, yet the problem is not discussed openly among physician peers, and there’s a paucity of relevant psychological services for physicians.  My personal solution: locum tenens.

I made the adjustment from working full-time to locum tenens through support and access to other locum doctors, and now I honestly look forward to my monthly 10-day assignments. Many productive people don’t do well when jerked into full retirement, and I have the best of both worlds: steady, satisfying work, on my terms of time and intensity, predictable income, and freedom from government/insurance company machinations and hospital political intrigues. The agreement (contract) with the hospital is clear, and short term, and the supply-demand balance for locum tenens doctors in my specialty is currently in my favor. When at home, I have the freedom to not answer the phone, the certainty that the concert or nice restaurant meal or the weekend away won’t be interrupted, and the security that my income checks will be as expected and on time. The conflict between family and profession is now moot.

Another issue is a sense of financial fairness. My income doesn’t depend on “production units,” euphemism for “you get more income if you see more patients, do more complicated procedures …” My value to the hospital depends on my professional ability, and availability. What used to be uncompensated time talking with patients and their families both in hospital and in the office is now mutually rewarding. Getting up at night to see an emergency room patient often used to be uncompensated time, while taking away from needed rest for the following day’s frenetic activities.

Now, I’m paid for the time spent taking care of folks, rather than for how much I can bill for this or that procedure. It’s a four-way win – families benefit from improved relationships with their doctor; I benefit professionally from the satisfaction of providing excellent care no matter how long it takes; the hospital benefits by providing continuity of care and consistent coverage, and I benefit financially by the time I spend in direct patient contact, whether in the operating room, emergency room, intensive care unit, etc.

In private practice, I had the pervading sense that because of all the distractions and competing agendas I wasn’t able to deliver the best care I was capable of.  There was an underlying layer of guilt, and of missed professional opportunity.  In speaking with many physicians in many physician lounges, I believe many still have this pessimistic view.

By moving my career into the locum tenens venue, these are issues of the past.

Duane Gainsburg works as a locum tenens physician with Weatherby Healthcare.

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  • Anonymous

    I worked locum tenens in family med for a bit back in the 90s.  It was great when I was off, but the money was pretty lousy and sometimes the practices were abusive.  The California HMOs in particular were abusive.  I was treated very well at an Indian reservation in Wisconsin and actually almost signed on there permanently.  One guy’s experience.

    • Anonymous

      I guess primary care pay is awful no matter the work environment.  Will retainer primary care feel the heat soon?

  • http://www.threehourmidlifecrisis.com/ Dike Drummond MD

    Every physician has their own personal definition of success and fulfillment with their career. The tragedy is that most of us don’t sit down and clearly define it until after we are burned out. We get busy and get toasted and THEN we ask ourselves … “what do I really want my career and life to look and feel like?.”

    I congratulate Duane on taking the time to get clear on his definition of success. AND am so happy that Locums fits that bill. Locum Tenens is not THE cure for burnout. It is Duane’s cure for his burnout. One size does not fit all.

    The important thing for all doctors IMHO is to take some time NOW to explore what you really want out of your medical career. Don’t wait until burnout has taken you down to begin that process.

    My two cents,

    Dike
    Dike Drummond MD
    http://www.TheHappyMD.com

  • Anonymous

    Would encourage anyone to try locums. You get your pick of where to work (travel and hotel paid), and if you try a place once and do not like it, you simply ask not to be scheduled again. No strings attached. Funny enough the same hospitals that nickel and dime you as an employee pay 1.5 to 3x/hr as a locums.

    When I started a decade ago, I thought it was too risky as opportunities may one day dry up and I would be left without a regular gig. Nope, there is so much turnover these days from dissatisfied docs that I am constantly turning down jobs. With EHR and a host of other baffling “patient satisfaction” endeavors, I will be in demand for years to come. 

  • Anonymous

    Gave up General Practice after 20 years in the UK
    Now locum two to three days per week in South Africa
    Not one regret

  • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

    Here’s the thing, though. The writer says that he is freed of the hassles of private practice.

    I’m not disputing that. But where did those hassles go? Why are they not there if not in private practice? Or more to the point, why do they exist in private practice?

  • http://www.facebook.com/rfdbbb Robert Bowman

    Alaska is paying one million more dollars with each passing year for locums, recruitment, and retention costs just on primary care for sites that are underserved. This is $2 more per person in the state with each passing year.

    This illustrates numerous areas such as a US design for training that fails Alaska and 30 other states lowest in health care workforce, failure to produce the family practice physicians needed most, failure of NP and PA to retain grads in family practice even when they train or start in family practice, rapidly rising costs of delivering care, and new types of costs that add to the cost of care delivery,

    Career choices represent a best fit for the professional as impacted by employer decisions. Locums is not wrong or right, There are benefits but there are consequences.

    • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

       Indeed. I’ve worked in various hospitals, urban, suburban, and rural, as I’m still trying to figure out what I want to do when I grow up.

      On more than one occasion, I’ve seen staff rather critical to the hospital, especially in a rural area. Think CRNA, or experienced flexible ICU nurse who feels comfortable switching to OB or ER, or taking a sicker-than-usual child in a usually adult ICU, one of those not quite sick enough to transfer, but everyone’s nervous in small town USA.

      Anyway, nurse wants raise. Cost of living is lower in rural USA, but not that much lower.

      Hospital says no.

      Nurse quits.

      Hospital can’t find a replacement, especially a replacement with that quality and flexibility.

      Hospital contracts with a locums firm. Hospital ends up paying what the nurse wanted for a raise in the first place, PLUS the locums firm fee, which is about the same as what the nurse was paid.

      And those executives make a lot of money to make those brilliant decisions.

    • Anonymous

      I worked a couple months in Kodiak AK back in the day.  Man, was I glad to get out of there. AK will always have a shortage, given isolation, weather, the nature of Alaskans, etc.  If docs got paid double there you might be able to keep them, but probably not. 

  • Bishan25

    ” I had the pervading sense that because of all the distractions and competing agendas I wasn’t able to deliver the best care I was capable of” – very good reflection – and I’m very happy for your choice and commitment to quality of both your life and the service you now delivery your patients! – from another physician who is passionate about creating a health work life balance in ones life!

    http://about.me/bishan.rajapakse