[Editor’s Note: This guest post is written by Dr. Doug Segan, a board certified EM physician and attorney. He currently teaches at Zucker Medical School at Hofstra University in Long Island, NY. We have no financial relationship.]
When physicians consider working locum tenens, before signing the contract, they will generally do a fine job investigating if the clinical aspects of the job will suit their skill set. We want to know in advance the type of clinical responsibilities that we will have, the medical and nursing support that is available, the patient volume and our work schedule.
This article, however, will focus on the non-clinical aspects of a locums job. These are the items that we frequently overlook that can make or break the experience. Doing the same due diligence with these ten points that you do in finding out about the clinical aspects of your potential next locums job will increase the likelihood of having a great experience. There is a myriad of reasons why physicians work locums. In my case, my ED group lost our hospital contract after many decades. I was out of a job but not ready to retire. Locums appealed to me because I wanted the freedom to work when I wanted to and I wanted to explore some new parts of the country. I was fortunate enough to have a delightful experience working locums jobs as a civilian military contractor at Naval hospitals in SC and NC and in several small civilian hospitals in northern Michigan.
9 Non-Clinical Questions to Ask That Will Ensure a Happy Locums Gig
1. What is my malpractice insurance coverage?
Malpractice insurance policy language can get complicated but you must make sure that your coverage is sufficient and is provided by a highly rated insurance company. WCI has a number of articles that will help you evaluate the malpractice insurance that you are being offered.
I was one of a group of locum and local health care providers that were named in a malpractice suit in Northern Michigan. Thankfully, I was protected by an excellent insurance company that provided superb support and exemplary legal representation and I was dismissed from the case after three years of discovery. Your financial and emotional well being is at risk so you must make sure that you will have decent malpractice insurance coverage.
2. Will I receive help with all the licensing hurdles and the hospital privileges forms?
Dr. Doug Segan
One of the negative aspects of working locums is the time and the cost to become licensed in other states and the time-consuming process of obtaining hospital privileges. It is a big plus if the locums company that you are considering will cover these costs and provide serious assistance taking care of all these forms.
I ended up working at a military hospital because one attractive aspect of working in federal government medical facilities is that you can generally use your current state medical license. For example, I was able to use my Michigan medical license when I worked in Naval hospitals in SC and NC.
3. Will you be paid for orientation time and overtime?
Becoming familiar with a new EMR and a new medical culture takes some time. When I first started working in a military hospital it took me several days to get oriented to a Naval hospital ED before I saw my first patient. Find out in advance if you will be compensated for this time and if you will be paid for overtime and at what rate.
4. May I have the names of several doctors who have worked with you at this location?
It is nice to hear rosy descriptions of a job that you are considering from the locums company and from the hospital department director. Much more valuable is conversing with doctors who are working at the site now or have worked there recently. You should also talk to doctors who are working with the locums company that you are considering.
5. Where will I be sleeping?
A good nights sleep (or in the case of many of my ED rotations, a good day’s sleep) is essential to a good locum’s rotation. If the hotel halls are noisy and there is a lot of ambient light and the HVAC system noisily goes on and off all day and you are sleep deprived then it will be a tough rotation.
There are folks who can sleep under any condition but I need a quiet room with my white noise machine or fan going and no ambient light coming in the room to be able to sleep well. If this is critical to you then make sure your locums company will work with you to make this happen. I have had to switch hotels and switch rooms to get this right. I would often buy a large fan at Wal-Mart at the start of my rotation to make white noise. I often used my collection of old clothespins to keep the curtains tightly closed to reduce light streaming in. My best luck in terms of quiet hotels has been at the Hampton Inn chain. They seem to be quieter than other hotels that I have stayed in and their complimentary breakfast is a convenient time saver. I always ask for a top floor room away from the traffic and far from the elevators and the ice machine. Having a gym, pool and whirlpool were hotel amenities that also made for a better experience for me.
I strongly recommend finding the closest suitable hotel to your work venue. When working in a new town you will not be used to the typical traffic patterns and the specifics of the rush hour and the shorter your commute the better. Being late when you are working locums is a major way to burn through any good first impressions.
When I worked in critical access hospitals in Northern Michigan I usually stayed right in the hospital so I did not have to worry about a commute or the road conditions after several feet of snowfall. It saved the locums company money and I could get some extra sleep.
If you will be needing a rental car you like to hear that the locums company wants you in a safe and comfortable ride. I saw lots of deer and one moose on my drives to the Upper Peninsula in Michigan and car-deer accidents were very common. The winters are notorious for major snowfalls and whiteout conditions. Thankfully, my locums company understood this and always provided a seriously heavy rental vehicle for me.
If you are flying to your rotation, it is nice to have a locums company that puts a priority on your time and convenience while also trying to find reasonably priced flights.
6. Are travel expenses covered in advanced or are you reimbursed?
I have worked for locums companies that take care of all your transportation and housing expenses in advance and you never have to pull out your credit card. In contrast to that model, I have also worked for companies in which you pay for all your travel expenses and after the rotation, you submit a request for reimbursement.
The financial end result is the same with both models, but the former is so much nicer and makes you feel very important.
7. Will the travel expenses of your spouse/significant other be covered?
If you plan to bring your partner, ask if the locums company will cover the additional travel expenses. The answer to this and similar type of questions will give you some preview of how the company will be dealing with you financially. You will get a sense of their generosity or frugalness when you ask the company about miscellaneous expenses like this. It is a nice forecast as to how you will be treated on more important financial issues.
8. Will I have a lunch or other break?
I know there are doctors who can work all day without a meal or bathroom break. For the rest of us, these niceties are essential. If they are important to you, make inquiries about these non-clinical logistics before you sign the contract.
9. What is there to do on my time off?
Your locums company may have some suggestions about your travel destination but this is a topic to research on your own. I only agreed to a locums job if I thought there were interesting places to explore nearby. If you discover interesting day trips, ask your locums company how flexible they are about flying you in a day or two early so that you go to someplace new. This was one of the big highlights of my locums rotations and the companies I worked for were very accommodating in this regard. On almost every rotation I tried to tie in an interesting place that I wanted to explore.
Locum tenens work can be both financially and spiritually rewarding. In addition to doing your due diligence about making certain that you are well suited to the clinical aspects of a potential locums job, you should also spend some time making sure that the non-clinical aspects of the job and the locums company will enhance the likelihood that you will have a rewarding experience.
Have you worked locum tenens jobs? What was your experience with non-clinical aspects of the work? What suggestions would you add to help others have a good experience? Comment below!
Great points. Seems like the headaches of learning the system (electronic records etc) could be a big barrier in addition to licensing and credentialing. I suppose that’s why locums tend to come back to the same locations repeatedly.
Thanks so much Todd!
I concur!
Good post but you missed the number one question- why does the employer need locum tenens? The answers range from all the other doctors quit because it is intolerable, to expanding and exploring candidates. Unfortunately, the more money is usually for the former. You also wont get the ‘truth’ until you have boots on the ground.
Excellent point Reuben71!
Yes, that is the elephant in the room that I did not even see.
I concur that you should at least try to find out why they need locums help.
Good list but there are only nine reasons not ten.
Good catch Amphora! Thanks!
The elusive 10th item escaped!
“You will get a sense of their generosity or frugalness when you ask the company about miscellaneous expenses like this. It is a nice forecast as to how you will be treated on more important financial issues.”
Staffing agencies are in this to make money. From, my experience, frugality is not in their interest. They pass on all of the travel and hotel expenses, plus 10% to “arrange” (reimburse) those expenses, to the groups employing. They make a lot of money off of each person they place. They forbid the groups from letting the locums MD know how much they are paying for them, too, probably to avoid people finding out how much they could really make.
I agree with the overview of locums and that they can also be pretty rewarding. I worked for one company but at several different locations before my present job. I did it for travel and because I wasn’t ready to sign up for a long term job. I agree with Reuben71 that ‘why’ they need locums is an important question. That being said, many places have good nurses, good facilities and horrible management. They are extremely thankful to have good ER-trained docs and you really feel like you are helping them out.
I will say that locums companies are definitely in this to make money, otherwise they wouldn’t exist. That being said, if you don’t want the hassle of dealing with all of the details- a good company can be really helpful and save a lot of time. You can also stop them from approaching specific areas/jobs so that you are not bound to using them for specific positions. I always made it clear where I didn’t want my resume going because if I wanted to do the legwork I would be able to make more money and not jeopardize the potential of a long-term position because of an expensive buy-out.
Good post and good reminder that this can be a viable option when change is needed.