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How To Get Started as a Locums

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Are you thinking about becoming a locum tenems? You are not alone. According to Staff Care’s 2020 report, more than 52,000 physicians were working as locums. The aging population, physician shortages, and pandemic-related changes have fueled increasing demand for locums. You may be considering switching to locums for the extra income, or the prospect of a better work-life balance, or just to escape your daily grind. Personally, I switched to locums because of an explosion of mold, but we'll get to that later. In any case, getting started as a locums is easier with some preparation and planning. 

To apply for a locums job, you need a complete and updated CV. Make a chronological list of every practice and affiliation since residency or fellowship, with correct dates. Everything will be verified and cross checked twice later. Don’t simply highlight the bright moments in your career. Any skeletons left in your closet will rattle their bones when the credentials committee and licensing boards pick over your application. Next, itemize your board certifications, training, and medical school information. 

Then, gather your documents. You will need clear electronic copies of your medical license, state licenses, diplomas, and DEA and state-controlled substance certificates. Obtain complete vaccination records for COVID, flu, TB, hepatitis, and childhood diseases. Keep all this in a secure virtual location accessible from anywhere, any time. I guarantee someone will urgently need something at the least convenient moment. You will need three peer references, plus two alternates, all of which must be in your specialty. Each of your chosen peers will be required to rapidly complete frustrating, repetitive, and absolutely essential forms on your behalf. Consider sending these colleagues a nice gift basket in advance, since it's a thankless and annoying task.

Next, decide on your initial work schedule and tempo. Your preferences will determine your income, but they will also create your newfound free time. When you finish your locums assignment, you can turn off your pager, leave your phone at home, and truly relax. I work about 10 days of 24-hour trauma calls per month. My income is about two-thirds of my previous full-time salary, but I also spend much more time having fun with my four-year-old son. 

The next step is to contact a locums company and start looking for jobs. Locums staffing companies are easily found with a moment's internet search. When the word gets out, your inbox will fill with jobs faster than the nursing station fills with cookies around the holidays. Before accepting a job, make sure it fits your preferred work style and schedule. The recruiter may not be able to give you a clear picture, but insist on getting enough information before you decide to move forward. 

Once you approve a job, your CV and particulars are forwarded to the hospital seeking a locums. In order to be considered, you will complete a background questionnaire that discloses and documents every malpractice event, complaint, investigation, sanction, drug use, or criminal charge you have ever experienced. As an example, I had one single malpractice allegation 23 years ago, which was promptly dismissed, but I must still document every minute detail about the case for any new job. If your background is satisfactory, a representative of the hospital will schedule an interview by telephone or video link. If you get the job, the locums company will create a lengthy contract spelling out the conditions, schedule, and pay. Read this document carefully. In my case, one contract had the payment details badly wrong. 

Your locums package will include coach class air travel, decent hotels, and middling rental cars. The daily and hourly pay rate will vary with work intensity and location. For surgeons, a Level I trauma call pays about double the rate for a Level III call. As a rule of thumb, working about 15 to 20 days a month should get you the same pay you had working full time.

Before you get too excited about the payoff, don't forget the cost of health, life, and disability insurance — these will be your responsibility. As a self-employed service provider you will be required to file and pay estimated taxes. On the bright side, being self-employed opens the door to new kinds of retirement plans. With good advice and planning, you may be able to sock away a larger portion of your paycheck. Seek professional help in this regard.

As a locums, you are free to choose your work location. Imagine the ideal location for your new locums practice: Would it be next to a popular beach with year-round sunshine, at the base of a world class ski resort, or in a vibrant city on the shores of a mountain lake? Now, forget about those places. They don’t need any locums there. Instead, think of fly-over states, rural areas, and non-descript mid-size cities with no good restaurants and plenty of rotten weather. You will be living out of your suitcase, sleeping in fair-to-middling hotels, eating at fast food restaurants, and driving crappy rental cars.

After all this, are you still interested in living the vida locums? Good. Get ready for your first locums assignment. You will need to learn brand-new ways of doing the same old things. It's a new hospital, a new system, with new rules. You’ll be using a frustrating new EMR system. Remember that your status as a locums is a bit lower than when you were a  highly respected member of an earlier team. However, if you treat everyone with respect and consideration, you'll get the same back. Just focus on the basics: Be reliably and promptly available, unfailingly affable, and adequately able. 

My personal transition to being a locums wasn’t carefully planned. Instead, my “normal” practice of orthopaedic surgery came to a sudden stop when Hurricane Irma hammered the Florida Keys in 2017. My hospital was left without power, full of rainwater, and sitting in the hot Florida sun. The resulting explosion of mold ultimately doomed the hospital and canceled my job. I switched to locums out of necessity and found myself working in rural hamlets in Maine, off-ramp cities in the Carolinas, and cow-pie towns in South Dakota. Suddenly, I had 20 days off every month with absolutely nothing to do except swim, sail, sit on the beach, try new restaurants, see old movies, learn to dance poorly, exercise, read, and take my son fishing. Priceless.

Good luck!

What is your experience with locums? Share in the comments.

Dr. Henry DeGroot is an orthopaedic surgeon who lives in Key West, Florida, and practices locums orthopaedic surgery in multiple states. He received his medical degree from University of Chicago Division of the Biological Sciences The Pritzker School of Medicine and has been in practice 30 years.

Illustration by April Brust and Jennifer Bogartz

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