Career Move: Locum tenens physician

Name: Avishai Meyer, M.D.
Title: General surgeon
Employer: LocumTenens.com
Education: Sackler School of Medicine, Tel Aviv, Israel. Residency at University of Colorado, Denver and University of Nebraska, Omaha. Fellowship at University of Nebraska Medical Center, Omaha.

What do you like best about being a locum tenens physician?

I’m a locum tenens physician on weekends currently in Pierre, S.D. I like the ability to interact with and provide medical care to a rural population in need. Also, it enables me to see what it’s like in the real world of a surgeon. As a fellow at the University of Nebraska Medical Center, I am sheltered from the burden of blame, if you will.

Working as a locum tenens physician gives me a taste for what it’s really like to be a doctor and incurring the entire responsibility of the care I am giving. That’s scary but welcome. It’s not just being carried by the attending. I’m doing it myself.

Is there anything you don’t like about it?

It’s sad to be away from my family. I happen to have a 6-week-old child, so not being around is a little upsetting. We also have a 2-and-a-half-year-old, so it’s difficult for my wife. I’m not there to help out. That would be the only complaint I have about it, but that’s my choice.

Why did you choose to practice locum tenens?

I’m making extra money, so I’ll be able to facilitate good things in the near future. Weighing the pros and cons, I thought it was definitely a pro. At this stage of the game, I can only give them weekends. I plan to do this weekend work for a long time.

It’s hard when you’re still in training. You don’t make much money, and you still have student loan debt and those kinds of things. One thing I do have is motivation and the ability to work.

Does the locum tenens company pay for your airfare and lodging while you are away from home?

Yes. My only out-of-pocket is for food and entertainment.

Do you have any advice for physicians who are interested in locum tenens?

Yes. First, ask every question you can possibly think about upfront, and keep asking as they come. In my experience, I’ve spoken to several agencies, and they are really excellent. They are not out to trick you or hide things from you.

Next, set your standards. Don’t just accept what they give you. Make sure you take an interactive part in where they are sending you and how this is going to happen.

Finally, especially what I’m doing now, the weekend work, that works well for me. If I had to sign up for two weeks, that wouldn’t be an option. From a monetary standpoint, I can put some serious money in my pocket for my family.

Was there anything that surprised you about being a locum tenens physician?

With regards to rural medicine, it was interesting to me because I’ve always worked with large tertiary care medical centers. When you’re not working with those, it’s interesting and surprising to see the absence of the utilities I’m used to having.

For example, intensive care facilities, radiology facilities, emergency care facilities and pharmacological facilities. This past weekend, I was going to put a person on a specific medication and I was told they didn’t have it. It’s not “fancy,” it’s just something I’ve given every day throughout my residency, and they didn’t have it to give. So, that’s interesting.

How would a physician get started on the path to becoming a locum tenens physician?

It’s profoundly easy. Once you are a resident, if you go to a job fair and put your name out there, they will find you. …You go through the process, they contact you, and you email back and forth. It requires a little will and time—that’s all.

Name: Bob Harrington, M.D.
Title: Chief medical officer
Employer: Locum Leaders, LLC (LocumLeaders.com)
Education: Undergraduate at Notre Dame. Medical school at Temple University in Philadelphia. Residency at the Medical Center of Delaware in Wilmington (now Christiana Care).
BACKGROUND: Residency in family medicine.

What do you like best about being a locum tenens physician?

I’m a hospitalist right now, so what I like best about what I’m doing is to be flexible on a clinical schedule so that I can help run the locum tenens company for which I work. I’m the chief medical officer, so obviously that requires a lot of time, travel, energy, and that type of thing.

What don’t you like about being a locum tenens physician? Is there something that’s more of a challenge for young physicians entering this field?

The major drawback that I would see in terms of working as a locum tenens physician is the understanding that, in almost all instances, you are going to be a 1099 independent contractor for whomever you work. You are not a full-time employee, so you don’t get the full-time benefits and you don’t get payroll taxes taken out. So you need to be a little savvier on the financial side in terms of making that work.

Most people we work with have some other opportunity to be able to get benefits. Their spouse works and they have benefits they can cover their family with. Most people end up forming a LLC or PC to be able to write off some significant job-related expenses. You have to be able to do those kinds of things and understand the 1099 independent contractor arrangement fairly well before you can get into this.

Like anything in life, surround yourself with the right people who can provide you with good advice. Attorneys and accountants can help you set up your LLC or PC. If you do this, I think you’ll be in good shape. Most people in the medical profession have professional acquaintances that are in other fields who can certainly help.

Was there any specific reason why you chose this profession?

I was with a national hospitalist company for about eight years before I took this job. I was VP of medical affairs. We had about 42 programs in 18 states. I was in charge of all of the medical directors affiliated with these programs.

My biggest frustration on the national level with hospital medicine and why I made the leap to this job is that we struggled everywhere we went with staffing. There’s a very large supply/demand mismatch in hospital medicine. I thought there was an opportunity to be part of the business that would impact both quality and efficiency of the locum tenens staffing agencies. So having been through those struggles in the past, I made a leap to look at it, focusing on temporary staffing particularly in hospital medicine and helping out some of those hospital medicine practices that struggled like I did.

Do you have any advice for young physicians coming out of residency who might like to become a locum tenens physician?

The last time I looked, the first three years out of residency, most physicians are going to change jobs two or three times. I think locum tenens is a nice way to give people an opportunity to try a job on for size, to get to know the ins and outs and to get to know the people without making a long-term commitment.

Also, to be able to see how a practice operates from the inside and then decide if it’s the right fit for him or her. I think for young physicians especially, it’s a nice way to do that.

We have a lot of physicians that work with us who are taking a year off and then applying or reapplying for a fellowship in a specific specialty such as cardiology, GI, etc. It’s a great way for them to get another year of general hospital medicine experience under their belt and I think better prepare them for a career in a specialty where they can understand the complexities of a hospitalized patient more thoroughly.

What’s the best way for physicians to go about finding a locum tenens position?

The best way I truthfully think is the Internet. Most locum tenens companies realize that the vast majority of their physicians or target physicians are fairly Internet and computer savvy, so they have robust websites and advertising on the web.

I think what I would do as a young physician coming out of residency would be to start looking through the Internet and then begin speaking to recruiters from one or two of those companies. I would advise them to try to limit it because it’s very overwhelming once you start submitting your name, email address and contact information to locum tenens companies. You can get a large number of emails and phone calls once you get put on a mailing list.

So I would just focus on two or three companies that really appeal to you through their Internet presence. Speak to one recruiter at each place. Let them know exactly what you are looking for and what geographic location you are looking at.

Are there locum tenens opportunities in smaller cities?

There are opportunities all over the country. I think that the one thing about locum tenens is that there are a lot of opportunities to travel to places you would not normally go, at the practice’s or locum tenens company’s expense.

We routinely place people in Alaska and Hawaii. If you had a year off between residency and fellowship to do something different, it would be nice to go to Hawaii, Alaska or New Mexico for three months. We do a fair amount of that where we will pay airfare, car rental, hotel and a per diem for meals and those kinds of things that allow people to travel.

We also have the other 40 to 50 percent of our physicians who are local to a particular practice with a need who provide fill-in coverage for nights, weekends and holidays. So you can do it either way, but if this was going to be a full-time job, I would suggest looking at the opportunities where you might be able to go to a location where you would not normally be able to go.

Is there anything that surprised you about locum tenens?

I was surprised at how much I actually enjoy it. As a locum tenens physician, you are faced with having to learn new systems, new medical staffs, new nursing staffs, new policies and procedures all of the time.

I was a little leery about doing that when I got into it. However, I think the exposure you get from the way people do things differently is a nice change of pace and it has not been as overwhelming as I thought it was going to be getting into it.

In my mind, it’s a good refreshing thing to get another person’s perspective on how to run a practice and a hospitalist program.