Lessons in Locum Tenens: Key Insights from the Locumstory Physician Advisory Board

Transcript

Announcer:
Your listening to Spotlight on Locum Tenens on ReachMD. This episode is sponsored by Locumstory. Joining us today are four locum tenens physicians to answer the question, "Why Locum Tenens?"

Our first guest is Dr. Rip Patel, an emergency medicine physician and Assistant Professor at the Baylor College of Medicine in Houston, Texas. Let’s hear from him now.

Dr. Patel:
Some of the missions I've been on have been across the country with locum tenens. I started my career in Houston with a staff job when I also joined faculty at Baylor College of Medicine at Ben Taub. And I just found the healthcare system was very crushing to work in between the metrics, the patient satisfaction, dealing with administrators. I just felt I couldn't do the quality of medicine I wanted to do, which was very difficult when you're working in the emergency department and every patient could be a potential emergency.

And so, I started traveling and I didn't really know what the locums world exactly meant. And my first assignment was on the border towns, which is an issue I've been passionate about for a while, and providing care to these evacuees, and migrants who were coming from central South America. From there, I traveled to other parts of the country. In New Mexico, I've worked in Espanola down to Carlsbad. I've worked in Louisiana, around New Orleans, Missouri, and as far as Vermont, and we also serve a town in Nebraska, where about 25 to 30 percent of the town are refugees from Africa that the town brings there.

And so, working with so many localities with so many patient populations, I feel it's just given me a very big breath of fresh air in my career and the scope of my practice.

Working in locums, a lot of my assignments, and for most people, assignments will generally be semi-rural or rural. I'm an emergency physician, and my father started out rural. He's a gastroenterologist, and he acted somewhat like an emergency physician because where he was in Virginia in the mountains in the Appalachia, there were no specialists. And so, in that sense for me, although I teach at a level one trauma center with a big emergency medicine residency. I also work in rural parts of this country which are extremely underserved where there are very minimal specialists. And so, these patients rely on the ER physician to be their family doctor as well. And so, aside from the primary care, we're also managing all these complicated procedures: gunshots, heart attacks, mass traumas, strokes, without really the specialty backup. And I think most importantly, being board trained, board certified, and bringing that skill set to these underserved areas has really been the most rewarding part about doing locums. Especially when I'm traveling throughout the country and I run into somebody in an airport and they ask me what I'm doing and they're from that town and they always say, ‘Thank you. Thank you for coming to help us because we need it.’

And so, in that sense, I think with the skill set and serving the populations with the broad skill set we have in emergency, it's certainly been the most rewarding aspect of doing locums for the last nine years.

Announcer:
Now let’s hear from Dr. Trevor Cabrera, a board-certified pediatrician based in Roseville, California.

Dr. Cabrera:
My experience with locum tenens has been definitely an adventure. Right out of residency, I decided that I wanted to do something completely different and decided to embark on doing full-time work only doing locum tenens. A lot of people told me not to do it, saying that it would be a very unstable and really different path, but it’s given me such a chance to do a lot of things with freedom, flexibility, making my own schedule, and I’ve also paid off all of my med school loans. In the last three years, I’ve worked at over 13 hospitals in nine different states.

For me, in particular, when I decided to do locum tenens, I wanted to personally get experience in these small places, and when I’ve been the only doctor for 60 miles, it’s really forced me to really step up and to learn on the job. And for me personally, wanting to go back to a fellowship training which I always knew I was going to do, this experience was really important to me and I feel like a lot of people can be very intimidated by that, and some people can thrive in it. So, I love it. I think everybody should do it.

Working in locum tenens has broadened my scope of practice by allowing me to see different parts of the country and different levels of hospitals. In the last year alone, I traveled 359 days working in towns of 5,000 people and towns of 500,000 people. I’ve seen hospitals that have only had 20 beds and hospitals that have had more than 200 beds. It has allowed me to get some practical experience and to really put myself in situations where I was the only provider that could work on certain clinical cases and provide certain skills. It’s allowed me the chance to broaden my experiences and also has given me some practical knowledge to go back to fellowship to be a neonatologist. You can find more on all of these adventures and everything I’ve done at my blog  which is thenomadicpediatrician.com.

Working locum tenens has allowed me to really be in control of my schedule and my life, and it has given me an opportunity to face burnout and have control over it. I think the biggest reason that people have burnout in healthcare is that they don’t have any autonomy anymore, and being a locum tenens has given me that flexibility to really do whatever I want and work for myself. I work a lot as a locum tenens because I like to go from job to job, and it has allowed me to pay off my student loans and has allowed me to really see a lot of the country. But I know some people that only work a short amount of time because, frankly, they need a break, and I think whatever the case is, whether somebody wants to work a lot and pay off their loans like I did, whether you want to see the country, want to gain some experience and see some of these small hospitals that are going to give a much broader, really rich, robust clinical experience, locums are a great way a great thing for people to do.

Announcer:
For those just tuning in, you’re listening to Spotlight on Locum Tenens on ReachMD. We’re joined by four locum tenens physicians here to answer the question, ‘Why Locum Tenens’?

Joining us to continue this discussion is Dr. Nick Kusnezov, an orthopedic surgeon and joint replacement specialist in San Diego, California. Here’s Dr. Kusnezov.

Dr. Kusnezov:
My experience with locum tenens has been nothing less than superb. I think I’m certainly biased because I’ve been doing locum tenens seamlessly for the past 5 years following residency. Locums really gave me the opportunity to maintain and to fine tune my surgical skill and clinical acumen right out of a busy training program. My first locum assignment was actually a very busy level 1 trauma center, which essentially mirrored what I had done in residency but allowed me to spread my wings into practice and from that point, I branched out to everything from elective practices in terms of clinic and OR to purely call coverage. Locums really gives you the opportunity to define your practice and your schedule, be it your primary practice or as a supplemental practice. Beyond that, the income I would also echo is second to none. Not only is it on par and often surpassing the income from primary practices, but it gives you the opportunity to really mold your schedule and to negotiate rates on a frequent basis so that you really feel like you’re getting paid fairly for your time. Additionally, it gives you the opportunity to travel. I’ve traveled everywhere from the Pacific Northwest up in Mendocino, California down to the southeast tip of the country and I think that each assignment that you go to furthermore acts as a potential job tryout, too. Often, facilities are looking for individuals to bridge gaps in coverage but may also be looking for more permanent parties, and that gives you the opportunity to feel out the facility yourself, and if it’s a good fit, you may get a job offer out of it. So, I think in a nutshell,  experience, versatility, and income.

I think locums in general will make you a very versatile individual. Certainly as an orthopedic surgeon it’s made me a more dynamic surgeon. I’m able to walk into a new or foreign environment confidently and be able to tackle whatever case comes in the door, be it clinic or the emergency setting  regardless of the complexity. I think I would liken it to the education system where it’s not so much what you learn but teaching your brain how to learn. Locums teaches you how to deal with these unfamiliar environments and really gives you that versatility to approach new and sometimes unfamiliar or daunting situations in a very controlled way. Be it actual cases or travel you see a variety of locations across the country and in pretty much as much of a variety of clinical settings as you can imagine so it really gives you that ability to adapt to new situations quickly and effectively.

Announcer:
And finally, we’re joined by Dr. Marye McCroskey, a family medicine physician based in Key West, Florida joining the discussion. Let’s hear from her now.

Dr. McCroskey:
My husband and I had always planned on retiring early, but as the age approached and the time approached for us to do that, I found that I was not quite ready to finish practicing medicine. We wanted to travel and spend more time next to the coast and in the water, so I started exploring options for us to be able to do that. I found that locum tenens would meet that need. My first assignment was actually in Hawaii where my husband was able to work as a scuba diving instructor and I was able to enjoy practicing medicine, and it turned out to be a really good fit. We stayed there off and on for several years. I ended up working almost full-time because I was enjoying the work so much. As time has gone on and I’m getting closer to the normal retirement age, I’ve been able to gradually cut back. Locum tenens has offered me an opportunity to work several months out of the year and take several months off and really reach more towards a gradual retirement, which I think has worked out much better for myself.

Locum tenens has given us the opportunity to do some of the things we had wanted to do in retirement in terms of traveling but allowed me to continue to work, feel like I’m contributing some of my medical skills, and working with people that I thoroughly enjoy. We’ve been able to travel and work overseas, we’ve worked in the Caribbean, I’ve been able to do some mission work in Guatemala, which was all very fulfilling. The work is interesting because you have to practice medicine in culturally appropriate manners when you work in these different environments, which is a challenge and one that I’ve enjoyed.

When I was younger and in training, which was a few years ago, I had heard of locum tenens physicians but had always kind of looked down on the idea as those were physicians who couldn’t make up their mind what they wanted to do. And while that may be true to some extent, it also is a wonderful opportunity both for young physicians as they’re deciding how they want to practice medicine, but also for older physicians who are looking for a change of pace who are burnt out in their primary practice, who are just not quite ready to quit practicing medicine entirely and would like to continue to enjoy the aspects of medicine that we all went to medical school for, which is being with patients. Being an older physician has given me an opportunity to teach and work with younger physicians and physician extenders and enjoy doing that in a work environment in a very collegial way.

Announcer:
You've been listening to Spotlight on Locum Tenens and this episode was brought to you by Locumstory. To access other episodes in this series, visit ReachMD.com/LocumTenens, where you can Be Part of the Knowledge. Thanks for listening!