Is the locum lifestyle right for you?

Whether you're just starting out or looking to semiretire, temporary practice opportunities may be just the ticket.

By Gail Garfinkel Weiss
Senior Editor

In 1993, after the birth of her fourth child, FP Noreen O'Shea took her first locum tenens job. "I wanted the freedom to work or not work as my family's schedule allowed. I didn't want to buy into a practice or fit into someone else's mold," she says.

Indeed, if there's a watchword to describe locum work, it's "freedom." Locum tenens is the practice option of choice for physicians who want to travel, work when it suits them, sample different practice types and settings, learn new techniques, or ease into retirement. It also offers freedom from nettlesome aspects of practice, such as overhead expenses, administrative hassles, and office politics.

You're not freed from putting in a hard day's work, though. And the itinerant lifestyle—living out of a suitcase, few opportunities to develop long-term relationships with patients and colleagues, limited (if any) health care coverage or other benefits—requires ingenuity and an ability to adapt.

Internist and gerontologist Ronald D. Vanden Brink, who has been on the locum circuit since 2001, advises physicians to approach temporary assignments "with a heavy dose of humor, a strong sense of adventure, and plenty of flexibility." (Read Vanden Brink's own story—chock full of tips—in "A locum adventure".)

Becoming a locum tenens: What's in it for you?

Almost 27,000 physicians worked on a locum tenens basis in 2001, according to Staff Care, a recruiting firm based in Irving, TX. About a quarter of locums were women, and 11 percent had just completed residency or fellowship programs—up from just 1 percent five years earlier. "Much of this," according to the Staff Care survey, "is because younger physicians want to 'test drive' opportunities before settling into a permanent practice setting or location."

The amount of work available for primary care physicians has held steady in the locum market, while the need for radiologists, anesthesiologists, and psychiatrists has soared—due, in part, to an overall decrease in the number of these specialists. But no matter what the specialty, the demand for locums exceeds the supply (see "Top 10 locum specialties").

Ron Vanden Brink never planned to become a locum, but he hasn't regretted his choice. "Initially, I envisioned filling in for doctors who were on vacation for a couple of weeks," he says. "The reality is that most locum placements are in underserved areas where a doctor has retired or left the community and the practice is having difficulty finding a replacement. These practices want you to stay as long as possible. To date, my shortest placement has been four weeks; my longest, four months."

Being a locum doesn't necessarily mean traveling to remote outposts—or even to another town. Family and occupational medicine physician Rich Sagall does several simultaneous locum jobs in the Philadelphia area, where he lives. And urban multispecialty groups, like the 250-physician Sutter Medical Foundation in Sacramento, often hire a locum if a staff doctor becomes ill, goes on maternity leave, or resigns, says internist Eugene Ogrod, the group's former chief medical officer for development.

Most locum staffing agencies try to place doctors near family or in areas where they can indulge in a favorite pastime. Ogrod acknowledges that the nearby ski slopes attract some who sign up with his group. "Explore all options, and pick an assignment that puts you where you want to be at the right time of year for your weather and adventure preferences," Vanden Brink advises.

Working as a locum won't make you rich, but it can be lucrative. Primary care physicians who contract with Staff Care, for example, make $8,000 to $9,000 a month, depending on how much call they take, says David Schumann, vice president of primary care. As a self-employed locum in Sioux City, IA, Noreen O'Shea asks for—and usually gets—$75 to $95 an hour, based on patient mix, complexity of care, and who pays for her liability insurance.

Lining up an assignment: agency or do-it-yourself?

In the locum world, you can go it alone, or cast your lot with a locum tenens agency.

Vanden Brink prefers the latter option. He recommends signing with at least two agencies, and providing as much detail as possible about your location preferences, time off requirements, and other inclinations.

Rich Sagall, on the other hand, developed his own referral network. The clinics he works for provide malpractice insurance, and one place where he's done fill-in work for three years even includes health insurance for him—a rarity for part-timers in any profession.

In general, an agency:

• Insures its doctors and expedites licensing and credentialing. Be prepared to have your claims history scrutinized. "If our insurance carrier won't cover a physician, he's not working for us," says David Faries, Staff Care's director of corporate communications.

• Arranges for travel, rental car, and lodging.

• Pays doctors directly, so they don't have to track their pay from job to job.

In contrast, when you arrange a locum assignment on your own, you often must make all travel, housing, and meal arrangements, and deal with any changes or problems. "There's no third party to buffer the situation," says FP Ronald S. Jolda, an experienced locum based in Webster, MA.

You also might need to carry your own malpractice insurance. If a practice insures its doctors, however, and you're subbing for one of those physicians, his or her insurance will probably cover you. "We've already paid that premium," says Ogrod. "If a locum isn't filling in for someone, we might have to pay an extra fee, but our carrier has a provision automatically covering a certain number of locums."

Going it alone also requires considerable networking. Before becoming a locum, Rich Sagall worked full time for several years, got to know local clinic administrators, and learned which clinics regularly needed additional help. "I assembled a client base of clinics where I could work with a certain degree of regularity," he says.

With locum jobs, Jolda points out, "you don't build equity. But you can build a reputation, and you can work steadily."

Living and working as a locum

Most practices that hire locums reimburse them for their travel expenses, Ron Vanden Brink points out. "The usual payment for physicians is mileage (36 cents a mile) or airfare (coach), whichever is cheaper. This is often negotiable, though, so don't hesitate to search for the best deal possible." But don't expect to be reimbursed for your spouse's travel expenses or your children's, he adds.

Taking a spouse and children along requires some careful planning, but it's becoming increasingly common as more doctors opt for the locum life. When Ron Jolda took an extended assignment in a small town, he put his five children in the local school. "The school had 60 students, so we increased enrollment by almost 10 percent," he says.

Once you've settled in, it's time to get to work. Despite the hiatus from business decisions, Eugene Ogrod cautions against viewing your locum experience as an opportunity to duck everything except patient care. "We've had locums who say, 'You hired me to see patients, not do paperwork.' My response is, 'No, you were hired to do a full practice, and that includes paperwork—and, especially in California, dealing with managed care.' "

In any location, it might take you a while to get your bearings, so don't hesitate to ask questions. Even the patient care aspect of locum work is apt to differ from what you're used to. Vanden Brink says that in the medically underserved areas he's been to he sees more acutely ill patients and has been asked to do things usually not required of internists in a multispecialty group, such as suture lacerations, drain abscesses, debride skin ulcers, and freeze skin lesions.

You must also conform to your assigned practice. You're not apt to last long if you have a tendency to shake things up. "You want to be transparent," says Sagall. "If I see something that's obviously incorrect, I'll say so. Otherwise, I try to go with the flow."

Top 10 locum specialties
(by demand)

Radiology and psychiatry each accounted for 16 percent of requests for a locum tenens in 2001; family practice for 13 percent. For every family practitioner available for temporary work, there were 1.63 requests from hospitals, multispecialty groups, clinics, and other employers.

Specialty

Demand

Opportunities
per physician

Radiology

16%

2.91

Psychiatry

16

2.54

Family practice

13

1.63

Anesthesiology

10

2.89

Internal medicine

8

1.61

Child psychiatry

4

8.64

Emergency medicine

4

2.01

Orthopedic surgery

2

4.11

Cardiology

2

2.72

Pediatrics

2

1.53

Source: Staff Care, from its 2002 Review of Temporary Healthcare Staffing Trends and Incentives

A locum adventure

By Ronald D. Vanden Brink, MD, and Jan Biddick Vanden Brink

We jumped into locum tenens work in 2001, after the clinic Ron had practiced at for 33 years went bankrupt and the plunging stock market shrank our retirement fund. The following nuggets of wisdom, which we've gleaned along the way, might prove helpful if you're considering locum work:

Housing and dining. Your housing will be adequate, but you will not be staying at the Ritz. To reduce the element of surprise, we strongly advise that you call your landlord before you leave home and have him describe your lodgings in detail.

During one placement in Washington state, we lived for six weeks in a Best Western hotel room next to a busy truck stop. Because we had only a microwave, sink, and small fridge, we had to forage for home-cooked meals. The local church we attended offered these on Wednesday nights, and we became regulars at community dinners and school fundraisers.

Once we stayed at a honeymoon B&B that had lots of lace and hearts everywhere. The owner was an exceptionally good cook. For another job we were housed in a furnished apartment with a large kitchen. To secure pots, pans, and utensils, we raided the kitchen of an empty apartment and searched local thrift shops. When we left, we sold some of the supplies we'd bought to the landlord and donated the rest.

Make your space your own during your stay. Plan to bring a few special treasures from home. Family photos are a must. Fill in the rest with thrift store finds, flowers, and seasonal decorations. But remember, you're there to make money, not spend it.

Social life. As with other aspects of locum life, attitude is everything. You can sit in your tiny apartment or motel room, or go explore.

Acquaint yourselves with your new community before you leave home. Get online and visit the area's Web sites to find out about local weather, history, attractions, and newspapers.

We try to locate a church as soon as we arrive in town. Besides getting spiritual nurturing there, we've met many people who have helped us acclimate to the community. We follow their recommendations for restaurants, local haunts, and shopping.

To date, our jobs have been a long way from home, so we've always rented bicycles. In one town, no rental bikes were available. We heard about a police auction of unclaimed stolen goods, and bought two junker bikes for $10 each. After spending $25 for repairs, we had the bikes up and running. When it was time to leave, we donated them to a thrift store.

Volunteer opportunities for locum spouses abound—check the local paper. A side benefit of volunteering at the Humane Society is that it helps ease the homesick pangs for pets left behind. Socially speaking, the best possible scenario is to connect with another locum couple. Exploring is all the more fun when you can share it with others.

Staying in touch. E-mail is a godsend for communicating with family and friends. In our present housing, Internet service is impossible because several tenants share one phone line. But the local library offers free e-mail and Internet access.

Whenever possible, before leaving for a new locum job we give everyone our new address—it's a treat to receive handwritten letters when you're far afield. We explored different ways of having our regular mail forwarded, and settled on the "snowbird service" our home post office provides. We leave money on account with the post office, and once a week it sends us all our mail, including periodicals, in one package.

Enjoying the rewards. A bonus of locum tenens work is that the practice really needs you, and the physicians, staff, and patients appreciate your help. Once you're through the orientation phase, locum work is as enjoyable as regular office practice, and much less stressful.

We believe locum tenens work is a viable way to supplement shrinking or inadequate retirement income while staying active and current in medicine. And you can have a very good time.

Ronald Vanden Brink is an internist and gerontologist. His wife, Jan Biddick Vanden Brink, is a social worker. When Ron's not working as a locum tenens, they live in Petoskey, MI.

Gail Weiss. Is the locum lifestyle right for you?.

Medical Economics

2003;6:78.