Locums Lessons

Life Lessons - Locums Lessons

Why can’t you just follow directions?

August 4, 2019 by 0 Comments

As a frequent traveler, I know my way around many airports.  The process is ultimately the same, right? Check your bags, go through TSA, wait at your gate and board the plane.  Recently, I flew out of Atlanta.  The TSA pre-check line required you to collect a large bin from the bottom row of conveyor belts, put all your belongings in the bin and place it back on the top conveyor belt to be screened.  After passing through the metal detector, you collected your bags as usual.  Thankfully, this day I did not set off any alarms, and as I removed by backpack and shoulder bag from the tray, I noticed the woman in front of me was visibly upset.  “I don’t understand why people can’t just follow directions.  Why does it have to be so difficult?”  She gathered several empty trays, stacked them at the end of the line and walked off in a huff with her travel companion.

Being aware of more than one TSA system makes traveling less daunting.  In many TSA pre-check lines there are no bins.  All items, except wallets and keys, go directly on the belt.  In some small airports, there are no separate TSA pre-check lines.  Other than keeping your shoes on, there are no special perks for being pre-check.  In many airports, the TSA agents collect and return the empty containers. Your end goal is still the same, to get on a plane. 

  • Traveling from Nairobi, Kenya to Bujumbura, Burundi with Dr. Bella

Being aware of more than one system of medicine makes practicing less daunting.  As physicians our goal is to take optimal care of patients. The traditional system of medicine teaches us that we need to get the right (if not perfect) grades, a high MCAT score, pick the right medical school, a competitive residency and the ideal job that we can keep for 35+ years until we retire.  This system does not teach us that we can change our minds and not finish medical school, or transfer out of a residency program or work in more than one place by choice.  We are taught to work until we are exhausted and that’s just the way it is.  We are taught that locums is only for transitioning or for physicians who just can cut it.  We are taught that we should feel guilty if we consider non-clinical options.  This system is no longer working.  As we are beginning to see, there are multiple ways to practice medicine.  Even more, we have the ability to choose or influence the system in which work.  The end goal is still the same: to take optimal care of patients.

Rounding at Our Lady of Lourdes Hospital in Mutomo, Kitui County, Kenya

We have the power to choose how we practice, when we practice and for how long we practice.  I joined a community-based practice in a suburban town, which I loved.  I enjoyed the diversity of the patients, the collegiality of my co-workers and the pace of the clinical requirements.  Over the course of a few years, the practice grew and changed.  The dynamics of the practice no longer fit my needs.  I approached the leadership to discuss the changes, looking for a new normal for me.  Instead, I realized my purpose could no longer be met by the organization and chose to move on.  One of my goals as a locums physician is not only to practice on my own terms, but also better understand the various practice models across the country so that I can help and encourage other physicians to choose to live a well-balanced life.  I want to see us practice safely; care for our patients, and ourselves and to feel like there are options to combat physician burnout other than leaving clinical medicine.

It struck me that the lady in the TSA line was accustomed to a single system, a single way of doing things.  Instead of acknowledging that others could be accustomed to a different system and adapting, she allowed her frustration to manifest in a way that was only destructive to herself.  As physicians, we may be overwhelmed and overshadowed by expectations of our groups, hospitals or accountable care organizations.  Exhaustion and frustration can lead to burnout, bailout and self-destruction.  When we recognize that we are not prisoners to the current system, we can adapt, change it or move on.  We don’t have to follow directions. We have options and burnout does not have to be one of them.

Enjoying the view, Jaco, Costa Rica

Living Your Best Life - Locums Lessons

Defining Their Own Practice as Partners in Love and Locums

August 30, 2017 by 0 Comments

Horseshoe Curve

Building and maintaining relationships is important to me.  As an introvert, one of the ways in which I work on professional relationships is by attending professional conferences each year.  One organization that is near and dear to my heart is the Student National Medical Association.  This organization was pivotal to my success as a medical student and consequently as a physician.  When I became an attending, it was imperative for me to volunteer with this organization and I had the awesome opportunity to serve on their Board of Directors for four years.  During my term, I re-connected with Dr. Renee Volny-Darko, a kindred spirit in Obstetrics and Gynecology, a believer in student mentorship and an advocate for health equity.  As part of her practice, Renee had worked as a locums physician while transitioning from one position to another.  It should be no surprise that when I started to consider a career doing locums tenens that I reached out to her to share her experience.  She was straightforward, honest and encouraged me to follow my path.

A little over a year later, I received a call from Renee.  She and her husband had decided not do only work as locums physicians but also to start their own locums company!  She asked me if I wanted to work with them and I said, “Of course!”  They offered me a position in Altoona, PA. I’ve traveled to Altoona a few times now.  Historically a railroad town in the middle of the state, the town is one of many working to redefine themselves now that the major industry has changed.  It is still the home the historic Horseshoe Curve built by the Pennsylvania Railroad.  However, the corners are now populated with Sheetz, a convenience store chain who house their corporate headquarters in Altoona.  Two hours from Pittsburgh and 4 hours from Philadelphia, Altoona has its own unique and inviting personality.

For that reason, the Darkos have decided to stay in Altoona as they work to grow their business. They have focused on recruiting physicians who are patient focused and team players with the goal of optimizing the experience for the physicians and the employer.  Working with Renee and Nii is like working with family.  And recently, the couple grew their family of two to three… Not only balancing practicing medicine, running a company, they are now the proud parents of a bouncing baby boy!

Today, I would like to learn more from Renee and Nii, partners in love and work, about how they are living their best life.

  1. Tell us a little about yourselves and your family.

We have been together for almost 15 years and married 4 years this November. We’ve accomplished many things together, but our greatest accomplishment is our soon-to-be four-month-old baby boy. Nii grew up partly in Queens, NY and Irvington, NJ. Renée grew up in Brooklyn, NY. We met in Kansas City, MO, where we attended and graduated from Kansas City University of Medicine and Biosciences and obtained a Masters of Business Administration from Rockhurst University. Nii trained in general surgery at the Morehouse School of Medicine in Atlanta and trauma/critical care in Miami. Renée trained in OB/GYN at Robert Wood Johnson Medical School in NJ.

We decided to work in Altoona after Nii had a locums experience there. Being newly married, it was important to us to be at a place that we liked and to be at the same hospital so that we could see each other even if our work schedules got busy. We did not want to live like two ships passing in the night. It has worked out very well for us!

  1. What is the most rewarding aspect of medicine for you?

Medicine has been a wonderful way for us to contribute to society both nationally and globally. Having worked primarily in underserved areas of the US, we are happy that we are helping to fill the gaps of medical care in communities in need. We have also done medical missions in Ghana with an organization called the International Healthcare Volunteers (IHCV). IHCV is a very rewarding experience because of its focus on educational exchange between US and Ghanaian doctors. We love to teach the Ghanaian doctors, residents, and medical students, but we learn so much from them as well. The impact of any mission is not measured in the number of patient encounters, but in the improving health of a nation as a result of education.

  1. How do you balance career, advocacy and parenting?

That’s a tough one! Being deliberate about balance is key. It won’t just happen organically. Early in our marriage, we established our family as our first priority. Nii worked full-time and Renée worked part-time, again, so that we could optimize our time together. If something interferes with our ability to live happily as a family, it’s not an option for us. Starting our locums company, Equal Access Health, has played an important role in giving us the balance that we need to be doctors, advocates, and parents. Working strictly as a locums physician allowed Renée the flexibility she needed during her pregnancy and now for us both to be home with our son as often and as long as we want. We’re also more free to spend extended visits with our parents and siblings. We have more time to work with IHCV on future plans to provide more continuous care and education in Ghana. We’re always reassessing our balance to ensure that we don’t over-extend ourselves.

  1. What advice do you have for young physicians as they start their careers?

Allow yourself to dream beyond the traditional practice of medicine. We are seeing very tragic repercussions of physician burnout. We are only human. It’s ok to be unconventional in your practice (like locums, part-time, or concierge) to fulfill your basic needs. We also encourage docs to have interests other than medicine. Our non-clinical ventures include the locums company, a podcast, a pre-med consultation service, and a lifestyle blog. We enjoy being doctors, but we have other talents that we’d like to explore.

  1. Mentorship is important to both of you.  How would you encourage professionals to stay connected to those still in training or early in their careers?

Remember that receiving and providing mentorship is lifelong. We both have mentors and we both continue to mentor. Like life balance, making a deliberate effort to maintain mentoring relationships is the key to staying connected. Continue to stay involved with your alma mater and student organizations. Look for opportunities to teach or precept residents.

https://www.equalaccesshealth.net/

 


 

 

 

 

 

Locums Lessons

Locums…is it true what they say? How do you choose the right company?

May 29, 2017 by 0 Comments

Locums…is it true what they say?  How do you choose the right company?

Usually by the time you’ve practiced for a while you will start to get emails from locums company representatives asking if you would be interested in locums work.  For residents, odds are at least one of your attendings has worked for locums company at one time or at least considered it.  The first time I heard of locums was during my third year of residency.  One of our attendings mentioned it as a good option to explore different practices before committing to a final hospital or location.  In my first year of practice, I received a random email from a larger locums company, I filed it away at the time.  I was happy and I didn’t have the time for additional clinical responsibilities.   But, when I decided to revisit locums, I went back to that email.  It was as good of a place to start as any.  Things to consider:

  1. Big Company vs Small Company. There are a multitude of companies out there.  From my experience, the bigger companies are consistent, they have great support staff and usually work hard to maintain a favorable reputation with their facilities.  Their representatives are available 24 hours a day for any issues that may arise while you’re on assignment or traveling to an assignment. This  also means they have more standardized (and possibly lower) pay rates.  Small companies will have less support staff and therefore less overhead.  They may offer higher pay rates, but you may have to be a little more flexible.  As with anything else, each company may have local or regional preferences, may work with government facilities or be geared toward clients that are seeking temporary to permanent positions.
  2. You are a contract employee of the locums company. You will have to complete credentialing application for each locums company, in addition to each facility you apply. As with any company, pay frequency may be weekly, bi-monthly or monthly.  You may receive paper checks or direct deposit.  Make sure you confirm with the company.
  3. If you are seeking employment within a small geographical area, then you may want to research which companies place more physicians in that particular area and plan to sign up with at least 2-3 companies.
  4. All companies generally offer to cover transportation to and from the site, including ground transportation to the airport, airfare and baggage costs. They cover or arrange lodging and rental car if needed.
  5. They may or may not cover additional state medical licenses, DEA applications and/or controlled substances certificates.
  6. They do not cover meals.
  7. They do not cover health care benefits or other benefits usually associated with full-time employment: disability insurance, retirement investments or CME reimbursements.
  8. Malpractice. They cover your malpractice while on assignment.  You will receive a copy of your malpractice coverage agreement when you start each assignment.  You will be responsible for your tail if you need it when leaving your current practice situation.
  9. If you have the time, talk to a few companies and build a rapport with a representative in your specialty area before you commit. Explain your reason for pursuing locums, what length of assignment you prefer, where and how you would like to work. This relationship will be very important as you move forward.  Remember that the representatives talk with each other and facilities talk to multiple locums companies.  Your reputation is important.  It can help you get or keep an assignment, be asked to return to an assignment, be considered for a permanent position or negotiate a higher pay rate.
  10. Be very clear with the representative if you would like to be “presented” to an organization. There are rules as to how often you can be presented to the same organization.  This detail can get tricky if you’re working with more than one company.  Once the company has your CV, it is possible that they can present you even if you’re not credentialed with them.  I now only send my CV to companies after I am confident that I plan to work with them.

I started with one company.  One of the larger ones.  For me it made sense to sign up with a company that had a solid reputation and great online resources.  Most locums physicians that you meet along the way, will tell you that if you do locums long enough you will add on additional companies.  One doc told me at one time he was up to 9!  I just added my second company, a smaller physician run company.  I imagine I will add a third next year.

Take homes:

  • Ask around. See which companies have the best reputation in the area(s) that you want to work.  Forge a relationship with a representative before accepting your first assignment.
  • Be clear about the type, location and/or length of assignment you are looking to find.
  • Do not let the representatives talk you into anything you’re not comfortable with doing. There will be another assignment.  You are in control.
  • Use this opportunity to build the life you want to live!

 

Resources:

https://www.nalto.org/

http://www.medpagetoday.com/KevinMD/41085

http://www.kevinmd.com/blog/2013/02/year-locum-tenens-physician.html

http://journal.practicelink.com/career-move/career-move-locum-tenens-physician/

Locums Lessons

Ways to Practice

May 24, 2017 by 0 Comments

 

Guymon, OK

Ways to Practice

There are multiple ways to approach locums work.  I decided to go the nomad route.  I signed up with one company and made myself available to go anywhere.   My only preference initially, was short-term assignments, typically 2-3 months in length.  That means I was covering gaps in time when hospitals were in the hiring process or maternity leaves, etc…  How you approach the type of assignment you want depends on your short term goals.  Questions to ask yourself:

  1. 1. Are you supplementing your full time job? Is this a short term option to bridge your time between jobs or training?  Do you plan to continue locums for more than 2 years?
  2. 2. Do you want to travel around the country or stay close to a home or family?
  3. 3. Do you want full-time/full-scope practice opportunities? Would you like to work 2 weeks out of a month? Would you like shift work as a laborist/hospitalist?
  4. 4. Do you want to work continuously or do you need to take breaks in between assignments?
  5. 5. If you plan to continue a full-time job and work locums on the side, you can find weekend work in many practices.  Practices in small communities use locum physicians to round out their call schedules.  A “weekend” in the locums world usually means Friday 8 am to Monday 8 am.

If you need to stay close to home or family, I would recommend signing up with at least 2-3 companies to give you more options.  Try to find locums physicians in the area and find out what companies they use.  Another option would be to approach facilities that may be short staffed and offer your services in a locums capacity.

Things to consider when taking a position as a laborist: 1) Are you first call or second call? 2) Who is first call if you’re not?  I have now worked as 2nd call for midwives or for family medicine physicians.  I have also been the laborist in academic programs that required residency teaching.   Taking positions as a laborist or hosptalist gives you the flexibility of shift work.  However, you will be only be doing inpatient work.  If you’re not ready to give up your generalist skills, I would suggest only taking laborist work to supplement a full-scope assignment.

If you don’t plan to take continuous, full-time assignments, I would suggest making your calendar at least 6 months in advance.  That way you can let your company(ies) know your true availability and plan accordingly.

When I first started, I was nervous that I wouldn’t be able to find enough work to keep me busy. And it is true, that I have had a few assignments fall through.  However, with proper planning, staying flexible and forging a good relationship with your locums representative(s) will usually prevent any unwanted gaps in work.

Locums Lessons

Tidbits from the Road

May 24, 2017 by 0 Comments

Lessons Learned:  Every Cloud has a Rainbow

  1. Less is More. I still am not efficiently packing.  Because I often transition from a work assignment to leisure travel or a national meeting/conference, I tend to pack a variety of clothes and shoes.  As I continue doing locums, I hope to pare down my wardrobe to be able to carry all the basics for any occasion into a carryon bag.
  2.  Eating well on the move. Short assignments are the most difficult.  Grocery shopping for 2-3 days can be challenging.  Most extended stay hotels have refrigerators and some have microwaves, but stovetops or ovens are uncommon.  On these type of assignments, I tend to eat out more which is not fiscally or health conscious.  Longer assignments, greater than a week, usually allow accommodations that include a stove and oven, which permits me to cook at home.
  3.  Thankfully, most hotels have an onsite gym.  My fitbit has been a great addition in helping me to track my exercise but also to use pre-programmed fitness routines to follow in a crunch.  Depending on the location, I try to find local gyms, the YMCA or community centers that allow short term passes, memberships or class packs.  It has been a great way to spend my off time and allows me to interact with the community in a non-clinical capacity.
  4.  Car rentals. USB ports and Bluetooth access are a must.  I spend a great deal more time driving than I have in the past.  Not driving during the course of the work week, but driving to assignments that are often 1-2 hours for the nearest airport.  This being the case, I use my car time to catch up with family and friends.  The USB ports allow me to charge my phone for both talk time and GPS utilization while driving.  Since I am driving alone, having the in car Bluetooth gives me one less device to keep up with and keeps me safe and hands-free!
  5.  Health Insurance. Aaargh!  The greatest barrier for me to initially obtaining health insurance was my nomad status.  I now belong to a health share organization that I hope will cover my needs.  I’ll have to write a more detailed post on this issue later, especially as the policies around health insurance coverage are rapidly changing.

Ferry ride to Anguilla