My first year as a locum tenens physician

Locum tenens (literally “place holder”) is professional work done to fill in where help is needed. It is what I have primarily been doing for the last year, and has been an interesting ride.

When I decided to leave my practice related to losing a couple of partners and wanting to update my knowledge base and re-evaluate my career, I decided to do locum tenens work. I had always thought that having the skills of a physician would be able to allow me to travel and interact with places and people in a meaningful way, have adventures, roll up my sleeves, get my feet wet, that sort of thing. It turns out that this is true. Doctors with certain skills, especially internal medicine and hospital medicine, are wanted all over the country, especially in small towns and rural hospitals, and locums are hired often to avoid catastrophe while a hiring a permanent physician.

I have worked in California, Washington, Oregon, Idaho and Alaska in the last year and it has been really interesting and mostly gratifying. I have met new colleagues, made friends for life, seen lots of patients with mysterious and interesting problems and fascinating life stories and felt like I was useful and appreciated. I have also felt frantic and overextended, gotten lost, slept and ate less than was ideal.

There are many locum tenens agencies in the US that find jobs for physicians like me. They take care of helping facilities make sure that I am a legitimate doctor, not a serial killer or child molester, facilitate licensing in new states and make and pay for the arrangements that include travel, lodging and advocacy with the various organizations which hire me. For this they get about the same amount of money per hour that I do, so the client pays about double the amount that I am compensated to have me work. This is a LOT of money. It is a painful amount of money for the hospital to pay, so they really only use locum tenens doctors if they are desperate. Which means that, no matter how much they may like me at a given facility, they will rejoice when they can replace me with someone permanent. This means that I go to places, get to know people and systems, get good at them, am appreciated, then leave and never come back. They have the right to cancel my work within 30 days if they find someone cheaper to do it, and this has happened a couple of times. It is disconcerting, because it is often not possible to find new desirable work to replace what was planned with such short notice.

Becoming a locum tenens physician is easy: one simply contacts an agency online and then begins to fill out application forms and send countless documents to various places. It is time consuming but simple. Then a locums recruiter will call and begin to offer all sorts of jobs. If a job is interesting, the recruiter will send curriculum vitae information to the client and if the client is interested, phone interviews follow and if what they want is what the physician wants to provide, credentialing and scheduling follow.

I have found that different locums companies have different job opportunities and that I like some recruiters more than others. I have worked with Staff Care, CompHealth and Weatherby and have found them all to be honest and mostly easy to work with. The recruiter, though, makes money when I work, so they are all pretty proprietary about my time. In order to have a job when I want and where I want, I need to apply for more than one job at a time. If more than one comes through, I either have to work more than I want to or disappoint someone which makes me feel like a flake.

Full time work that pays much more than I made as a full time primary care doctor is 7 days a week, every other week, about 12 hours a day. This allows me to have real time off, which is great. Still, I spend lots of time on travel and lots of time away from my home, friends, family and dog. If I decide to do something creative in my off week, like attend a meeting or go on a trip, then I am away from home for 3 weeks in a row, which I virtually never did for the 20 years preceding starting locums. This is a little bit disruptive to anything that I have established at home, plus my dog gets really depressed.

Locum tenens work is a truly great option. It allows me to know that I will be able to stay busy in my field and make enough money to support my family and to have breathing space to do other important things. It is also not something that I will want to do as a primary occupation for very long.

Janice Boughton is a physician who blogs at Why is American health care so expensive?

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  • drg

    I did this when i first started out. it is disconcerting that the middleman makes just as much money as the physician for doing nothing. It feels like another way doctors are being taken advantage of. I decided to get my own locums job directly–do my own paperwork and ended up making a lot more money although not all places will let you do that. i just couldn’t let them gouge me one more time…

    • ninguem

      Quite true. If you’re paid “X” as a locums physician, the locums agency charges the hospital “2X”.

      So whatever you’re making, the locums agency gets the same.

      It’s a racket.

      • drg

        yes it is a racket. Don’t know why we put up with this. We’re doing all the work and they are making the salary doing nothing much. The economic term is i believe called rent seeking. It would be better if doctors did their own negotiating and would save quite a bit on cost.

        • jld

          How do you do your own locums? Find an area and cold call?

          • buzzkillerjsmith

            Exactly right. Call Ketchikan AK or Cordova AK or any place in AK. Cutting out the middleman saves money for them and pays better for you.

          • drg

            yes like buzzkillerjsmith says. basically underserved areas are the ones interested. prisons as well–not my cup of tea. If they are desperate they’ll work with you.

            I heard in the NY times that there is an influx of workers for the oil boom and SEVERE shortage of medical care. I think there is a severe shortage–only one doc for everyone. That would be a place to cash in! Hey if they are making tons of oil money and NO docs in town, I bet you could ask for anything you wanted.

            http://www.nytimes.com/2013/01/28/us/boom-in-north-dakota-weighs-heavily-on-health-care.ht

    • http://www.facebook.com/shirie.leng Shirie Leng

      actually the locums companies do a lot of work. They handle the contracts and, more importantly, state and hospital credentialing, which is a paperwork nightmare.

  • http://twitter.com/PorterOnSurg Chris Porter MD

    Thanks for writing about the importance of locums to existing practices. We cried for a good locum on many occasions at my first practice.

    I too had a rewarding locums experiences (with Vista, who I give two thumbs up) before my first permanent job.

    Now I’m working as a general surgery hospitalist (enabling schedule flexibility for other commitments). I have some unease about continuity of care and I miss the medium-term surgeon-patient relationships that locums and hospitalist begets, but I really enjoyed the adventure of travel and being the new guy as a locum.

  • http://www.facebook.com/shirie.leng Shirie Leng

    Locums is a great option for people who a) don’t know where they want to practice yet; b) are transitioning in life in some way; c) like the flexibility of it; d) like going new places and meeting new people; e) are independent. I’m not sure why all the comments are vilifying the locums companies. They are very efficient and supportive.

  • drg

    You obviously must work for a locum tenems company. and your thinking is the kind of thinking that adds to unnecessary healthcare costs. You think that ancillary work should be paid equal to a physician that does the actual work?
    Actually I did all that credentialing work myself and it was NOTHING compared to the work I did working as a doctor. i stand by what i said that NO ONE is entitled to making EQUAL to my salary HOUR for HOUR when what all they have done is paperwork.
    And I am aware of what locums does since if you read my post I did it myself!

  • kreig1@hotmail.com

    Locums companies make about 1/3 of what the physicians are paid. And out of that they pay large staffs of credentialing coordinators and recruiters. The recruiters do all of the work of finding facilities in need of doctors and handle all of the payroll for the client, in essence providing a loan to the client for which they are nominally remunerated. Locums recruiting is a service to clients who are in need of doctors, not a service to doctors.

  • ninguem

    I’ve worked as a locum for a few agencies. One of the locum companies, a big national firm, had taken me on to work for them. I had a few weeks free time to fill with some productive work.

    I was going to cover some time at General Hospital of Rural County.

    They were going to pay me “X”.

    I said fine, send me the contract.

    They sent me the wrong contract by mistake. Instead of sending the contract for Doctor Ninguem, they send me the contract for General Hospital of Rural County, to have me work there. In addition to the usual provisions, the finders fee if I stayed on there, etc., there was the fee that the locums company expected General Hospital of Rural County to pay for my services through their locums agency.

    It was 2X.

    The locums agency was extremely chagrined, to say the least, when they learned the wrong contract had been sent to me.

    I suspect heads rolled.

    But yes, contrary to what some may say, whatever you’re paid, the locums agencies charge double that.

    It’s up to you, to decide if that’s worth it.

    For a short-term thing that I wanted to do, I’d say yes. If you’re doing locums full-time, for any period of time, I’d say build up your clientele and run your own locums business.

    • drg

      Exactly. If they were being fair or reasonable it would not have mattered if you got the wrong contract. The idea is to hide it from you so they can make the doctor think it is fair and the doctor doesn’t have to worry their pretty little heads off about these business matters. Everything is taken care of for them!

  • drg

    of course locum tenems are “nice”and supportive. it sounds like some of you have drank the coolade. That is right they are getting paid by the hospital and you the doctor are the one being sold as the commodity”. As Ninguem says for a short time it may be worth it to some– but if you don’t want to see the exploitation going on here of doctors services. then drink up and enjoy!

  • Suzi Q 38

    What about your personal life..as far as being away from home for so long?

    • http://www.facebook.com/people/Janice-Boughton/562084033 Janice Boughton

      I like going away but I also like coming home. Once I get used to a place, the relationships with new colleagues, nurses, patients, fills the void pretty well. If I am gone every other week I can spend time with my husband and dog and my friends, but if I go somewhere like for CME or vacation on the weeks off, then I am gone for 3 weeks in a row and that just feels like too long.

  • NTA

    I work for a locums agency. The markup on rate charged to the hospital or physician group is nowhere near 100%, at least not with our firm, and we have been in business over 25 years. On very high side around 30%, more like 20-25%. It depends on the specialty. Locums agencies have to pay doctors on time while waiting for the hospitals to pay their bill. This requires huge lines of credit. We also have to maintain large malpractice insurance policies (occurrence form in our case), and a support staff handling credentialing, compliance, government compliance, scheduling, etc. Not saying Locums wins the beauty pageant but it has a place in the system. I strive to treat the doctors with whom I work as true professionals and view my job as enhancing their role in the healthcare delivery system.

    • drg

      No it does not win the beauty pageant. But good PR.

  • Mary Biljanic

    It’s troubling to hear you suggest that your services aren’t wanted by a facility, or that you are somehow replaceable. Hospitals (and the communities they serve) are, in fact, desperate for skilled physicians, whether the care comes from a permanent staff member or a locum tenens.

    If a facility actually needs a permanent staff physician, a locum tenens fills the void until the right person can be found, hired and on-boarded. Without a locum tenens, that facility might have to put off surgeries or treating patients in the meantime.

    Very often a facility’s need for a doctor is only temporary, e.g., during peak tourist season. The need lessens considerably during low volume months. In this case, hiring a permanent physician would be far more expensive in the long run when you factor in all the costs associated with a full-time equivalent employee.

    And locums usage isn’t exclusive to rural facilities. Big city hospitals often need extra coverage because it’s a constant challenge to maintain an adequate permanent staff, particularly when recruiting high-demand
    specialists.

    So before concluding that it’s wasteful for a facility to contract a physician’s services, or pay for the convenience that a staffing firm offers (i.e., save on time and effort costs), consider the value that a qualified, pre-screened/licensed/credentialed and ready-to-work locum tenens provides.

    For hospitals, locum tenens increase revenue stream while helping meet community demand. For patients, locum tenens increase accessibility to quality health care–and how do you put a price on that?

    Personally, I want to thank you for the care you give regardless of your employment status.