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Not for the Faint of Heart: Life Considerations for Travel Locums

Op-Med is a collection of original articles contributed by Doximity members.

Are there more cons than pros to travel locums? Thinking about working for three months and then traveling to an exotic location before your next stint? Measure the pros and cons before making this life and career changing step. The following are some ideas to navigate to avoid the pitfalls of travel locums before deciding to embark on this new chapter of your career. I say cons because there are very many obstacles to overcome to successfully complete the journey to ‘travel and locum.’

Starting a LLC May Help Obtain Higher Rates of Return

Starting a LLC will allow you to bill for 1099 income. The pros of forming a LLC is that if you have precise accounting you will be able to deduct more for taxes at the end of the year and will have more revenue than a W-2 contract. However, companies tend to cancel you often at the last minute as you are a contractor and they have no legal obligation to you for reimbursement. You will basically fill a need when there is one and if you are not needed last minute you may be cancelled. Even more complicated are the ‘At Will’ states such as Florida where the law protects more the employer than the employee. Know your state before choosing your next position. For example, California has more protection of its employees than Florida.

It is common to travel and show up at work with a 1099 contract and be told that you were replaced by an internal hire and ‘somebody forgot to notify you.’ The staffing agency could state that they did not get paid therefore they have no obligation to pay you. Quite frankly, if there is no work for a 1099 contractor then you are not given the work. There is however, more protection as a W-2 employee by law and sometimes when cancelled they will pay you. It is very important to read the fine print of a contract and to add clauses to protect yourself as a clinician if you are cancelled or replaced by a cheaper or more convenient provider.

Monthly accounting is required and reporting revenue is required when you form a LLC. There are different types of LLCs that you can choose from to best fit your revenue. When you contract your own services as a sole proprietor then you are more able to utilize your profession as a business asset. Be aware that the accounting can be grueling and boring for clinicians who take fulfillment in seeing the patient.

Is the Pay Robust?

The pay will need to be robust to offset travel expenses, mortgages, lag time between contracts, extra medical bills, and car rentals/rideshare services. The pay is not much more than what you will get paid if working the job permanently. You will need to budget for your retirement, health care, vacation and expenses. There really is not a lot of money left over to enjoy. You will want to take advantage to explore where you stay otherwise what is the point of traveling? At the point in time that we travel we usually do not need the experiences for our resumes as we have already established our profession.

Rural Postings Offer More Rewards

Many times the opportunities that pay for both travel and accommodation are very rural. They are places that have a difficult time having full-time people commit due to the location. These are often a minimum of three months commitment and will require you to have a car rental in order to ‘escape’ once in a while. You really need to enjoy the outdoors as the places often boast extraordinary scenery. Be ready to be away from your family and to not have many visitors when the placement is rural. These placements are perfect for clinicians working on a Doctorate or Master’s Degree where you need alone time to study.

Start Dates are Often Delayed

Very often the start dates end up being delayed as a result of credentialing or references not returning feedback on time. As a clinician you do not have access to the behind-the-scenes credentialing that the experts do in order to prepare your assignment. Often the liability insurance of the travel company requires very strict screening and they verify all prior jobs held during your career. This often may mean contacting any foreign school that you attended. Even if you graduated 30 years ago and are fully licensed in your state, the company, due to liability insurance requirements, will contact your school. One way to dodge this is to do a 1099 contract and have your own practice insurance. The cost of independent practice insurance is a few hundred dollars more per year than regular insurance but it will open up more contracts. Be prepared for a delayed start date which in some cases are often up to one month. Can you afford to not work that unplanned time off? It happens frequently. Sometimes the confirmation occurs only the weekend before your start date so travel has already been confirmed in order to get good flights. Can you afford to pay a rebooking fee or cancel Airbnb if not booked on time? Having the more cost effective flights and accommodations often are not refundable and are booked far in advance. Having to book last minute waiting for a confirmed assignment will cost you more money. Have you budgeted for this?

Competition for the Better Assignments

It is not true that if you apply for a locum job that you will get it. The more rural jobs are of course, easier to contract, than a job in a fun city. The competition now is not only from one placement agency but several. There are actually headhunters that scour the employment ads daily and will find your resume and contact you. Beware of these agencies as they are often paid per contract and not per service and often will never follow up with you. For example, you may submit your application and ask for notification if rejected and the recruiter promises to call you back but never does. I would not work for this company because it does not show respect for you as a clinician. Obviously the end goal of agencies is business but the great skill in running their business is still to make you feel respected and valuable. It is shocking to see how many recruiter promise to call back and never due despite your follow-up emails. Remember that some clinicians do locums for a very long time and will get to choose the best positions first. As a new traveler, you will get the other positions that are not that popular until you can build up senority or do an amazing work job that the employers will request your services.

States such as Florida are highly saturated with clinicians and many foreign clinicians that will settle for lower wages. The Sunshine State is very difficult to find locum work in and often it is very much underpaid. You will need a specific specialty to get much work in Florida and of course, anything South of Tampa requires fluency in Spanish.

Time off: Either Too Much or Too Little

If you plan accordingly and budget ferociously you can have the lifestyle that affords time off or time to travel. You will need to live simply during your work days in order to save for the time off as many times as you do not have benefits. The pay and tax breaks are often better if you do not accept benefits. However, you need to budget for your vacation, sick time, and retirement! Believe me after all the deductions there is not always a lucrative income. I think the main benefit of locums is a more flexible schedule and the variety of working different places.

Trust Takes Time to Build With your Patients and Colleagues

As a new clinician it takes time for your colleagues and patients to trust you. No matter how many degrees or A+’s behind your degree it does not matter when you do locums. It is what your colleagues see on a daily basis and positive patient reports that make or break your stay. Having a positive attitude and being flexible is so important to fitting in with the new team. Being open to criticism and the fatigue of learning new charting procedures, coding, etc., is very draining. The plans of an hour workout at the gym after work may take a couple weeks to happen as sometimes the fatigue is enormous when everything is new. Reading the patients medical history prior to seeing them, reviewing all labs, diagnostics, and prior appointments is very challenging when you are a locum. You do not know almost every patient that you see unless you have been there for one month or more. Then, it is very reassuring to see the same patient for follow-up but this is often not the case. Often locums get assigned same day urgent visits of which you often always feel behind as there is no prior time early in the morning to review the chart as the patient is an add-on to the day. You must take the time to review and this could potentially put you for being behind schedule. It really helps to have experience under your belt before attempting locums because you do not have to spend time looking up guidelines or reviewing diagnoses.

Whew! Are you ready to travel? These are some of the most common challenges of doing travel locums with the main benefit of never being bored and getting to travel and meet new people. You need to weigh all the cost-benefits prior to taking the step to form your own LLC and to be an independent contractor. Travel locums is not for everyone and it is an often a frightening yet exciting step in a career move that you have to be very well prepared for emotionally, physically and financially. Of course, your family needs to be on board and okay with long periods of time away from them. This is very difficult to do if you have children. Travel locums become a life that is very similar to military deployment. Travel locums are not for the faint of heart. Decide if this is for you and then take the plunge with full assurance that you can weather the bumps along the road. A couple weeks on sunny beaches may be the reward worth the sacrifice. 

Connie Lapadat, NP, is a family nurse practitioner in El Cajon, CA. She is a 2018–19 Doximity Author.

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