My new locums job starts bright and early tomorrow morning, and things aren’t going my way. My flight is delayed, and the guy in front of me just took the last overhead bin. My seat is back in row 23 next to a woman unwrapping a giant burrito. Time is ticking by, and the chances of making my connection are disappearing fast.
I've been a locums orthopaedic surgeon for six years, ever since Hurricane Irma swept away my hospital and my “regular” job. I thought it might be interesting to share what I've learned, so let’s go back to the phone call that got me this job, and put me on this flight.
Most locums jobs start out as a posting on one of the national databases. My agent from the locums agency called me about a posting they needed someone for. It seemed to fit my schedule and my preferred work style, so I asked my agent to present me for it. The hospital then spent a few days looking over my credentials, my work, and my malpractice history, and seemed to like what they saw. Next, I had to dig into many hours of applications, paperwork, and telephone calls to secure hospital privileges and a new state license.
The lady in the next seat finishes her burrito in no time, and the captain announces we’re ready for take off.
I wonder how this assignment will turn out. Some jobs make me feel like a valued player on an elite orthopaedic care team, others feel more like I’m like the night janitor, doing lonely work cleaning up little messes in an empty hospital. As for the pay, it also varies. I’ve earned $1,400 for a very leisurely days’ work in a small rural hospital, and up to $4,400 for 24 hours of busy level 1 trauma call. Hospitals pay agencies various fees on top of your pay which may even exceed what my total pay is for the job. On top of that, the hospital pays for your travel, lodging, and rental car. The agency helps with paperwork, licensing, and makes all your travel arrangements. They also arrange and pay for malpractice coverage to cover your assignment. In a good year, I can make about 50% of a normal orthopaedic salary working seven or eight days per month, but there are no benefits included. Over the years, my income has varied quite a bit, since locums jobs are by definition episodic, and unfortunately any assignment can be canceled on short notice. As an independent contractor, I get a 1099 in January from each agency.
The lady with the burrito taps me on the shoulder — she needs to go to the restroom. I suddenly remember I need to file and pay my estimated taxes.
Once I have accepted a particular job, the agency will furnish a contract which outlines the work requirements, schedule, and pay. The contract commits me to the job as defined, and there is little or no flexibility. However, there is always a 30-day cancellation policy, which can sometimes give me an edge in salary negotiations. I had one assignment where the pay was quite low for the intensity of the work, so I called my rep 31 days before I was due to work again. I made it clear I was ready to walk away if they didn't come up with a reasonable raise. They knew all too well how long it takes to place a new health care professional, so my strategy worked. The 30-day cancellation can work both ways. One facility had me confirmed for a week of call every month for all of 2022. It was a good hospital and I was pleased to have a regular full year schedule and a predictable income. At the last minute, one of the staff orthos decided to take the call himself. They canceled my entire year with just 30 days notice, throwing all my plans into disarray.
The burrito lady is back in her seat, and the airline gods are feeling kind, so I make my connecting flight by a whisker. Soon, I am buckling myself into a rental car on my way to the hotel.
This work assignment is in a large hospital system, so I have two paid days of onboarding, with meetings, lots of fun Epic training, and the usual hospital tours. The onboarding process is variable, too. I’ve worked in small hospitals where the desk clerk simply hands me a badge and a pager and wishes me good luck. I’ve never been given any formal training other than what’s offered during onboarding, but other clinicians and staff have always been willing to help.
As a surgeon, I prefer locums jobs where I am frequently in the OR. I need to operate to retain and develop my surgical skills, as well as to collect an adequate number of cases to retain my hospital privileges and board certification. As a short-term employee, I am very aware that each patient and staff interaction could be a rock on which I build a solid reputation, or a reef on which my professional standing can founder. On the other hand, I don’t need to worry about racking up as many RVUs as possible, so I have time to do thorough histories, complete examinations, and well-indicated surgeries. I also have some free time to explore the local area and find one or two decent restaurants.
As my assignment draws to a close, I repack my roller bag and get ready to go. It’s time to sign out. Handing off my patients can be a source of problems, since surgeons tend to be reluctant to take on cases from other surgeons. A well-documented signout should ensure that each patient receives the ongoing care they require, and also serves as a clearly defined moment when my professional responsibility for the patient comes to an end. Once my signout is received and acknowledged, I can turn off my beeper, hand in my badge, and walk out the door, heading for a week or two of complete rest and relaxation. If you remember the feeling you had on the first day of summer in fifth grade, you’ll know how that moment feels.
For me personally, my locums journey is about to draw to a close. One of the facilities where I worked offered me a full-time position and I’ve decided to take it. Instead of living out of a roller bag and eating fast food, I’ll be able to enjoy a more “normal” life. I’ll have a lot less free time, but I’m looking forward to a regular schedule and a predictable paycheck. I’ll be able to develop a long-term relationship with patients and colleagues, and I think my wife will appreciate me being home.
What is your experience with locums? Share in the comments.
Dr. Henry DeGroot is an orthopaedic surgeon who 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.
Image by Malte Mueller / GettyImages
