Is locum tenens your dream gig?

Chicken tikka masala, two samosas and a bowl of yellow dal steam on my hotel table. There is no fight over the last samosa — they all belong to me. The room is quiet and peaceful. My pager does not ring. The paper plates do not need washing. No child clamors for my attention. After savoring dinner, the internal debate starts over whether I should work out in the hotel gym or sit in the jacuzzi. The jacuzzi wins. My time is my own. The freedom is intoxicating. Any reasonable person would assume that I’m on vacation. On the contrary, I am hard at work. Or I was. Earlier today, I was hopping from patient to patient, and I will do it all again tomorrow. The in between, however, is beautiful. I am a locum tenens physician.

I’m often asked why I work as a locum tenens physician. My colleagues ask: “Isn’t all that travel hard?” On the contrary, the few days a month that I work locum tenens shifts are a throwback to simpler days. I tear through dozens of novels each month on plane flights, heaven to a bibliophile like me. My Kindle Unlimited subscription is useful again. After the plane lands and my shift is over, my time is my own. Why wouldn’t I work for a company that pays for my hotel and lets me eat dinner uninterrupted? If I were a more adventurous sort, I would hike the coast on the long summer nights after work, maybe tack on a few extra days to explore the area at the end of the assignment. These days, however, a good book and a hot cup of tea are a wild Saturday night for me, and my peaceful dinner is more than enough.

The counterargument to working locum tenens in exchange for a few nights of free time would be to take an actual vacation. I’m not great at taking vacations, as is true of many physicians. The inability to sit still is a pathology worthy of its own essay and remains beyond my comprehension. Finishing a locum tenens shift signals my workaholic brain to relax for the evening. Of course, you would think that at the end of my regular workday, I could sit back and put up my feet. But if I were at home, some chore would inevitably suck me in. Bills to pay, laundry to fold and dishes to do means my day job is sometimes where I go to relax. But away from all my domestic responsibilities, the end of the workday after a locum tenens shift really is the end of the workday. It’s a sort of forced leisure.

While the art of relaxing in my own home may mystify me, I do understand making money. Conservatively, I make 50 percent more per shift than I do at my day job. Holiday bonuses or plain-old desperation from chronically understaffed hospitals sometimes drive the rates higher. Even without the freedom of unfettered evenings, I’m seduced by the extra income. I’ve maxed out my 401(k) every year, paid off my student loans, and built a real-estate portfolio — all with the income earned from my side gig. The higher pay affects my attitude as well: even while being crushed with patients, I don’t feel unappreciated or underpaid. I know I’m being paid well enough to work hard, so I do it gladly.

The generous pay makes my peers suspicious. They challenge me, asking why these locum tenens jobs have to offer higher wages. “Isn’t it tough working in a rural hospital? The patients must be sick. Do you even have specialists there?” Yes, it’s hard. Yes, the patients are sicker. After practicing in a large, wealthy city for years, I miss sick people. That’s something I never thought I would say. The thrill of being a diagnostician again excites me. Usually, I treat patients already followed by five sub-specialists with yet another exacerbation of their extensively documented co-morbidities. The cardiologist, pulmonologist and nephrologist manage their respective organs, leaving nothing for this hospitalist but the patient’s bowel regimen and electrolytes. Cardiology and nephrology even replace the electrolytes sometimes. There are moments on a locum tenens assignment when I long for my sub-specialist colleagues’ support, but the opportunity to run the show again is refreshing. When I don’t have the answer to a question at my fingertips, I dig in, reading articles and bouncing ideas off my fellow hospitalists. It’s a rare trip when I don’t learn something new or at least dust off some obscure medical fact that’s been buried in the far corners of my brain.

The relatively easy access to care for patients in my usual job also means any new diagnosis is a zebra. Any real zebras are just non-existent. After an internal medicine residency spent desperately hoping for a simple chest pain rule-out and not yet another train wreck, who knew miliary tuberculosis would start to look good? Organophosphate poisoning and valley fever don’t happen much in my part of town, but it’s bread and butter in the rural agricultural areas that I visit. The patients are almost esoteric enough to be board questions. The rural ERs are full of obscene cardiac murmurs, end-stage cancers and a plethora of diseases in advanced states that I haven’t seen since residency.

The drawbacks to locum tenens are real, and I don’t deny them. After all, if it weren’t work, they wouldn’t have to pay me. I do miss my family, the travel can sometimes be tedious, and the patients are sicker. Despite all of those things, I have no plans to stop. With each trip, I come home a sharper diagnostician and a more satisfied human being.

Catherine Carroll is a hospitalist who blogs at Locum Society.

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