Living the Locum Lifestyle

Scott A. Cooper, MD, is a board-certified internist, critical care and emergency medicine specialist and a graduate of Loyola University’s Stritch School of Medicine. After a 28-year career in a full-time practice environment and now for the past four years, he has practiced almost exclusively as a locum tenens physician in a variety of practice settings throughout Illinois. Dr. Cooper believes that fostering collegial relationships with other physicians who take up the independent and sometimes solitary lifestyle of the locum physician is important for thriving in practice.

He knows a few other things too:

What got you into locum work?

After years as a conventionally employed physician, I was getting only a few weekends off and I worked the vast majority of holidays, which made it difficult to travel with my family. There’s an incredible shortage of emergency physicians with a tremendously high burnout rate. I began researching the (locum) field and quickly realized that the talent shortage that made my traditional setting so stressful made me a very attractive candidate as a locum. Emergency physicians are very much in demand.

Say I’m a physician who reads this and starts thinking about locum work. Or maybe I’ve received an interesting overture from a colleague or a staffing agency. What issues should I focus on first? 

Everyone has unique circumstances for making a career choice in medicine, but if you’re thinking about locum work, here are major points most doctors consider:  

• Flexibility: We talk about work/life balance and burnout in medicine, and there are different ways to address that, but locum work allows you to choose when, where and how you want to work. If that’s important to you, locum work is worth evaluating.
• Pay: For some locum doctors, pay can be a big part of the decision. Depending on your specialty and where you practice, you can be paid well, but the money tends to be in the toughest locations that often require long shifts and extended stays. You might find that many assignments are in underserved areas that may or may not offer interesting things to do when you’re not working. 
• Travel: If you’re commuting from home to locum assignments, you may still be traveling at least an hour and sometimes significantly more to get to your assignment. If you’re in-state, you’re in your car a lot. If you’re out of state, you may have to commit to overnights or weeks or months of living out of your suitcase. There may be advantages in terms of pay or patient experience to consider. But distance and the length of shifts you’re working affect everything.
• Work Culture: Starting a new job in a strange location with hours or tight patient scheduling is tough enough to get used to in a traditional practice environment. How good are you at trying that on every few weeks or months?  Also, how well do you deal with “outsider” status in a work environment? If you need long-term, close relationships at work to thrive, locum might not be for you.
• Financial Risk: If your specialty is in demand in locum work, you can work constantly if you want. But as I mentioned, locum doctors are in business for themselves. Could you handle a dry spell or a potential interruption in assignments? That’s why you need to examine your finances before you take on this work. If your risk tolerance is low or if you live paycheck to paycheck now, breaks between locum assignments could be unsettling. 
• Running Things Yourself:  Keep in mind that you take on self-employed status as a locum physician, so you’ll typically be paid without withholding. That means you’ll probably have to handle your taxes, money management, health coverage, contractual issues, retirement planning and other financial issues differently than you do now. There may be significant tax advantages to locum work, but that depends on your situation. And don’t forget credentialing – depending on the agency or the organization making the hire, you may get some assistance, but develop an always-current credentialing packet that makes it easy to start that process quickly. Always keep your CV absolutely current and reach out to staffing agents, medical directors or other experts you know about changes in market factors or regulation that might affect the information you’ll need a the ready.
• Happiness:What makes one locum happy could be a situation no one else would want to touch. Ask questions and know yourself. Talk in depth to your staffing agency about the placements they offer and get outside help with contractual issues if you need it.  It’s important to review all aspects of a locum assignment before you take it on.

So what does your schedule look like now?

I have two regular assignments at two hospitals within a few hours’ drive of my Chicago home. At one, I work 12-hour shifts, and at another 24-hour shifts, but with off time that allows me the flexibility I need to travel and do other activities I never had time for in a more traditional work environment. As a freelance doctor, you can negotiate what matters most to you – pay, time off and certain other elements based on your specialty, but remember, there will always be compromises. For the toughest-to-staff situations, doctors often have to work long hours in environments far from home – sometimes it means living out of a suitcase for weeks and months at a time. That doesn’t work for everybody.

What types of doctors do you see in locum work now?

Two groups, based on my experience. You have experienced doctors like myself who want more flexibility in their careers and are willing to take on a bit of financial risk to do that. But we also see relatively new physicians building careers in established locations – hospitals or group practices – who will use days off or vacation time to do locum work in higher-paying destinations. It’s a great way to pay off school debt faster. One more advantage for new grads doing locums – you get to see different practice environments, and sometimes the grass is greener on the other side.  Before settling down to a long-term practice, locum work can help you learn what you like and dislike.

So, young doctors with debt and late-career doctors needing flexibility. That’s the locum audience in a nutshell?

It seems to be now, but we’ll see. Medicine’s changing, and in virtually every stage of a physician’s career, we’re hearing more about burnout. Could locum “sabbaticals” become common? Could we see more mid-to-late career physicians considering locum work who would have never considered it during their prime working years? I guess it depends how future generations define work/life balance issues for themselves. 

TAKEAWAYS:

1. As with any career change, a move into locum work takes planning. Consider how your specialty, lifestyle preferences and financial picture might influence your locum experience.
2. Consider testing the waters first. You don’t have to commit to a full-time locum decision immediately. It might be worth experimenting with locum assignments over weekends and vacation days to see if it works for you.
3. Credentialing is key. Every new work environment presents potential credentialing hurdles. Speak to experienced locums about how they handle their licensing and credentialing issues wherever they practice, particularly if your goal is to practice out-of-state or internationally. Organized paperwork is a must.

Healthcare staffing agencies of all sizes can count on ISMIE Indemnity to provide medical liability coverage for top locum professionals in all settings.