Lecture by Dr. Andrew Wilner – Episode 446
In today's presentation from the Nonclinical Career Summit, Dr. Andrew Wilner explains how to make the Locum Life better than ever as you contemplate career options.
- flexibility in hours worked or type of employer,
- ability to experience different models of care,
- better income,
- avoidance of involvement in organizational politics,
- a way to slow down prior to retirement,
- and a way to create extended time off to pursue hobbies and other interests.
Andrew's lecture covers most of the important topics covered in detail in his book, The Locum Life, which is recognized as one of the best resources available for pursuing life as a locum tenens doctor.
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Exploring the Locum Life
Writing has been a part of his life since high school. After medical school and internship, Andrew became an emergency room doctor while trying to decide the next steps for his career.
Using the flexibility that came with a locum tenens emergency medician job, Andrew continued to write. It not only allowed him to write books and continue his clinical work, but it helped him discover an interest in neurology. This led to his completing a neurology residency and an epilepsy fellowship at McGill University in Montreal.
During his long career, Andrew has held many locums positions over the years. And he leaned on locum tenens to enable him to pursue his love of writing and of scuba diving in many exotic locations around the world.
Make the Locum Life Better for Everyone Involved
In today's 25 minute excerpt from his 50-minute Nonclinical Summit lecture and Q&A, he lists numerous attractions of locums work, breaking it down by the stage of life of the physician.
He also spends some time describing how to identify the best recruiters, the importance of being well-organized and disciplined, why you should do your best to meet the employer's needs, and the tax considerations working as an independant contractor.
Summary
Today's presention is engaging, thought-provoking, and instructive. It provides an introduction to the pros and cons of the “locum life,” and provides insights into how to make the locum life better than ever for you and your employer.
NOTE: Look below for a transcript of today's episode.
Links for Today's Episode:
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- Dr. Andrew Wilner's Website, including links to The Locum Life, his other books and resources.
- Shifting from Medical Writing to the Locum Life
- How to Blend Medical Writing and the Locum Life
- Healthcare Startup Founder: How To Restore Physician Autonomy
- Why Locum Tenens Is the Best Way to Practice on Your Own Terms – 202
- How to Free Yourself Using Locums and Coaching with Dr. Nana Korsah – 074
- 19 Nonclinical Career Summit Lectures
- Nonclinical Career Academy
Download This Episode:
Right Click Here and “Save As” to download this podcast episode to your computer.
Transcription PNC Podcast Episode 446
How to Make the Locum Life for Doctors Better Than Ever
- Lecture by Dr. Andrew Wilner
Dr. Andrew Wilner: I'm Dr. Andrew Wilner here today to talk to you about locum tannins. I wrote a book called The Locum Life, and there's 20 chapters, and one of the cool things about that book is not only does it share my experiences, but there's a chapter where I've talked to about 15 other physicians about their locum experiences. And I started working locums in 1982, off and on since then, and so lots of experience to share.
Now, this presentation right now is prerecorded, so please hold your questions, but I will be available live to answer your questions as soon as this is completed. So I hope you find this interesting and valuable in your search for an alternative non-traditional career. Thanks for attending this conference, and here we go. Dr. John Jurica asked me to talk to you about locum tannins and answer a few questions. So let's pull these up here.
All right, first of all, why did I do locum work? Well, in 1981 to 1982, I did my internship in internal medicine at the Long Beach Veterans Hospital, and it was pretty intense, and I loved every minute of it, but I didn't have time for anything else. And ever since junior high school, I was a writer, and I had this book in my head, and I wanted to write the book, but internship, on call every fourth night, going to the hospital pretty much every day, seven days a week, didn't allow for writing a book. I had to create space to do some writing. So I took an ER job. Back in those days, you didn't have to be an ER doc, and it was a big adventure.
I treated dog bites and car accidents and delivered babies and sutured and took foreign bodies out of eyes, but it was three days a week, 12-hour shifts, 36 hours, part-time for a physician, right? Only 36 hours in a week, and it gave me some time to write a book. So, and I think the story of my life is that's how I've used locums to help achieve work balance, not necessarily work-life balance, but to create space so that I could write and do other things, follow other passions.
I worked locums again after, well, I took a job in private practice, and that was great, and then I merged to academics, and that wasn't so great, and then I worked as a medical journalist for 10 years without any practice at all. And then when I went back into practice, I worked locums again, and again, looking for work-life balance. Locum tenants at that time allowed me to go to Southeast Asia for several months at a time, and I would write there, and my other hobby, if you will, passion is scuba diving.
In fact, you can see some of my dives on the YouTube channel, Underwater with Dr. Andrew. So, that was a lot of fun, and I achieved some work-life balance there. I did medical missions in the Philippines.
Eventually, I ended up with an apartment over there, and I would come back to work to have enough money to live on and go over to the Philippines for a few months and come back and do locums. So, for me, locums was a way to create time for myself, for my other passions. It wasn't that I didn't like clinical medicine.
It was that, well, clinical medicine took up too much time, and I needed to find some balance. So, question number two, what did I like about this non-traditional career? Well, when you talk about locums, it's all about flexibility because you accept an assignment either through an agency, which is the most common, or just one-to-one, and I've done both.
The usual process is you contact an agency, and as soon as you start exploring on the internet, you'll see there's many like Comp Health and Staff Care. There's over 100 agencies, and many are listed in my book, of course, and if you just give them a call or send them an email, the floodgates will open, and they'll let you know about all the offers.
The ideal thing is to find an agent that you have some comfort with, and you say, look, this is what I want to do. Help me find an assignment that works for me, and in my case, what I wanted was several months at a time doing inpatient work primarily, although I've also done locums outpatient. I've done locums inpatient academic, outpatient academic, inpatient non-academic in a community hospital, outpatient non-academic in a private practice, so all of these are possible, and so I think that's one of the things that I like about it, this non-traditional career.
Number one, flexibility. You can work 365 days a year in locums to try and maximize your income, or you can do what I did, was work about six, seven months a year to provide sufficient income so that spend the rest of time doing what I wanted to do. The other advantages of locums, one is you're temporary, so it's a temporary relationship, and well, that means that hospital or clinic politics are completely irrelevant to you. You don't serve on any committees.
Whatever's going on behind the scenes is not your problem. Your only responsibility is to show up, see your patients, do your charting, and go home. That's all you have to do, and whatever else is going on isn't your problem because you're temporary, and you know, once you're permanent, well, then you're part of the system. You have obligations, but the beauty of locums is you're temporary, so then geography. You can travel. You can go wherever you want to go.
There's locums available. Right now is probably like the golden age of locums. You know, doctors are retiring. Many of them are my age, had enough. There's doctor shortages everywhere. You want to work locums.
You have lots of options, and of course, one of the other benefits of locums is you're self-employed, so as a self-employed individual, you are the employer paying yourself, and from a tax point of view, that means you have to pay quarterly taxes, estimates, but it also gives you the ability to have a 401(k) and put a whole lot more money into that 401(k), assuming you're earning it, than you would as a traditional W-2 employee. That's if you look at your statement at the end of the year.
If you're employed, it's called the W-2. If you're self-employed, when you work for someone and they pay you more than $600, you get something called a 1099, and so we refer to that as you're a 1099 employee, and whoever you work for, if it's an agency or one-on-one with a hospital or clinic, they'll generate that paperwork for you so you can do your taxes, so by being a self-employed person, you can put away a lot more money for retirement, and also your business expenses, your home office, your computer, your CME are tax deductible because your travel, of course, is tax deductible. How to get started?
Well, as I mentioned earlier, I think the best way to get started is to find an agency. Call the agency or send them an email. Somebody will call you right away and talk to that person. If you don't like that person, find a different person. Eventually, you'll find someone at the agency where you will outline what your goals are, so that's very important to get started. Always ask why. Why do I want to work locum tenens? Well, maybe you're like me. You want to work half the year and go play the other half, so maybe you're very unhappy with traditional employment.
You just want more freedom. Maybe you want to travel. You want to work locums in Alaska and see what that's all about. You can work locums in Guam and see what that's all about, or Idaho or Montana. I worked in South Dakota. Maybe you want to see the world.
Maybe you want to maximize your income. Now, that's a bit tricky because you'll hear that, well, locum pays more, and it should because locum tenens does not pay vacation time. It does not pay travel time.
Does not contribute to your 401(k). Does not pay your health insurance. Does not pay your disability insurance, so these benefits are not paid, so your hourly rate, which is usually how you're paid in locums, has to be higher than your hourly rate as an employee, so make sure you compare apples to apples because your compensation as a W-2 employee working for the hospital may be a lot lower than your compensation with locums, but your locums doesn't include any of the benefits.
So make sure that those balance out, make sure that the locums is really paying you a lot more because you're going to have to pay your own health insurance, and when I was working locums, worked for another stretch for about 10 years, and I had to pay health insurance. It was in that time $1,500 a month just for me and my wife to have health insurance.
I did have the advantage of having an HSA at that time because of the health insurance that I had, and probably I should mention here that once you do get started, you probably want some help, and there are CPAs available, certified public accountants, who are familiar with locums because you may work in different states, so you have to have tax returns in those different states, so you may need some professional help. I would not advise doing your tax return as a locums physician all by yourself unless you really know what you're doing, and H&R Block is probably not the way to go, and if you contact me, I'm happy to send you names of a couple people that I know who can help out with that, so getting started back to your why.
There's kind of three big categories of people who want to do locums, right, so there's the newly graduated physician, just finished residency, just finished fellowship, not really sure what they want to do or gigantic loans want to pay back asap.
The other scenario is the graduating physician has a partner who's a year behind. So you kind of tread water for a year maybe working locums here or there until the other partner catches up. Then they can graduate together and go to their permanent job. So, for the new physician it's a great way to try out geography. I've always wanted to work in California. Let's go for six months, it's a way to try out a clinic. I think I want outpatient only. Let's try that. It's a great time to experiment without making a commitment because well, kind of like marriages, a lot of first jobs don't last forever. So good to test the waters a bit.
The second category is the mid-career physician who has got a great job, but is a little short on cash. And so may want to take vacation time to work locums a couple of weeks here, a couple of weeks there, and bring in some extra cash. Or maybe that mid-career physician is kind of fed up and is looking to try out some other type of, some other medical work somewhere else, or is starting a nonclinical career.
And many of you here are to learn about nonclinical careers, but don't want to go cold turkey. And usually when you start a new job, there's a ramp up period. So working locums is often pitched as a bridge from a full-time medical career to a nontraditional medical, but nonclinical career.
So it's a way to maintain income. Whether you're starting a restaurant or going to work in a pharmaceutical industry, whatever it is you're going to do, you can keep your feet wet. And it also keeps you from burning bridges.
And I've said this many times, I'm going to say it again, because I was the victim of this. If you are out of practice, I was out of practice for 10 years, but if you're out of practice for more than two years, and in some case one year, it can be very difficult to get back because of requirements for hospital privileges that you need recommendations from your peers of your clinical work within the last one or two years.
Well, if you've been out of practice, like I was for 10 years, how can you get that recommendation? It's impossible. I had to go through sort of a supervised period and get a letter, and I worked for a hospital who then let me in, but only because they really, really needed somebody. And there are these re-entry programs that are created, because if you take three years out, four years out, to raise a young child or sail around the world, and then you want to go work as a surgeon, for example, or even as an internist, hospitalist, you may be blocked.
And re-entry programs are lengthy, they're expensive, and they're kind of ridiculous in my point of view, because if you're a good physician and you keep up, you probably don't need it, but the system will require it. So locums is a way to keep your clinical activity current so that you don't fall into that trap. Well, gee, I ran this restaurant for three years, I'm all done, I want to go back into practice, and then you can't. You don't want to be in that position.
One other category is the pre-retirement physician, 68, 70 years old, working, but tired of working 60 hours a week or more, but don't want to stop. So don't want to lose the identity of being a clinician, don't want to lose the income of being a clinician.
And so as a locums physician, and older physicians are very welcome in the locums world, because what the locums agency wants, what the hospital wants, or the clinic wants, they want somebody who knows what they're doing, who can just show up, I use the analogy like a substitute teacher, just show up, pick up the ball on day one, and know what they're doing.
And so, a senior physician, somebody who's been around, knows the score, knows how to handle patients, isn't going to get frazzled, is actually the ideal candidate to show up. With a proviso that you know how to use the EMR. And I always advise, find out where that EMR which, you're going to go to Alaska, which EMR are they using, and insist that day one and day two, when you get there, you're not seeing patients, somebody's training you, you don't know how to use it, because modern medicine you can't function without the computer.
So you got to be able to do that. As a locums physician myself, I've used several different EMRs, and that's just something you've got to accept when you go to new places, that not only did you have to learn your way around the hospital, and who's who, but you have to learn the EMR. So three big categories, newly graduated physician, mid-career physician, and pre-retirement physician, and all have different whys, you know. So figure out why do I really want to do this and so that you know, do I want six months, do I want 12 months, do I just want two weeks? Do I need the money? Where can I go? Will I just go wherever I need to go to get the highest salary?
The Midwest tends to pay higher than other places because they don't have a coastline, you know. There's always a trade-off. So you got to decide what your priorities are. Thank you very much. I will be available for questions after this lecture, and best of luck with your new adventures.
Speaker: Can you tell us what unforeseen issues that you didn't address in your video that you have faced in your locums career?
Dr. Andrew Wilner: Travel. My first assignment to South Dakota, it was snowing in Chicago or Cincinnati or wherever I was changing planes, and we were supposed to change at 06:00 P.M., and a typical airport story, oh, don't worry, don't worry, there's a new plane, and finally at midnight they said, oh, their flight is canceled. And this was my first time going to this particular place, and I didn't want to make I was supposed to be working at 8 a.m. the next day, and I had built in plenty of time based on my schedule, but now not only was I not going to be there at 8 a.m., I didn't really know who to call or what to do, or this is really I'm a big fan of the Woody Allen philosophy that 90% of success is showing up, and here I was, I was not going to show up.
That was a case where having an agent, I was working with an agency for that particular assignment, I was able to call somebody at midnight I had this emergency number, and they were going to call first thing in the morning because chances are that I would have been in transit first thing in the morning, so even if I wanted to call, I couldn't call, and they dealt with it, but travel, of course, there's, luckily, the COVID, this was pre-COVID COVID made travel pretty horrendous, but now that's fading out a bit, so I think you have to build in extra time.
And one of the things I think I mentioned in the talk, one of the negatives of working low-comes is that you are, although your travel is paid, the agency will be very happy to pay your flight and rental car and hotel, and that's great, but they do not pay for travel time.
I was working week on and week off, and that meant it was a day of travel there and a day of travel back, even though it was only a three-hour flight you got to be there two hours ahead of time, and then rental car and all of that, so it ends up taking better part of a day, and there was no income, there were no expenses, but there was no income for that day, and there was no income for the day coming back, so every two weeks, I lost, like, three days, so you have to learn to sort of make, be productive I have a laptop, and I did a lot of work in the waiting areas and on the plane, but I think that's a clear downside of low-comes.
Now, if you're only going to go travel once and stay there for six months and then come back, you've lost two days out of six months, it's not a big deal, but if you're going back and forth, back and forth, back and forth, you do lose a lot of time, so you have to travel intelligently, and in some cases, that means driving it may be easier to drive five hours than to try and fly, even though, hypothetically, it's as the crow flies, it would be faster, but the way airports are and airplane schedules, it's not always faster to fly, so I think that's an important consideration.
Speaker: When you take a low-comes engagement, typically, where do you live?
Dr. Andrew Wilner: Yes. Well, in one case, I had a low-comes for a year that I negotiated directly with the hospital, and they did not pay my housing, so I just rented a beautiful condo about three blocks from the hospital that was on the waterfront, and I paid for it out of my pocket, and that was up to me.
Usually, if you work with an agency, they will house you, depending upon the amount of time, so when I worked in Minnesota, I stayed in a hotel about three blocks. It's downtown, Hennepin County Medical Center, so I was in a hotel three blocks away, so I could walk to work every day, no hassle with the car in the mountains of snow and ice, just walk, and they take care of that, and I got zillion hotel points that I've made good use of since then.
I think a rule of thumb is if you're going to stay there, sorry about that, if you're going to stay there longer than six months, they'll get you an apartment, and shorter than six months, usually a hotel, and the hotel's sort of B minus type hotel, and then if you have a family, or a dog you can negotiate with the local tennis company, say, hey I need a bigger room, or I need a suite and see how far you get. It depends how badly they need you, you know. They have budgets for this stuff, so you can push them a little bit, see what happens.
Speaker: Do the hospitals ever put you up in their hospitals themselves?
Dr. Andrew Wilner: I have heard of that, but I never did that myself, no.
Speaker: One of the contras to doing locums is that there's a reason why there's an opening that they need locums for, that you're basically walking into somebody else's problems. How, what are your thoughts on that?
Dr. Andrew Wilner: You're absolutely right, Tom, and I may not have focused on that enough. You should assume that the place you're going to is a mess, that's like, that's a given, because the reason they are hiring you is because they cannot get a full-time person for that job. Now, it may be just an emergent thing where one of their regular physicians took sick leave, or is on maternity leave, and they just need someone to fill in for a few months, and then back to normal, and the place really isn't in that bad shape that that it's a situation of where they can't recruit.
However, very often it is a scenario where the hospital, for one reason or another, is unable to recruit, and that may be for a lot of different reasons. It may just be that the hospital's in the middle of nowhere which I largely, no offense to anybody, but for me, that's mostly the Midwest, and they have a lot of trouble recruiting, and it's hard to get people to want to stay, and Fargo, and places like that. So it's not necessarily a bad place to work, but it may be a difficult place for them to recruit permanent people who are going to spend their lives there.
On the other hand, it may well be that the place is poorly run, and people just don't want to be there. So I go with extremely low expectations. I assume that there's going to be a lot of problems, that that's a given, and then if there aren't, then that's great, but if there are I got my seatbelt on.
My job is to take care of the patients as best I can in the system that exists, and as a locums person, I don't really have that kind of guilt or burden that I have to fix the system.
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Transcription PNC Podcast Episode 446
How to Make the Locum Life for Doctors Better Than Ever
- Lecture by Dr. Andrew Wilner
Dr. Andrew Wilner: I'm Dr. Andrew Wilner here today to talk to you about locum tannins. I wrote a book called The Locum Life, and there's 20 chapters, and one of the cool things about that book is not only does it share my experiences, but there's a chapter where I've talked to about 15 other physicians about their locum experiences. And I started working locums in 1982, off and on since then, and so lots of experience to share.
Now, this presentation right now is prerecorded, so please hold your questions, but I will be available live to answer your questions as soon as this is completed. So I hope you find this interesting and valuable in your search for an alternative non-traditional career. Thanks for attending this conference, and here we go. Dr. John Jurica asked me to talk to you about locum tannins and answer a few questions. So let's pull these up here.
All right, first of all, why did I do locum work? Well, in 1981 to 1982, I did my internship in internal medicine at the Long Beach Veterans Hospital, and it was pretty intense, and I loved every minute of it, but I didn't have time for anything else. And ever since junior high school, I was a writer, and I had this book in my head, and I wanted to write the book, but internship, on call every fourth night, going to the hospital pretty much every day, seven days a week, didn't allow for writing a book. I had to create space to do some writing. So I took an ER job. Back in those days, you didn't have to be an ER doc, and it was a big adventure.
I treated dog bites and car accidents and delivered babies and sutured and took foreign bodies out of eyes, but it was three days a week, 12-hour shifts, 36 hours, part-time for a physician, right? Only 36 hours in a week, and it gave me some time to write a book. So, and I think the story of my life is that's how I've used locums to help achieve work balance, not necessarily work-life balance, but to create space so that I could write and do other things, follow other passions.
I worked locums again after, well, I took a job in private practice, and that was great, and then I merged to academics, and that wasn't so great, and then I worked as a medical journalist for 10 years without any practice at all. And then when I went back into practice, I worked locums again, and again, looking for work-life balance. Locum tenants at that time allowed me to go to Southeast Asia for several months at a time, and I would write there, and my other hobby, if you will, passion is scuba diving.
In fact, you can see some of my dives on the YouTube channel, Underwater with Dr. Andrew. So, that was a lot of fun, and I achieved some work-life balance there. I did medical missions in the Philippines.
Eventually, I ended up with an apartment over there, and I would come back to work to have enough money to live on and go over to the Philippines for a few months and come back and do locums. So, for me, locums was a way to create time for myself, for my other passions. It wasn't that I didn't like clinical medicine.
It was that, well, clinical medicine took up too much time, and I needed to find some balance. So, question number two, what did I like about this non-traditional career? Well, when you talk about locums, it's all about flexibility because you accept an assignment either through an agency, which is the most common, or just one-to-one, and I've done both.
The usual process is you contact an agency, and as soon as you start exploring on the internet, you'll see there's many like Comp Health and Staff Care. There's over 100 agencies, and many are listed in my book, of course, and if you just give them a call or send them an email, the floodgates will open, and they'll let you know about all the offers.
The ideal thing is to find an agent that you have some comfort with, and you say, look, this is what I want to do. Help me find an assignment that works for me, and in my case, what I wanted was several months at a time doing inpatient work primarily, although I've also done locums outpatient. I've done locums inpatient academic, outpatient academic, inpatient non-academic in a community hospital, outpatient non-academic in a private practice, so all of these are possible, and so I think that's one of the things that I like about it, this non-traditional career.
Number one, flexibility. You can work 365 days a year in locums to try and maximize your income, or you can do what I did, was work about six, seven months a year to provide sufficient income so that spend the rest of time doing what I wanted to do. The other advantages of locums, one is you're temporary, so it's a temporary relationship, and well, that means that hospital or clinic politics are completely irrelevant to you. You don't serve on any committees.
Whatever's going on behind the scenes is not your problem. Your only responsibility is to show up, see your patients, do your charting, and go home. That's all you have to do, and whatever else is going on isn't your problem because you're temporary, and you know, once you're permanent, well, then you're part of the system. You have obligations, but the beauty of locums is you're temporary, so then geography. You can travel. You can go wherever you want to go.
There's locums available. Right now is probably like the golden age of locums. You know, doctors are retiring. Many of them are my age, had enough. There's doctor shortages everywhere. You want to work locums.
You have lots of options, and of course, one of the other benefits of locums is you're self-employed, so as a self-employed individual, you are the employer paying yourself, and from a tax point of view, that means you have to pay quarterly taxes, estimates, but it also gives you the ability to have a 401(k) and put a whole lot more money into that 401(k), assuming you're earning it, than you would as a traditional W-2 employee. That's if you look at your statement at the end of the year.
If you're employed, it's called the W-2. If you're self-employed, when you work for someone and they pay you more than $600, you get something called a 1099, and so we refer to that as you're a 1099 employee, and whoever you work for, if it's an agency or one-on-one with a hospital or clinic, they'll generate that paperwork for you so you can do your taxes, so by being a self-employed person, you can put away a lot more money for retirement, and also your business expenses, your home office, your computer, your CME are tax deductible because your travel, of course, is tax deductible. How to get started?
Well, as I mentioned earlier, I think the best way to get started is to find an agency. Call the agency or send them an email. Somebody will call you right away and talk to that person. If you don't like that person, find a different person. Eventually, you'll find someone at the agency where you will outline what your goals are, so that's very important to get started. Always ask why. Why do I want to work locum tenens? Well, maybe you're like me. You want to work half the year and go play the other half, so maybe you're very unhappy with traditional employment.
You just want more freedom. Maybe you want to travel. You want to work locums in Alaska and see what that's all about. You can work locums in Guam and see what that's all about, or Idaho or Montana. I worked in South Dakota. Maybe you want to see the world.
Maybe you want to maximize your income. Now, that's a bit tricky because you'll hear that, well, locum pays more, and it should because locum tenens does not pay vacation time. It does not pay travel time.
Does not contribute to your 401(k). Does not pay your health insurance. Does not pay your disability insurance, so these benefits are not paid, so your hourly rate, which is usually how you're paid in locums, has to be higher than your hourly rate as an employee, so make sure you compare apples to apples because your compensation as a W-2 employee working for the hospital may be a lot lower than your compensation with locums, but your locums doesn't include any of the benefits.
So make sure that those balance out, make sure that the locums is really paying you a lot more because you're going to have to pay your own health insurance, and when I was working locums, worked for another stretch for about 10 years, and I had to pay health insurance. It was in that time $1,500 a month just for me and my wife to have health insurance.
I did have the advantage of having an HSA at that time because of the health insurance that I had, and probably I should mention here that once you do get started, you probably want some help, and there are CPAs available, certified public accountants, who are familiar with locums because you may work in different states, so you have to have tax returns in those different states, so you may need some professional help. I would not advise doing your tax return as a locums physician all by yourself unless you really know what you're doing, and H&R Block is probably not the way to go, and if you contact me, I'm happy to send you names of a couple people that I know who can help out with that, so getting started back to your why.
There's kind of three big categories of people who want to do locums, right, so there's the newly graduated physician, just finished residency, just finished fellowship, not really sure what they want to do or gigantic loans want to pay back asap.
The other scenario is the graduating physician has a partner who's a year behind. So you kind of tread water for a year maybe working locums here or there until the other partner catches up. Then they can graduate together and go to their permanent job. So, for the new physician it's a great way to try out geography. I've always wanted to work in California. Let's go for six months, it's a way to try out a clinic. I think I want outpatient only. Let's try that. It's a great time to experiment without making a commitment because well, kind of like marriages, a lot of first jobs don't last forever. So good to test the waters a bit.
The second category is the mid-career physician who has got a great job, but is a little short on cash. And so may want to take vacation time to work locums a couple of weeks here, a couple of weeks there, and bring in some extra cash. Or maybe that mid-career physician is kind of fed up and is looking to try out some other type of, some other medical work somewhere else, or is starting a nonclinical career.
And many of you here are to learn about nonclinical careers, but don't want to go cold turkey. And usually when you start a new job, there's a ramp up period. So working locums is often pitched as a bridge from a full-time medical career to a nontraditional medical, but nonclinical career.
So it's a way to maintain income. Whether you're starting a restaurant or going to work in a pharmaceutical industry, whatever it is you're going to do, you can keep your feet wet. And it also keeps you from burning bridges.
And I've said this many times, I'm going to say it again, because I was the victim of this. If you are out of practice, I was out of practice for 10 years, but if you're out of practice for more than two years, and in some case one year, it can be very difficult to get back because of requirements for hospital privileges that you need recommendations from your peers of your clinical work within the last one or two years.
Well, if you've been out of practice, like I was for 10 years, how can you get that recommendation? It's impossible. I had to go through sort of a supervised period and get a letter, and I worked for a hospital who then let me in, but only because they really, really needed somebody. And there are these re-entry programs that are created, because if you take three years out, four years out, to raise a young child or sail around the world, and then you want to go work as a surgeon, for example, or even as an internist, hospitalist, you may be blocked.
And re-entry programs are lengthy, they're expensive, and they're kind of ridiculous in my point of view, because if you're a good physician and you keep up, you probably don't need it, but the system will require it. So locums is a way to keep your clinical activity current so that you don't fall into that trap. Well, gee, I ran this restaurant for three years, I'm all done, I want to go back into practice, and then you can't. You don't want to be in that position.
One other category is the pre-retirement physician, 68, 70 years old, working, but tired of working 60 hours a week or more, but don't want to stop. So don't want to lose the identity of being a clinician, don't want to lose the income of being a clinician.
And so as a locums physician, and older physicians are very welcome in the locums world, because what the locums agency wants, what the hospital wants, or the clinic wants, they want somebody who knows what they're doing, who can just show up, I use the analogy like a substitute teacher, just show up, pick up the ball on day one, and know what they're doing.
And so, a senior physician, somebody who's been around, knows the score, knows how to handle patients, isn't going to get frazzled, is actually the ideal candidate to show up. With a proviso that you know how to use the EMR. And I always advise, find out where that EMR which, you're going to go to Alaska, which EMR are they using, and insist that day one and day two, when you get there, you're not seeing patients, somebody's training you, you don't know how to use it, because modern medicine you can't function without the computer.
So you got to be able to do that. As a locums physician myself, I've used several different EMRs, and that's just something you've got to accept when you go to new places, that not only did you have to learn your way around the hospital, and who's who, but you have to learn the EMR. So three big categories, newly graduated physician, mid-career physician, and pre-retirement physician, and all have different whys, you know. So figure out why do I really want to do this and so that you know, do I want six months, do I want 12 months, do I just want two weeks? Do I need the money? Where can I go? Will I just go wherever I need to go to get the highest salary?
The Midwest tends to pay higher than other places because they don't have a coastline, you know. There's always a trade-off. So you got to decide what your priorities are. Thank you very much. I will be available for questions after this lecture, and best of luck with your new adventures.
Speaker: Can you tell us what unforeseen issues that you didn't address in your video that you have faced in your locums career?
Dr. Andrew Wilner: Travel. My first assignment to South Dakota, it was snowing in Chicago or Cincinnati or wherever I was changing planes, and we were supposed to change at 06:00 P.M., and a typical airport story, oh, don't worry, don't worry, there's a new plane, and finally at midnight they said, oh, their flight is canceled. And this was my first time going to this particular place, and I didn't want to make I was supposed to be working at 8 a.m. the next day, and I had built in plenty of time based on my schedule, but now not only was I not going to be there at 8 a.m., I didn't really know who to call or what to do, or this is really I'm a big fan of the Woody Allen philosophy that 90% of success is showing up, and here I was, I was not going to show up.
That was a case where having an agent, I was working with an agency for that particular assignment, I was able to call somebody at midnight I had this emergency number, and they were going to call first thing in the morning because chances are that I would have been in transit first thing in the morning, so even if I wanted to call, I couldn't call, and they dealt with it, but travel, of course, there's, luckily, the COVID, this was pre-COVID COVID made travel pretty horrendous, but now that's fading out a bit, so I think you have to build in extra time.
And one of the things I think I mentioned in the talk, one of the negatives of working low-comes is that you are, although your travel is paid, the agency will be very happy to pay your flight and rental car and hotel, and that's great, but they do not pay for travel time.
I was working week on and week off, and that meant it was a day of travel there and a day of travel back, even though it was only a three-hour flight you got to be there two hours ahead of time, and then rental car and all of that, so it ends up taking better part of a day, and there was no income, there were no expenses, but there was no income for that day, and there was no income for the day coming back, so every two weeks, I lost, like, three days, so you have to learn to sort of make, be productive I have a laptop, and I did a lot of work in the waiting areas and on the plane, but I think that's a clear downside of low-comes.
Now, if you're only going to go travel once and stay there for six months and then come back, you've lost two days out of six months, it's not a big deal, but if you're going back and forth, back and forth, back and forth, you do lose a lot of time, so you have to travel intelligently, and in some cases, that means driving it may be easier to drive five hours than to try and fly, even though, hypothetically, it's as the crow flies, it would be faster, but the way airports are and airplane schedules, it's not always faster to fly, so I think that's an important consideration.
Speaker: When you take a low-comes engagement, typically, where do you live?
Dr. Andrew Wilner: Yes. Well, in one case, I had a low-comes for a year that I negotiated directly with the hospital, and they did not pay my housing, so I just rented a beautiful condo about three blocks from the hospital that was on the waterfront, and I paid for it out of my pocket, and that was up to me.
Usually, if you work with an agency, they will house you, depending upon the amount of time, so when I worked in Minnesota, I stayed in a hotel about three blocks. It's downtown, Hennepin County Medical Center, so I was in a hotel three blocks away, so I could walk to work every day, no hassle with the car in the mountains of snow and ice, just walk, and they take care of that, and I got zillion hotel points that I've made good use of since then.
I think a rule of thumb is if you're going to stay there, sorry about that, if you're going to stay there longer than six months, they'll get you an apartment, and shorter than six months, usually a hotel, and the hotel's sort of B minus type hotel, and then if you have a family, or a dog you can negotiate with the local tennis company, say, hey I need a bigger room, or I need a suite and see how far you get. It depends how badly they need you, you know. They have budgets for this stuff, so you can push them a little bit, see what happens.
Speaker: Do the hospitals ever put you up in their hospitals themselves?
Dr. Andrew Wilner: I have heard of that, but I never did that myself, no.
Speaker: One of the contras to doing locums is that there's a reason why there's an opening that they need locums for, that you're basically walking into somebody else's problems. How, what are your thoughts on that?
Dr. Andrew Wilner: You're absolutely right, Tom, and I may not have focused on that enough. You should assume that the place you're going to is a mess, that's like, that's a given, because the reason they are hiring you is because they cannot get a full-time person for that job. Now, it may be just an emergent thing where one of their regular physicians took sick leave, or is on maternity leave, and they just need someone to fill in for a few months, and then back to normal, and the place really isn't in that bad shape that that it's a situation of where they can't recruit.
However, very often it is a scenario where the hospital, for one reason or another, is unable to recruit, and that may be for a lot of different reasons. It may just be that the hospital's in the middle of nowhere which I largely, no offense to anybody, but for me, that's mostly the Midwest, and they have a lot of trouble recruiting, and it's hard to get people to want to stay, and Fargo, and places like that. So it's not necessarily a bad place to work, but it may be a difficult place for them to recruit permanent people who are going to spend their lives there.
On the other hand, it may well be that the place is poorly run, and people just don't want to be there. So I go with extremely low expectations. I assume that there's going to be a lot of problems, that that's a given, and then if there aren't, then that's great, but if there are I got my seatbelt on.
My job is to take care of the patients as best I can in the system that exists, and as a locums person, I don't really have that kind of guilt or burden that I have to fix the system.
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