Interview with Dr. Stephanie Freeman
Today, my guest explains why locum tenens is the best way to practice on your own terms. This is especially true when starting your career following residency or fellowship.
Dr. Stephanie E. Freeman is a board-certified critical care specialist, best-selling author, speaker, and consultant. In addition, she is the expert in helping doctors discover alternative careers in medicine.
As Founder and Chief Medical Advisor of DrStephanieICU.com, Dr. Stephanie discusses real-world career strategies to help physicians “think outside the box” regarding their careers. By sharing advice on how to find alternative careers, Dr. Stephanie helps physicians practice medicine on their own terms.
Our Sponsor
We're proud to have the University of Tennessee Physician Executive MBA Program, offered by the Haslam College of Business, as the sponsor of this podcast.
The UT PEMBA is the longest-running, and most highly respected physician-only MBA in the country. It has over 700 graduates. And, the program only takes one year to complete.
By joining the UT Physician Executive MBA, you will develop the business and management skills you need to find a career that you love. To find out more, contact Dr. Kate Atchley’s office at (865) 974-6526 or go to nonclinicalphysicians.com/physicianmba.
Stephanie earned her medical degree from the University of Alabama School of Medicine. She completed her Internal Medicine Residency at Wake Forest University Baptist Medical Center and her Critical Care Fellowship at the University of Pittsburgh Medical Center.
She also completed a Geriatrics Fellowship at Wake Forest University Baptist Medical Center. And she obtained an MBA at Auburn University.
Locum Tenens Is the Best Way to Practice
Stephanie started working in a private medical group after completing her fellowship. The group attempted to transition from its traditional outpatient-based practice to an in-house hospital-based service. It did not go well, and ultimately Stephanie lost her job with the group as a result.
But that provided an opportunity for her to complete her MBA. And while searching for her next opportunity, she discovered locum tenens. She was amazed by the practice model. It aligned well with her needs and her desire to run other side hustles.
Coaching and Speaking
Stephanie's enthusiasm is contagious. So is her love of locum tenens as a way to practice on her own terms. If more of us would follow her example, I think we might enjoy our clinical careers much more. She has developed her speaking and coaching by teaching others about locums and other nonclinical careers.
To learn more about all that she does, you should visit her website at drstephanieicu.com. Better yet, if you want to access Stephanie’s Free 5 Step Process for getting a locums position, go to freelocumstraining.com.
Licensed to Live Conference July 16 & 17, 2021
I know that I’ll learn more about locums myself when I attend Dr. Stephanie’s presentation at the upcoming Licensed to Live Conference in Philadelphia. It’s not too late to join Stephanie and me there. I will be sharing my expertise about unconventional career options based on almost 4 years of interviews with experts on the topic.
You can learn all about the conference at www.licensedtolive.com. Don’t forget to use my Coupon Code “nonclinical” (all lower case) to get a $50 discount on the registration fee. That also lets Dr. Jarret Patton know that I invited you.
Summary
The passionate coach and speaker Dr. Stephanie Freeman explains her reasons for choosing locum tenens as the best way to practice. And she provides advice and inspiration for physicians looking to bring more freedom and success to their professional lives.
NOTE: Look below for a transcript of today's episode that you can download or read.
Links for Today's Episode:
- Dr. Stephanie Freeman's Web Site
- Free Locum Tenens Training
- Licensed to Live Conference (Use “nonclinical” coupon code for a $50 discount)
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Transcription PNC Episode 202
- Why Is Locum Tenens a Doctor's Top Career Alternative? - Interview with Dr. Stephanie Freeman
John: In less than three weeks from the release of this episode, I will be participating in the live licensed to live conference at the Marriott Philadelphia hotel, organized and presented by Dr. Jarret Patton. I can't wait. And one of the esteemed presenters at the conference is here with me today. She's a sought-after speaker, author of several books, expert on entrepreneurship, nonclinical careers, and locum tenens where she's done a lot of. So, Dr. Stephanie Freeman, welcome to the PNC podcast.
Dr. Stephanie Freeman: Thank you so much John for having me. I'm so excited and honored to be here.
John: Well, it's my pleasure because I love to hear about non-traditional careers. So that's where the locums come in. I also like to talk to other people who are doing coaching for physicians or with physicians and teaching entrepreneurship. So, we have a lot to cover today. Before we get into the nitty-gritty here, I need to know about your background a little bit and clinically what you have been doing, but where your education was. And then we can segue into what you're up to now.
Dr. Stephanie Freeman: Yes. So, I'm Dr. Stephanie Freeman. I'm a double board-certified critical care physician, born and raised in Alabama. So, the accent is a real accent. I am a true southerner. I was born and raised in Tuscaloosa, Alabama. I live in Houston, Texas. So, like I said, I am a true southerner.
I did medical school at UAB School of Medicine. I did an internal medicine residency at Wake Forest University School of Medicine. Then I did a geriatrics fellowship, and then I did a critical care fellowship at the University of Pittsburgh. And then I got my MBA at Auburn University and I'm double board-certified twice over. And it's about time for me to recertify in internal medicine in 2023. And so, those recertification years, whew, they kind of come at you quickly.
And I've been doing locums since 2008. And so, I am a locum's expert. I live the locum's life. I am currently on a locum assignment in Alaska right now. I work anywhere between 14 and 21 locum shifts a month. So, I am truly living the locum's life.
John: Awesome. So, we're going to definitely get into that because I have a lot of questions about just your personal experience with locums. But I do want to segue a little bit, or at least make a right turn here because I know you're doing other things. You're teaching other physicians, you're a speaker, you've written several books. So, tell us how those activities started out.
Dr. Stephanie Freeman: You know how in medical school and in residency, there was always that one physician that was always doing other stuff, that always had like a side hustle going on, that was always the one that was moonlighting? I was that physician. I was that girl. Because it goes back to how I was raised. My parents got divorced when I was young and my mother is a teacher and she just retired after 42 years of teaching. And so, my mother was the teacher and she was raising two kids on a teacher's salary and it was tough. But she always had extra jobs. In addition to the full-time teaching, she always taught extra jobs, always did extra stuff, just so that she could take care of us. And so, I picked up that from her.
And then my mom was also an entrepreneur as well. She always told us about the importance of owning your own business. Then she had always been a strong believer that entrepreneurship was the way to go. So as a matter of fact, my mother was the one who told me to go back and get my MBA because she's an English teacher. She reads, she knows about the different trends that are coming because she spends all day reading because she's an English teacher.
And so, she was like, "You really need to go back and get your MBA because I really foresee that that's something that physicians are going to need". So, I kind of had that in my bones. Always about, I love medicine, but I love entrepreneurship. And there are so many other things that I want to experience and do and be.
I would tell you that I fell into locums and that it was a fairytale story, but there are no such things as fairy tales. Actually, the way I fell into locums was the fact that after I finished my training at the University of Pittsburgh and John, you know how we are all so idealistic when we finished training. And we think that we're just going to save the world because we think that everybody's going to welcome us with open arms and experience, love us for what we have to offer as physicians who want to change the world. Well, we know it doesn't happen like that.
So, my first job out of fellowship, here I was finishing up a critical care fellowship at the University of Pittsburgh. The University of Pittsburgh was where critical care was born. So, we're all about critical care and right here, right now with the intensivist model, I had really fallen in love with Pittsburgh and I wanted to stay and there was this nice little community hospital 10 minutes from my house. And I thought I was just going to work there and settle down and get married and have a family. And that didn't work.
So, I take this job with the private group. And so, you know where I'm going with this. So, a private group, pulmonary critical care doctors, here I am coming from an academic center that was used to the intensivist model. This private pulmonary critical care group is not used to that, but they're trying to transition to an intensivist model, and needless to say it didn't work out. So, my contract was not renewed and I was devastated. Because you don't hear about physicians undergoing contract non-renewals are A.K.A being fired. Nobody tells us about that in residency and fellowship. Nobody tells us about that.
The traditional physician employment model is either you are employed as a physician or you're in private practice or you're in academics. And the traditional model is that you stay at one job forever. So, we weren't prepared. And I was not prepared for this churning of the medical marketplace. And I was surprised and devastated needless to say, but remember, I'd always been that fellow and that resident that always had a moonlighting gig. I always had something in my back pocket. So, I was just able to be like, "Okay, well this isn't working out. Let me just call so and so from the hospital down the street, I still have privileges. Let me just slide into their schedule". Fine. No worries.
Then I was trying to figure out what I wanted to do. And I had these other business ideas that I was kind of dibbling and dabbling in. And my mom was like, "You really need to consider getting an MBA if you're going to do all of this extra stuff". And I was like, "Sure, I'll do it".
And the way I fell into doing locums, it's the funniest thing. I was at a critical care conference with my critical care bestie. One of the locums' companies had a display and I was like, "Huh, what is this?" And they just started talking to me. I was like, cool. They explained to me what locum was, but you have to remember, I had always done moonlighting. So, I was used to that concept of sliding in, filling in for a shift or a couple of shifts where I'm needed, leave, get paid, rinse and repeat.
I was already used to that concept. So, I was like, "You can really do this". So, when I took my first locums assignment, I was like, this isn't bad because I went, worked, and had a nice time. Money was in my account the next 10 days. And at that time, I was transitioning to getting my MBA. And I was like, I'll just work enough shifts to pay my bills, to support what I need to do. And I can focus on getting my MBA. So, that's really just how I got started with my locum's journey. It was kind of by accident, but by design.
John: All right. I got a comment on some of those things. First, you're right, in terms of the traditional way that we practice, because we're the type of business as a physician that you have to usually build a practice. So, if you're going to be a hairdresser or you're going to be a barber, or you're going to be a plumber, or are going to be a physician, you want to build a practice over time. It's kind of gone out the window now with the way people are churned through, you got a two-year or three-year contract, "Oh, we're not going to renew it for whatever reason". So, there's a lot of that now. And it has changed a lot. So, you didn't know though what locums wasn't necessarily, other than what you were doing with moonlighting, but once you found out, you really were attracted to that model.
Dr. Stephanie Freeman: I had no idea that it was a thing. I knew moonlighting was a thing, but I didn't know it was a thing and an entire industry. And there were higher agencies who did nothing but that. Because where we're coming through, we weren't exposed to that. And if we weren't supposed to, it was kind of like, "Oh, what's wrong with them? Why can't they get a real job?"
John: What was that first one like? Was it something that was recurring like every month after month, certain days? Or was it like a set for six weeks or weekends? How was that whole structure of that first one?
Dr. Stephanie Freeman: Maybe in a critical care physician, we work in shifts. So full-time critical care is like fourteen 12 hour shifts a month. And so, the staffing model is kind of like seven days on, seven days off 12-hour shifts either day or night shifts or day shifts with call. So, for that first assignment, I went to Pikeville, Kentucky. That's a whole nother conversation. I went to Pikeville, Kentucky. I worked at this hospital seven days in a row and took call at night. And at the time, for me, the money was bonkers. It was ridiculous. I'm like, "Y'all are paying how much money? Sign me up!" And so, I went really in the middle of nowhere, middle of Appalachian, black girl, black doctor, and I came out alive, survived it.
John: So, was that recurring? How long were you doing those seven days shifts?
Dr. Stephanie Freeman: I think I did that assignment for maybe four, maybe six months. And that's kind of typical for these things because when you take a locum's assignment it is usually because of one or two reasons. It's usually because the place is trying to build a program or they just lost some physician. So, they only need you for a couple of months until they're able to recruit and onboard their new physicians. And that's exactly what locum is. Locum is Latin for placeholder. That's exactly what you are. You're holding a place until a permanent physician arrives. And usually, they only need you for two or three months, three or four months, and you just fit into the schedule like they need you. And then it's off to the next assignment.
John: You've been doing locums for a long time, from what I understand. So, you've mentioned some of the reasons you like it or love it. Tell us some of the reasons why it's a good option for physicians. Particularly I would think someone who was looking to do something different, wants a little more freedom.
Dr. Stephanie Freeman: Absolutely. It's a great option because it allows you time to transition. We are all so tired. We've been in school for 20 years. And then when you get out of school, it's this constant grind, not of just being a physician, but also of having to, like you say, build a practice or establish yourself, or build a rapport or get being an attending physician under your feet.
And then there are the finances that everybody deals with. But we're not honest enough about it. So, you got these loans or you have these other obligations you need to pay back. But then again, at the same time, you're tired of living in self-deprivation. So, then you want to have a nice lifestyle. You want a house in a nice neighborhood, in a good school district. You want to be able to start taking some vacations.
Locums gives you the opportunity to say, "Okay, this traditional medicine thing isn't working for me. And I may not have quite figured out what I want to do, but I need to figure it out. But meanwhile, I need to be able to pay my bills". Locums give you the opportunity to transition. So, you can go from being an employed physician that has a whole bunch of restrictions, because you know that the employer physician contract is very restrictive. You may not be able to moonlight. You may not be able to write a book. They want to claim your intellectual property. You may not be able to go speak anywhere. They want to give you permission. You may not be able to do case reviews or legal depositions.
When you're an employed physician, there are so many things that you can't do. Meanwhile, we are all multitalented and the whole world needs all of us. And you want to transition to some of the other things, but you still have bills to pay.
So, I look at sometimes locums as being that middle ground that's going to help you get to your promised land because you can leave traditional employment, transition to nontraditional careers, nonclinical careers, but locums will give you the finances that you can still do it. Because you can still moonlight. You can still do locums because you're an independent contractor. You're still making a great salary, but you don't have the restrictions of an employed physician.
So, these places where I go work, they know me as Dr. Freeman. They don't know me as Dr. Stephanie. They don't know that I do locum coaching. They don't know that I have books. They don't know that I have webinars. They don't know and they don't care because they've contracted with Dr. Freeman. Dr. Freeman is going to work these 14 days. Dr. Freeman is going to do her job and take care of the patients and not mix and mingle things.
While I'm working for them, I'm doing critical care work. But when I'm not at that hospital and when I'm not on the clock, what I do with my time is my time and they have no claim to it. And that's not necessarily the case when you're an employed physician. So that's what locums are able to help people do. Locums can be the bridge to, like I said, your dream life from where you're coming from.
John: Yeah, I hadn't thought about that before. I've talked to people who've done locums and it never occurred to me that it's ideal for those that are natural entrepreneurs. People diversify their income through other passive income or active income activities. So yeah, it really gives you, you just have to plan things out appropriately, obviously, during those times when you're not working as a clinician. And I would assume also it varies a little bit by your specialty. But yeah, it sounds pretty attractive.
Dr. Stephanie Freeman: Oh, it is. It's amazing. I was just on the phone the other day with a gynecologist who is going through a horrible time at her job. But she's an entrepreneur and she's building an amazing beauty brand. And I'm like, "Honey, let me help you do locums so that you can fulfill your real dream and your real calling with your beauty brand and your entrepreneurship. Let me help you with that transition". Because I'm like "You know it's time for you to go. It's time for you to leave that job and transition over. And that's why you're having problems on that job because you know you need to leave. Let me help you transition through".
John: All right. We're going to talk about some of the other things you're doing, but I do want to have you maybe give us two or three landmines to avoid, so to speak, or things that we need to be a little careful about if we decide to pursue locums.
Dr. Stephanie Freeman: The first thing that you really need to be careful about, I say your locum's experience is really made or broken based on the company you choose to work with. And so many physicians when they get started have a bad experience because they didn't work with the good locum's company or a good locum's recruiter who really explained the process to them. A lot of physicians ended up kind of feeling like they've been taken advantage of.
So, I would say the first thing you need to do is really vet these companies and vet these recruiters so that you can make sure that you're getting somebody who is going to treat you fairly. That's the first thing.
The second thing, and I think this is the biggest thing that a lot of physicians fall prey to, is not managing their expectations. A lot of physicians have either unrealistic expectations of what locums is, or they just don't know what to expect. And they think everything is going to go perfectly. And we physicians are type-A people and we expect everything to be done decently in order.
But one of my favorite recruiters used to say something to me that really made a difference. He said, "If these places that need your services had everything together, they wouldn't need you".
John: That's true.
Dr. Stephanie Freeman: So, think about it. If they had everything together, they wouldn't need temporary physicians because their physicians wouldn't have quit or they wouldn't have been in turmoil if everything was together. So, I have to tell my physicians who are going on these assignments to keep an open mind and to go with the flow because things are not going to run smoothly. Because if everything was going to run smoothly and be perfect, they wouldn't need you to be there.
And so, once you kind of lower your expectations and be like, "Okay, it is what it is. I'm just here to see the patients and make sure these patients get the care that they need and let everything else kind of fall into place".
John: Now, at the same time, I've heard from some of my friends who have done locums that they usually welcome you. They're looking forward to having you there because they really need you.
Dr. Stephanie Freeman: Yeah. Some of them are. They're like, "Oh my God, you're here. Thank you for coming. We need help". So, it's actually been kind of fun, but at the same time, you can walk into some pretty nasty political situations. And that goes back to getting a good recruiter who is giving you the 411 about what is actually going on and why you're actually there.
I've walked into some situations in which it's like the group that was there, unceremoniously lost their contract and it was a big deal. And then they're bringing locums in until they can bring the other permanent doctors there. And so, then it's a lot of chaos. It's lot of hurt feelings. People have chips on their shoulders and they're taking it on the locum's doctor. And you're like, "I'm just here to work. I don't know anything. I'm sorry". So, I've been in those situations as well too.
John: But you're there to take care of the patients, right? The patients need you. And so, you've got to fill in while they're trying to sort through their political messes.
Dr. Stephanie Freeman: Exactly.
John: We're going to be at the conference in a few weeks with Dr. Jarrett Patton. And so, are you going to be covering this topic? What are you going to be talking about at the conference?
Dr. Stephanie Freeman: What I'm going to be talking about in the conference is how do we locums and considering locums during this pandemic. And the reason why I'm talking about this is because, as you know John, this COVID pandemic has completely ended the way medicine is practiced. And I think a lot of physicians are now realizing that we are seen as disposable.
We have physicians who literally put their lives on the line, continue to work throughout this pandemic, which is still going on. We worked extra hours. We faced unsafe situations. We worked with a lack of PPE. We will call it heroes and some of us got thanked by what? Getting fired? Contracts not renewed and facing pay cuts? And that's because the market has changed because money has changed. Cash flow has changed.
And so, I'm here to really talk about how physicians who are in this churning of contracts are being renegotiated because hospitals and healthcare organizations are redoing their practice models and their financial models, how physicians can utilize locums as a way to kind of shore up themselves personally and professionally and financially.
Because even though we think the pandemic is over, we physicians know it's not over. The numbers are dropping, but we know this isn't over. And we're now seeing the financial ramifications of this. I've talked to many physicians who have just lost their jobs. I've talked to many physicians whose contracts are being renegotiated and not in a favorable way.
So, I'm going to talk about how we can use locums and the types of locums that we need to be doing in order to be able to navigate these market changes that have happened as a result of this pandemic.
John: Okay. So that's going to be awesome. I'm definitely going to have links later in the show notes for the conference. Licensedtolive.com basically is going to be where you go. But I'll talk more about that in my outline. But the thing is not everyone is going to be able to come to that conference. Although I want everyone to come and say hello to both of us if they can. So, they can get some more information and training about locums from you directly, from what I understand at www.freelocumstraining.com.
Dr. Stephanie Freeman: That's right.
John: So, tell us a little bit about that. What will we get out of that?
Dr. Stephanie Freeman: Yeah, this is just a little introductory course that really will give you the basics about what you need to do to get started doing locums right now. Just an easy five-step process. And I've had so many people get this and get started with it because I tell everybody the time to get started with considering locums is now. If it has crossed your mind, then it's time to get started now. And so, that's what that course is about. It's a free course, and it talks about just the steps you need to take in order to begin your locum's journey.
John: I'll put that link in there, but there is planning involved in doing locums from what I understand. So, you don't want to just jump into it and think you're going to have your first position in a week from now.
Dr. Stephanie Freeman: No, no, no. I will take you through the process.
John: That'll be awesome. But now with the locums that you've done, and you're obviously creating courses for people, but you're doing some other things. I saw that you're a speaker. Can you tell us some of the venues you've talked at?
Dr. Stephanie Freeman: Yes. I have spoken at The Momentum and Medicine conference, which was amazing. I've also spoken in The Women and White Coats virtual conference. And then I also did a talk about locums for the virtual conference for the American College of Osteopathic Obstetrician and Gynecologists. And that was amazing and it was extremely well-received.
John: Very nice. And then you've got some books. I read that your most recent book is about locums. So, we can get those on Amazon, right?
Dr. Stephanie Freeman: That is correct.
John: And of course, you have your website, which is drstephanieicu.com. Also, you're doing some coaching. So, tell us about that.
Dr. Stephanie Freeman: Yes. I am doing some coaching. And I have some online coaching programs and online courses because what I really want to do is to allow physicians to know that they have options. There are so many people that are on the verge of just hanging up their white coats and their stethoscopes. And I'm like, "You don't have to do that. There is a better way. Let's figure it out".
So, I do some one-on-one coaching and I also have some online courses that are designed to walk physicians through the process in more detail and tell them about not only how to get clarity about why you're doing locums, how to look for good recruiters, how to choose assignments, what is a good market rate to get paid for your assignments, but also some of the business issues and the tax issues and the legal issues that are associated with being a locums doctor and an independent contractor. So, I do have some online courses for those as well.
John: Yeah. I think that's a big thing that some physicians forget about is if you're going to be doing any kind of freelancing or locums, things like that, you really have to have your own LLC and set up the proper structure, protect yourself liability-wise.
Dr. Stephanie Freeman: And pay those taxes.
John: Taxes? Oh, yeah. You've got to make those estimated tax payments during the year, or are you going to be in for a big shock at the end of the year. But it's good. You're a natural entrepreneur and your mom pushed you for that MBA. That gives you a little head start than let's say the typical physician who's come right out of residency and never thought about those things.
Dr. Stephanie Freeman: You know what? I love working with residents. I do. And I think it's an excellent way for them to get started in their medical career. Because what I like to tell residents who are about to be attending is to say that "You don't know anything about your style as an attending. You don't know what you value. You don't know what's important".
And sometimes they feel a relief that they can just do locums and not have to worry about signing a three-year contract right off the bat. So, it gives them some leeway. It gives them some breathing room. It gives them six months, eight months to take some time to relax and know themselves as human beings and really a way through this job market and to make the right choice. So, anybody can do locums at any stage in their career.
John: It sounds like if you're doing it at the beginning, you get to check out some different geographic locations around the country, different structures, big groups, little groups, rural, big cities. So yeah, it makes a whole lot of sense, especially at the beginning, but I've known people that have done it at all parts of their career too.
Dr. Stephanie Freeman: All parts.
John: All right, now we're going to have to go soon. So, do you have any last bits of advice for our listeners who are thinking about nonclinical careers or locums, or other nontraditional careers?
Dr. Stephanie Freeman: I say, go for it. There are so many opportunities out there. And I say, do your research, keep an open mind, but don't be afraid to go for it. And the time is now.
John: Awesome. Great words of wisdom. I can't wait to talk to you face to face in Philadelphia in a few weeks. That's going to be fun and we're going to really try to inspire the guests that come and listen to the students and people that attend. And so, before we go, I will, again, recommend if you are interested in locums to go to www.freelocumstraining.com or go to drstephanieicu.com to see everything else that Stephanie is up to. And I want to thank you for being here today. It's been great. And I think my listeners are going to love this episode.
Dr. Stephanie Freeman: Thanks for having me and I'll see you in Philadelphia.
John: Okay. Bye-bye now.
Dr. Stephanie Freeman: Bye.
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Transcription PNC Episode 202
- Why Is Locum Tenens a Doctor's Top Career Alternative? - Interview with Dr. Stephanie Freeman
John: In less than three weeks from the release of this episode, I will be participating in the live licensed to live conference at the Marriott Philadelphia hotel, organized and presented by Dr. Jarret Patton. I can't wait. And one of the esteemed presenters at the conference is here with me today. She's a sought-after speaker, author of several books, expert on entrepreneurship, nonclinical careers, and locum tenens where she's done a lot of. So, Dr. Stephanie Freeman, welcome to the PNC podcast.
Dr. Stephanie Freeman: Thank you so much John for having me. I'm so excited and honored to be here.
John: Well, it's my pleasure because I love to hear about non-traditional careers. So that's where the locums come in. I also like to talk to other people who are doing coaching for physicians or with physicians and teaching entrepreneurship. So, we have a lot to cover today. Before we get into the nitty-gritty here, I need to know about your background a little bit and clinically what you have been doing, but where your education was. And then we can segue into what you're up to now.
Dr. Stephanie Freeman: Yes. So, I'm Dr. Stephanie Freeman. I'm a double board-certified critical care physician, born and raised in Alabama. So, the accent is a real accent. I am a true southerner. I was born and raised in Tuscaloosa, Alabama. I live in Houston, Texas. So, like I said, I am a true southerner.
I did medical school at UAB School of Medicine. I did an internal medicine residency at Wake Forest University School of Medicine. Then I did a geriatrics fellowship, and then I did a critical care fellowship at the University of Pittsburgh. And then I got my MBA at Auburn University and I'm double board-certified twice over. And it's about time for me to recertify in internal medicine in 2023. And so, those recertification years, whew, they kind of come at you quickly.
And I've been doing locums since 2008. And so, I am a locum's expert. I live the locum's life. I am currently on a locum assignment in Alaska right now. I work anywhere between 14 and 21 locum shifts a month. So, I am truly living the locum's life.
John: Awesome. So, we're going to definitely get into that because I have a lot of questions about just your personal experience with locums. But I do want to segue a little bit, or at least make a right turn here because I know you're doing other things. You're teaching other physicians, you're a speaker, you've written several books. So, tell us how those activities started out.
Dr. Stephanie Freeman: You know how in medical school and in residency, there was always that one physician that was always doing other stuff, that always had like a side hustle going on, that was always the one that was moonlighting? I was that physician. I was that girl. Because it goes back to how I was raised. My parents got divorced when I was young and my mother is a teacher and she just retired after 42 years of teaching. And so, my mother was the teacher and she was raising two kids on a teacher's salary and it was tough. But she always had extra jobs. In addition to the full-time teaching, she always taught extra jobs, always did extra stuff, just so that she could take care of us. And so, I picked up that from her.
And then my mom was also an entrepreneur as well. She always told us about the importance of owning your own business. Then she had always been a strong believer that entrepreneurship was the way to go. So as a matter of fact, my mother was the one who told me to go back and get my MBA because she's an English teacher. She reads, she knows about the different trends that are coming because she spends all day reading because she's an English teacher.
And so, she was like, "You really need to go back and get your MBA because I really foresee that that's something that physicians are going to need". So, I kind of had that in my bones. Always about, I love medicine, but I love entrepreneurship. And there are so many other things that I want to experience and do and be.
I would tell you that I fell into locums and that it was a fairytale story, but there are no such things as fairy tales. Actually, the way I fell into locums was the fact that after I finished my training at the University of Pittsburgh and John, you know how we are all so idealistic when we finished training. And we think that we're just going to save the world because we think that everybody's going to welcome us with open arms and experience, love us for what we have to offer as physicians who want to change the world. Well, we know it doesn't happen like that.
So, my first job out of fellowship, here I was finishing up a critical care fellowship at the University of Pittsburgh. The University of Pittsburgh was where critical care was born. So, we're all about critical care and right here, right now with the intensivist model, I had really fallen in love with Pittsburgh and I wanted to stay and there was this nice little community hospital 10 minutes from my house. And I thought I was just going to work there and settle down and get married and have a family. And that didn't work.
So, I take this job with the private group. And so, you know where I'm going with this. So, a private group, pulmonary critical care doctors, here I am coming from an academic center that was used to the intensivist model. This private pulmonary critical care group is not used to that, but they're trying to transition to an intensivist model, and needless to say it didn't work out. So, my contract was not renewed and I was devastated. Because you don't hear about physicians undergoing contract non-renewals are A.K.A being fired. Nobody tells us about that in residency and fellowship. Nobody tells us about that.
The traditional physician employment model is either you are employed as a physician or you're in private practice or you're in academics. And the traditional model is that you stay at one job forever. So, we weren't prepared. And I was not prepared for this churning of the medical marketplace. And I was surprised and devastated needless to say, but remember, I'd always been that fellow and that resident that always had a moonlighting gig. I always had something in my back pocket. So, I was just able to be like, "Okay, well this isn't working out. Let me just call so and so from the hospital down the street, I still have privileges. Let me just slide into their schedule". Fine. No worries.
Then I was trying to figure out what I wanted to do. And I had these other business ideas that I was kind of dibbling and dabbling in. And my mom was like, "You really need to consider getting an MBA if you're going to do all of this extra stuff". And I was like, "Sure, I'll do it".
And the way I fell into doing locums, it's the funniest thing. I was at a critical care conference with my critical care bestie. One of the locums' companies had a display and I was like, "Huh, what is this?" And they just started talking to me. I was like, cool. They explained to me what locum was, but you have to remember, I had always done moonlighting. So, I was used to that concept of sliding in, filling in for a shift or a couple of shifts where I'm needed, leave, get paid, rinse and repeat.
I was already used to that concept. So, I was like, "You can really do this". So, when I took my first locums assignment, I was like, this isn't bad because I went, worked, and had a nice time. Money was in my account the next 10 days. And at that time, I was transitioning to getting my MBA. And I was like, I'll just work enough shifts to pay my bills, to support what I need to do. And I can focus on getting my MBA. So, that's really just how I got started with my locum's journey. It was kind of by accident, but by design.
John: All right. I got a comment on some of those things. First, you're right, in terms of the traditional way that we practice, because we're the type of business as a physician that you have to usually build a practice. So, if you're going to be a hairdresser or you're going to be a barber, or you're going to be a plumber, or are going to be a physician, you want to build a practice over time. It's kind of gone out the window now with the way people are churned through, you got a two-year or three-year contract, "Oh, we're not going to renew it for whatever reason". So, there's a lot of that now. And it has changed a lot. So, you didn't know though what locums wasn't necessarily, other than what you were doing with moonlighting, but once you found out, you really were attracted to that model.
Dr. Stephanie Freeman: I had no idea that it was a thing. I knew moonlighting was a thing, but I didn't know it was a thing and an entire industry. And there were higher agencies who did nothing but that. Because where we're coming through, we weren't exposed to that. And if we weren't supposed to, it was kind of like, "Oh, what's wrong with them? Why can't they get a real job?"
John: What was that first one like? Was it something that was recurring like every month after month, certain days? Or was it like a set for six weeks or weekends? How was that whole structure of that first one?
Dr. Stephanie Freeman: Maybe in a critical care physician, we work in shifts. So full-time critical care is like fourteen 12 hour shifts a month. And so, the staffing model is kind of like seven days on, seven days off 12-hour shifts either day or night shifts or day shifts with call. So, for that first assignment, I went to Pikeville, Kentucky. That's a whole nother conversation. I went to Pikeville, Kentucky. I worked at this hospital seven days in a row and took call at night. And at the time, for me, the money was bonkers. It was ridiculous. I'm like, "Y'all are paying how much money? Sign me up!" And so, I went really in the middle of nowhere, middle of Appalachian, black girl, black doctor, and I came out alive, survived it.
John: So, was that recurring? How long were you doing those seven days shifts?
Dr. Stephanie Freeman: I think I did that assignment for maybe four, maybe six months. And that's kind of typical for these things because when you take a locum's assignment it is usually because of one or two reasons. It's usually because the place is trying to build a program or they just lost some physician. So, they only need you for a couple of months until they're able to recruit and onboard their new physicians. And that's exactly what locum is. Locum is Latin for placeholder. That's exactly what you are. You're holding a place until a permanent physician arrives. And usually, they only need you for two or three months, three or four months, and you just fit into the schedule like they need you. And then it's off to the next assignment.
John: You've been doing locums for a long time, from what I understand. So, you've mentioned some of the reasons you like it or love it. Tell us some of the reasons why it's a good option for physicians. Particularly I would think someone who was looking to do something different, wants a little more freedom.
Dr. Stephanie Freeman: Absolutely. It's a great option because it allows you time to transition. We are all so tired. We've been in school for 20 years. And then when you get out of school, it's this constant grind, not of just being a physician, but also of having to, like you say, build a practice or establish yourself, or build a rapport or get being an attending physician under your feet.
And then there are the finances that everybody deals with. But we're not honest enough about it. So, you got these loans or you have these other obligations you need to pay back. But then again, at the same time, you're tired of living in self-deprivation. So, then you want to have a nice lifestyle. You want a house in a nice neighborhood, in a good school district. You want to be able to start taking some vacations.
Locums gives you the opportunity to say, "Okay, this traditional medicine thing isn't working for me. And I may not have quite figured out what I want to do, but I need to figure it out. But meanwhile, I need to be able to pay my bills". Locums give you the opportunity to transition. So, you can go from being an employed physician that has a whole bunch of restrictions, because you know that the employer physician contract is very restrictive. You may not be able to moonlight. You may not be able to write a book. They want to claim your intellectual property. You may not be able to go speak anywhere. They want to give you permission. You may not be able to do case reviews or legal depositions.
When you're an employed physician, there are so many things that you can't do. Meanwhile, we are all multitalented and the whole world needs all of us. And you want to transition to some of the other things, but you still have bills to pay.
So, I look at sometimes locums as being that middle ground that's going to help you get to your promised land because you can leave traditional employment, transition to nontraditional careers, nonclinical careers, but locums will give you the finances that you can still do it. Because you can still moonlight. You can still do locums because you're an independent contractor. You're still making a great salary, but you don't have the restrictions of an employed physician.
So, these places where I go work, they know me as Dr. Freeman. They don't know me as Dr. Stephanie. They don't know that I do locum coaching. They don't know that I have books. They don't know that I have webinars. They don't know and they don't care because they've contracted with Dr. Freeman. Dr. Freeman is going to work these 14 days. Dr. Freeman is going to do her job and take care of the patients and not mix and mingle things.
While I'm working for them, I'm doing critical care work. But when I'm not at that hospital and when I'm not on the clock, what I do with my time is my time and they have no claim to it. And that's not necessarily the case when you're an employed physician. So that's what locums are able to help people do. Locums can be the bridge to, like I said, your dream life from where you're coming from.
John: Yeah, I hadn't thought about that before. I've talked to people who've done locums and it never occurred to me that it's ideal for those that are natural entrepreneurs. People diversify their income through other passive income or active income activities. So yeah, it really gives you, you just have to plan things out appropriately, obviously, during those times when you're not working as a clinician. And I would assume also it varies a little bit by your specialty. But yeah, it sounds pretty attractive.
Dr. Stephanie Freeman: Oh, it is. It's amazing. I was just on the phone the other day with a gynecologist who is going through a horrible time at her job. But she's an entrepreneur and she's building an amazing beauty brand. And I'm like, "Honey, let me help you do locums so that you can fulfill your real dream and your real calling with your beauty brand and your entrepreneurship. Let me help you with that transition". Because I'm like "You know it's time for you to go. It's time for you to leave that job and transition over. And that's why you're having problems on that job because you know you need to leave. Let me help you transition through".
John: All right. We're going to talk about some of the other things you're doing, but I do want to have you maybe give us two or three landmines to avoid, so to speak, or things that we need to be a little careful about if we decide to pursue locums.
Dr. Stephanie Freeman: The first thing that you really need to be careful about, I say your locum's experience is really made or broken based on the company you choose to work with. And so many physicians when they get started have a bad experience because they didn't work with the good locum's company or a good locum's recruiter who really explained the process to them. A lot of physicians ended up kind of feeling like they've been taken advantage of.
So, I would say the first thing you need to do is really vet these companies and vet these recruiters so that you can make sure that you're getting somebody who is going to treat you fairly. That's the first thing.
The second thing, and I think this is the biggest thing that a lot of physicians fall prey to, is not managing their expectations. A lot of physicians have either unrealistic expectations of what locums is, or they just don't know what to expect. And they think everything is going to go perfectly. And we physicians are type-A people and we expect everything to be done decently in order.
But one of my favorite recruiters used to say something to me that really made a difference. He said, "If these places that need your services had everything together, they wouldn't need you".
John: That's true.
Dr. Stephanie Freeman: So, think about it. If they had everything together, they wouldn't need temporary physicians because their physicians wouldn't have quit or they wouldn't have been in turmoil if everything was together. So, I have to tell my physicians who are going on these assignments to keep an open mind and to go with the flow because things are not going to run smoothly. Because if everything was going to run smoothly and be perfect, they wouldn't need you to be there.
And so, once you kind of lower your expectations and be like, "Okay, it is what it is. I'm just here to see the patients and make sure these patients get the care that they need and let everything else kind of fall into place".
John: Now, at the same time, I've heard from some of my friends who have done locums that they usually welcome you. They're looking forward to having you there because they really need you.
Dr. Stephanie Freeman: Yeah. Some of them are. They're like, "Oh my God, you're here. Thank you for coming. We need help". So, it's actually been kind of fun, but at the same time, you can walk into some pretty nasty political situations. And that goes back to getting a good recruiter who is giving you the 411 about what is actually going on and why you're actually there.
I've walked into some situations in which it's like the group that was there, unceremoniously lost their contract and it was a big deal. And then they're bringing locums in until they can bring the other permanent doctors there. And so, then it's a lot of chaos. It's lot of hurt feelings. People have chips on their shoulders and they're taking it on the locum's doctor. And you're like, "I'm just here to work. I don't know anything. I'm sorry". So, I've been in those situations as well too.
John: But you're there to take care of the patients, right? The patients need you. And so, you've got to fill in while they're trying to sort through their political messes.
Dr. Stephanie Freeman: Exactly.
John: We're going to be at the conference in a few weeks with Dr. Jarrett Patton. And so, are you going to be covering this topic? What are you going to be talking about at the conference?
Dr. Stephanie Freeman: What I'm going to be talking about in the conference is how do we locums and considering locums during this pandemic. And the reason why I'm talking about this is because, as you know John, this COVID pandemic has completely ended the way medicine is practiced. And I think a lot of physicians are now realizing that we are seen as disposable.
We have physicians who literally put their lives on the line, continue to work throughout this pandemic, which is still going on. We worked extra hours. We faced unsafe situations. We worked with a lack of PPE. We will call it heroes and some of us got thanked by what? Getting fired? Contracts not renewed and facing pay cuts? And that's because the market has changed because money has changed. Cash flow has changed.
And so, I'm here to really talk about how physicians who are in this churning of contracts are being renegotiated because hospitals and healthcare organizations are redoing their practice models and their financial models, how physicians can utilize locums as a way to kind of shore up themselves personally and professionally and financially.
Because even though we think the pandemic is over, we physicians know it's not over. The numbers are dropping, but we know this isn't over. And we're now seeing the financial ramifications of this. I've talked to many physicians who have just lost their jobs. I've talked to many physicians whose contracts are being renegotiated and not in a favorable way.
So, I'm going to talk about how we can use locums and the types of locums that we need to be doing in order to be able to navigate these market changes that have happened as a result of this pandemic.
John: Okay. So that's going to be awesome. I'm definitely going to have links later in the show notes for the conference. Licensedtolive.com basically is going to be where you go. But I'll talk more about that in my outline. But the thing is not everyone is going to be able to come to that conference. Although I want everyone to come and say hello to both of us if they can. So, they can get some more information and training about locums from you directly, from what I understand at www.freelocumstraining.com.
Dr. Stephanie Freeman: That's right.
John: So, tell us a little bit about that. What will we get out of that?
Dr. Stephanie Freeman: Yeah, this is just a little introductory course that really will give you the basics about what you need to do to get started doing locums right now. Just an easy five-step process. And I've had so many people get this and get started with it because I tell everybody the time to get started with considering locums is now. If it has crossed your mind, then it's time to get started now. And so, that's what that course is about. It's a free course, and it talks about just the steps you need to take in order to begin your locum's journey.
John: I'll put that link in there, but there is planning involved in doing locums from what I understand. So, you don't want to just jump into it and think you're going to have your first position in a week from now.
Dr. Stephanie Freeman: No, no, no. I will take you through the process.
John: That'll be awesome. But now with the locums that you've done, and you're obviously creating courses for people, but you're doing some other things. I saw that you're a speaker. Can you tell us some of the venues you've talked at?
Dr. Stephanie Freeman: Yes. I have spoken at The Momentum and Medicine conference, which was amazing. I've also spoken in The Women and White Coats virtual conference. And then I also did a talk about locums for the virtual conference for the American College of Osteopathic Obstetrician and Gynecologists. And that was amazing and it was extremely well-received.
John: Very nice. And then you've got some books. I read that your most recent book is about locums. So, we can get those on Amazon, right?
Dr. Stephanie Freeman: That is correct.
John: And of course, you have your website, which is drstephanieicu.com. Also, you're doing some coaching. So, tell us about that.
Dr. Stephanie Freeman: Yes. I am doing some coaching. And I have some online coaching programs and online courses because what I really want to do is to allow physicians to know that they have options. There are so many people that are on the verge of just hanging up their white coats and their stethoscopes. And I'm like, "You don't have to do that. There is a better way. Let's figure it out".
So, I do some one-on-one coaching and I also have some online courses that are designed to walk physicians through the process in more detail and tell them about not only how to get clarity about why you're doing locums, how to look for good recruiters, how to choose assignments, what is a good market rate to get paid for your assignments, but also some of the business issues and the tax issues and the legal issues that are associated with being a locums doctor and an independent contractor. So, I do have some online courses for those as well.
John: Yeah. I think that's a big thing that some physicians forget about is if you're going to be doing any kind of freelancing or locums, things like that, you really have to have your own LLC and set up the proper structure, protect yourself liability-wise.
Dr. Stephanie Freeman: And pay those taxes.
John: Taxes? Oh, yeah. You've got to make those estimated tax payments during the year, or are you going to be in for a big shock at the end of the year. But it's good. You're a natural entrepreneur and your mom pushed you for that MBA. That gives you a little head start than let's say the typical physician who's come right out of residency and never thought about those things.
Dr. Stephanie Freeman: You know what? I love working with residents. I do. And I think it's an excellent way for them to get started in their medical career. Because what I like to tell residents who are about to be attending is to say that "You don't know anything about your style as an attending. You don't know what you value. You don't know what's important".
And sometimes they feel a relief that they can just do locums and not have to worry about signing a three-year contract right off the bat. So, it gives them some leeway. It gives them some breathing room. It gives them six months, eight months to take some time to relax and know themselves as human beings and really a way through this job market and to make the right choice. So, anybody can do locums at any stage in their career.
John: It sounds like if you're doing it at the beginning, you get to check out some different geographic locations around the country, different structures, big groups, little groups, rural, big cities. So yeah, it makes a whole lot of sense, especially at the beginning, but I've known people that have done it at all parts of their career too.
Dr. Stephanie Freeman: All parts.
John: All right, now we're going to have to go soon. So, do you have any last bits of advice for our listeners who are thinking about nonclinical careers or locums, or other nontraditional careers?
Dr. Stephanie Freeman: I say, go for it. There are so many opportunities out there. And I say, do your research, keep an open mind, but don't be afraid to go for it. And the time is now.
John: Awesome. Great words of wisdom. I can't wait to talk to you face to face in Philadelphia in a few weeks. That's going to be fun and we're going to really try to inspire the guests that come and listen to the students and people that attend. And so, before we go, I will, again, recommend if you are interested in locums to go to www.freelocumstraining.com or go to drstephanieicu.com to see everything else that Stephanie is up to. And I want to thank you for being here today. It's been great. And I think my listeners are going to love this episode.
Dr. Stephanie Freeman: Thanks for having me and I'll see you in Philadelphia.
John: Okay. Bye-bye now.
Dr. Stephanie Freeman: Bye.
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