SHAUN S. BERGER, MD, remembers the moment he realized he wanted to work locum tenens. The pediatrician was working as a junior faculty member one year after finishing residency in an urgent care center at a children’s hospital. The schedule had him working 12-hour shifts 10 days a month, freeing up the other 20 or so days. “At that point, I realized that you don’t have to be the traditional doctor working only one job.” With that epiphany, his days of working a single full-time permanent job were done.
Several years later, while vacationing in Costa Rica, Dr. Berger took that notion a step farther. “I realized that I could work hard and take a nice vacation once in a while,” he says, “or I could be on vacation all the time and work every once in a while.” He decided to live in Costa Rica and travel to assignments that lasted between 10 and 12 days in California and Alaska. “I was earning dollars and spending colones.”
“You have to be willing to do things the way each place wants them done.”
Dr. Berger’s schedule has changed over the years, in part to match the needs of his growing family. (He and his wife have a five-year-old and a seven-year-old.) Today, he works a half-time permanent job to earn medical benefits, then adds in enough locum assignments to round out a full-time job. When possible, he takes 24-hour shifts so he can compress his days away from home into as few as possible
“I’m working a full-time schedule,” says Dr. Berger. “I’m just working fewer days.”
Locum work: end goal or detour?
Not so long ago, locum tenens work was viewed as the province of older physicians transitioning to retirement or as a way to try a new position before signing on for a permanent commitment.
While there are still many doctors interested in locum assignments for just those reasons, a growing number are taking a new view of locum work, defining it as an end goal instead of a detour on the road to a permanent position. These physicians are drawn to locum work because they like the flexibility to choose their own workplaces and schedules.
Chris Noel, one of the founders of Integrity Healthcare Locums, has more than 20 years of experience both in employing physicians directly and in providing contracted recruitment and locum tenens services. Mr. Noel says that many physicians that Integrity places aren’t looking to practice in the traditional W-2/employee capacity.
Why? “Being an independent contractor or a 1099 locum status gives them more schedule flexibility and choices,” he says.
Flexible scheduling is the big plus of locum work for anesthesiologist Elizabeth Noel Lumpkin, MD, who has worked locum for more than 12 years. She frequently commutes from her home in Portland, Ore., to Anchorage, Alaska, where she has worked at the same hospital for seven years. Dr. Lumpkin tries to get work assignments that last between one and three weeks (she likes to be home at least one week a month), but she can work less if she wants.
She estimates that she has two to three times as much time off as her colleagues with permanent fulltime jobs. And while she probably earns a little less than they do, it’s a tradeoff she’s happy to make. “The benefits I like the most are the free time and the control I have over my schedule,” she says.
Dr. Berger similarly values scheduling flexibility. While locum assignments require him to travel up to two weekends a month, he ends up ultimately spending more time with his children. “I might work one or two weekends a month,” he explains, “but the rest of the month I’m working a little more than a half-time job for my permanent employer.” Some weeks, he says, “I work only Monday and Thursday, and that’s it. So I’m at home more than other people who go to work at 6 or 7 in the morning and come back after the kids are asleep.”
Life on the road
Paul Birinyi, MD, who’s completing a fellowship in minimally invasive spine surgery, works locum several times a year for an entirely different reason: Because he will need to sit for the neurosurgery boards after his fellowship, he wants to keep his general neurosurgery skills sharp.
“I have to send in 150 cases,” Dr. Birinyi explains, “and I have to answer questions about general neurosurgical cases. It’s much less stressful if I’ve seen some of those cases recently.”
Dr. Birinyi, who works with one hospital regularly in Missouri but also takes other assignments, says that at the end of his neurosurgery residency, he felt proficient with all types of neurosurgery. “I don’t want to lose my cranium and trauma skills because I’m so focused this year.”
While Dr. Birinyi likes working locum, he says there are downsides. He works one locum week every four to six weeks, an arrangement his fellowship program has signed off on. Because he’s often providing coverage to allow other doctors to take time off, he worked the weeks around Thanksgiving and New Year last year. “These are not times when you joyfully give up being away from your family,” he says.
Dr. Birinyi’s experience touches on what can be a major downside for some locum work: life on the road. Dr. Lumpkin, who estimates that she spends about six months of the year in a hotel, puts it this way: “When you live in a hotel for one week, it can be fun; someone cleans your room and makes your bed. Two weeks is OK. Three weeks starts to get annoying. By the end of four weeks, I am ready to throttle someone.”
That’s because “one of the hardest things about doing locum is learning to entertain yourself,” Dr. Lumpkin says. “You are in a city you do not know, and you do not know the people. When you are staring at the four walls of a hotel room, the fatigue and boredom can get on your nerves.”
That doesn’t mean she hasn’t made lasting friendships, particularly in Alaska where she’s worked for years. “People will ask, ‘When are you back up here next? We’ll plan out things.’ And sometimes if you’ve been gone for two weeks, people will say, ‘Noel’s back.’ At times like that, working locum might even be better than being permanent.”
Learn to adapt
Another challenge of working locum is having to walk in somewhere new all the time and be prepared for whatever is thrown at you.
According to Dr. Lumpkin, the single most important character trait for doctors thinking of working locum is flexibility. “Sometimes you go somewhere and you think, ‘That’s not how I would do that,’ ” she explains. “But then you look at what they are doing and you say, ‘I guess that does work.’ You cannot be wedded to only one way of doing something, or you will start to rub people the wrong way. The more flexible you are in all aspects of your life, the more success you’ll have in locum tenens.”
She has shown up for assignments, for instance, and has received literally no orientation or training. “They say, ‘You’re here. You’re in OR No. 8.’ That is pretty much my orientation, so it can be challenging.
As an anesthesiologist, she starts by checking out the anesthesia machine and the cart. “I open all the drawers and in the first 10 minutes, I get a snapshot of where things are. Usually within a day or so, I have the lay of the land. I have learned the more you do this, the quicker you become at adapting to totally new situations.”
Dr. Lumpkin uses a cooking analogy to explain the challenges of her work life. “Working locum tenens is like cooking Thanksgiving dinner in someone else’s kitchen,” she says. “You know how to fix the meal, but you look around and you think, ‘They have a slightly different stove and they keep their measuring cups in a different place and they like scalloped potatoes, not mashed.’ But it is still Thanksgiving dinner. People get hung up on the wrong aspect. They look at what is different, but I try to first look at what is the same.”
Good match for new physicians?
Being so flexible can be a challenge, but it may be something that early-career physicians are uniquely prepared for.
“You have to be willing to do things the way each place wants them done,” Dr. Berger says. “I think as a resident, you’re used to that, and it’s no worse than going into a new rotation. You walk into a new rotation and you have to learn the ropes.” Residents are also uniquely situated, he adds, “in that they have recent training in a broad range of skills in high-acuity areas compared to someone who has been in private practice for many years.”
As a physician still in training, Dr. Birinyi says he often braces for the worst when he’s walking into a new place and not sure how he’ll be received. “There is always the possibility that you get a call with an emergency the first hour there,” he explains, “so you have to figure things out very quickly. It has not happened to me, but it’s always in the back of my mind.” But most people, Dr. Birinyi adds, “are very forgiving and accommodating. It definitely gets easier.”
Dr. Lumpkin agrees. “The confidence factor could be an issue,” she says, “but if a group or hospital knows you are right out of residency, your hope is that they will ease you into practice.”
She also urges physicians working locum to look for what she calls “allies.” “You find the people who are going to be your resources for information,” she explains. “Everywhere you go, there will be someone willing to help you.”
If you do find yourself all alone with no other physician to consult, Dr. Berger urges you to talk—and listen—to the nurses, as well as to reach out to old mentors.
While Dr. Berger says you shouldn’t practice beyond your comfort zone, he often defers to the experienced nurses he works with. “When I had no idea what was going on,” he says, “I’d ask the nurses, ‘What do you usually do in this situation?’ ” And remember, he adds, “in a new situation, you can get in trouble fighting with the nurses. Trust the experience of the people around you.”
Edward Doyle is Editor and Publisher of Today’s Physician.
Is a locum career sustainable?
IS WORKING LOCUM a sustainable career path? For some, the commitment to working locum is as temporary as the assignments they’re working. Spinal surgery fellow Paul Birinyi, MD, for example, doesn’t plan on working locum once he’s finished his training. He already has a job lined up at a practice where he’ll need general neurosurgery skills.
Dr. Birinyi thinks that to succeed as a neurosurgeon, his best bet is to settle down in one location and build a reputation. (He adds that if he were going into a specialty like hospital medicine or emergency medicine, he would consider a career as a locum.) “To build a career as a surgeon,” he says, “you have to make a name for yourself, so I need to be in one place. You have to hang out your shingle and set down roots somewhere.”
“Probably 80% of the locum assignments I’ve been offered have the ability to transition to a full-time, permanent practice.”
He points out, however, that working locum is a great way to try out a practice before joining permanently. “That might be ideal,” Dr. Birinyi says, “particularly in smaller towns or locations where people aren’t sure they want to relocate to. Probably 80% of the locum assignments I’ve been offered have the ability to transition to a full-time, permanent practice.”
What about veteran locum physicians? Pediatrician Shaun S. Berger, MD, has already changed his locum work to meet the needs of a growing family. Will he have to rein in his locum work even more as his children get older? While Dr. Berger says he can’t rule out that possibility, he points out that he makes up for the days he spends away from them with huge blocks of time spent at home.
Anesthesiologist Elizabeth Noel Lumpkin, MD, has worked locum for a dozen years. She says the one thing that could bring her back in from the road is the health of her 80-year-old mother, who lives with her. “Thankfully, my mother is in good health,” she says, “but if she needed more support from me, that could change things.”
For now, however, Dr. Lumpkin plans to work locum until she retires. “I can confidently say that I cannot think of any job that someone could offer me that would make me want to leave locums.”