Shifting from Medical Writing to the Locum Life

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Transcription PNC Podcast Episode 362

Shifting from Medical Writing to the Locum Life

- Interview with Dr.Andrew Wilder

Andrew: Yeah, I thought, you know, this is really tough. So, then I discovered again, locum tenens. And now I was back in the system, the locum tenens market is wide open for all specialties. It never dawned on me there would be locum tenens for neurologists. And it turns out that psychiatrists of all things are the most in demand.

John: Interesting.

Andrew: Yeah, so I called a couple of the companies and, "Oh yeah, we've got this. We've got that." Seemed kind of crazy. You just fly in somewhere, you show up, you're the doc of the week or the month or six months. But I liked the idea that I would show up, work 100% of the time and then stop. And then I could go back to the Philippines and go diving and work on my next book.

John: Sounds like a great lifestyle, but of course it's not as easy as just saying show up somewhere, right?

Andrew: Right. The downside, and I write about this in my book, is the credentialing and licensing and CME credits. The bureaucracy of medicine, you don't realize it once you're just, you're in practice and you kind of perk along and you do your CME and you renew your license. It's a nuisance but it's not overwhelming.

Andrew: But at one point, I had licenses in 10 states. And just applying for these and keeping them up and they all have different CME requirements and different registration dates and different fees. There's a lot of little secrets.

Andrew: I'll tell you one. DEA. Everybody knows that you need a Federal DEA number to prescribe scheduled drugs like Oxycontin and stuff like that. What everybody doesn't know, is that if you work in two states, say Massachusetts and Rhode Island, you've got a clinic in each one or you moonlight, you need another DEA for the second state.

John: Oh.

Andrew: Nobody knows that. And there's one guy already that lost his license because he didn't know that, who I corresponded with. You would think it's a Federal number. Now the complexity is you can transfer your DEA from state-to-state. Like, suppose I worked in Minnesota after I worked in Arizona, so I took my Arizona DEA and I transferred it to Minnesota. I don't have to get a new one. But one DEA is not good for two states at the same time. Why? I don't know. But that's a rule. And if you break that rule, you can get into major trouble.

Andrew: So if you do go from state-to-state within the same time period, bouncing back and forth which is not unusual. You might work six months in Arizona and six months in Nevada and go back to Arizona, you need two. So that's my little tip of the day.

Andrew: There's a lot of those in my book, by the way.

John: Let me ask you this, just to kind of help clarify it. So it seems like when I had to re-institute my DEA, because I had stopped clinical for a while. What they were really particular about your place of employment, so it's almost like it's linked. The DEA is almost attached to where you're working in a sense.

Andrew: Yes, exactly. That's exactly right.

John: So if you're in another state, you need another one, because you're working someplace else.

Andrew: Yes. Yes. So when I researched my book and also practicing locums all over the country, you kind of learn these things because you have to. The other thing I learned about locums, my first job, I think was in South Dakota. I never even thought about South Dakota. I'm kind of a coastal guy. You know, there's the east coast and west coast, South Dakota, I don't know. It's cold, it's somewhere in the middle. There's an air force base there. That's all I knew.

Andrew: So anyway, I drop in there and it turns out they've got a fantastic, modern hospital system, they've got residents. It's like, "This is a great job." And that was pretty much my experience with locums, wherever I went.

Andrew: The other thing about locums that you don't anticipate, is that you're appreciated, because you're showing up where they really need you. You're not angling for the job. They're paying an agency or you're contracting directly, usually with an agency, a lot of money because they need you now. So you show up and it's like, "Oh, welcome Doctor Wilner. We're so glad you're here." And it's like, oh wow, my reputation precedes me, that's great.

Andrew: But it's not that. They're just happy that you're there. All you have to do is a good job and they love you, it's fantastic.

John: A lot better than being taken for granted, I guess.

Andrew: Yeah, you're not just a cock because ... and that has pluses and minuses. Because everyone knows you're a temporary, so in terms of developing long-term relationships with your peers and fitting into the community and making changes in the hospital, you can't do those things. Because they know you're just passing through.

Andrew: On the other hand, because you're just passing through, you don't really have to take all these things to heart. You show up, you do your work. At night, I could do my writing and I know that when the thing is over, I'm going to do my very, very best because if it's a good job, I want them to ask me back, or maybe even offer me a permanent position if I really do like it. That has happened. And I know that's happened to other locums tenens physicians as well. Because you're really happy to be there. Well, you need the money because you've been goofing off, following your passion. But you're also, now it's a special thing that you've chosen to do as opposed to, "Oh, I've got to go to work. It's Monday again."

Andrew: So it's kind of all in the eye of the beholder. It's your mindset. But I found locums was just a really, really special opportunity.

John: Now in your book, you mentioned that the attraction of locums may be different for the early, mid- or late-career physician. So I wonder if that ties in or maybe you can explain a little bit about that?

Andrew: Yeah. No, I think that's really important. Most locums physicians are over 50. And many of them don't even try it until they're over 50. And that was my case as well. For that group ... well, there's sort of two groups there. There's the mid-career guy, which I guess, despite my age, I think I'm still a mid-career guy. And then there's the pre-retirement guy.

Andrew: So we'll start with mid-career. So mid-career guys are very often, will work locums as a moonlighting option, because they can't be bouncing around for three months here, six months there, I'll go to Alaska, I'll go to the Caribbean, oh let's try New Zealand for a year, because they've got three kids in school and they've got a mortgage and they've got this whole system that revolves around them. But they need some extra money. So it's a way of supplementing income on vacation time, something like that.

Andrew: Or I've also seen it as a way to explore a new clinical practice. It's like, "You know, I'm stuck here, I've got this job. I really need a full-time job, I'm not too happy with this full-time job. Maybe there's something better out there." So by doing locums, just as a temporary person, you can see how the other half lives and maybe apply for a different permanent job.

Andrew: In fact, I have one guy who's in my book. I interviewed a lot of other physicians. When I started writing the book, it was mostly because I had all these stories, some of which I'm sharing with you, things I had learned along the way that I wanted to share. Then I thought of, when I said, "Well, I bet there's a lot of other stories out there. I'm just one guy, I'm a neurologist. I wonder what the anesthesiologists, which is also a common locums thing. I wonder what their experiences are. I wonder what the residents' experience are, just graduated." So I interviewed a lot of other physicians and they're in chapter 20, called Tales from the Trenches. And I think that's the best part of the book. I asked them, "What was your best locums experience? What was your worst?"

Andrew: But one of those guys, oh, he was in a job that was just a disaster. He was a partner, but the group wasn't making money. And every month, they were making less and less, and working harder and harder. And this is not uncommon. And he wanted out. But he loved where he lived and he had a two-year noncompete. So he was stuck. And being stuck, I think that has a lot to do with burnout. It's not just the problem, it's the realization that you're helpless.

John: Right, exactly.

Andrew: That's what really makes you burned out is I'm powerless to fix this. And he just felt powerless. So against his better judgment, he finally talked to a locums agent. And I think it took him about a year of going back and forth before he decided to give it a try. Because he could work out-of-state. So he could work locums anywhere else, get out of his noncompete geographic restriction area and see what happened.

John: And he didn't have to sell his house or property and everything, yep.

Andrew: Right, he just let the clock run out.

John: Very nice.

Andrew: So he did it and not only did the clock run out, but he discovered a whole new world of opportunities. And he was the other guy, when I did every other week in Minnesota at the County Medical Center which was a wonderful job. It's a teaching hospital, it's a innercity hospital with lots of immigrants. Every other room, they're speaking another language and have some exotic disease. The residents are really good. I had a great time there.

Andrew: So he was the guy who did the other week. I did my seven days and then he would show up and do his seven. But we never actually met in person because I'd be flying out Monday morning and he'd be flying in Sunday night, and we probably passed at the airport, but I'd been in touch with him. And he has since landed a job in South Carolina as a neurologist and director of the stroke program, and he actually chose to move because while he was doing locums, he was talking to people and getting invitations to interview here and interview there. And he found the perfect job for him that he never would have found.

John: So he was networking?

Andrew: He was networking. So locums is a terrific opportunity to work and network at the same time. You just do it without trying, right? They drop you in a new place, you don't know anybody. You have to network just to find out where to get dinner.

John: Awesome. So what about the pre-retirement?

Andrew: For example, we've got a guy here where I work now, he must be in his late 60s, he's been doing clinical practice 40 years. He's an excellent, excellent clinician. I'm sure he's financially stable. And he loves what he's doing, but I think he doesn't really want to do it every day anymore. I think it's just a matter of stamina.

Andrew: The other thing is you get older, you see your days are kind of numbered. So there are some other things you wanted to do.

John: For sure.

Andrew: But he doesn't want to give it up. And the truth is it is very hard to have a ... like we talked earlier, to cut back. There just aren't that many opportunities to work four days a week or three days a week, because for physicians, they need a slot. You've got to fill the slot. Sometimes you can balance it with somebody else, if you're both half. But cutting back is very, very tough and usually at severe financial penalty.

Andrew: So he told me, "What about this locums thing?" So we started talking about it and he realized that this would be perfect for him. Because it allows you to work. You want to work three months a year, six months a year, nine months a year, two weeks a year? It's completely up to you. But you don't have to hang up your shingle. You don't have to give it up. And you can work it into the life that you want for however much time you've got left as a functioning physician. Maybe five or 10 years without the commitments and the routine.

Andrew: It's like, "Oh, I really want to go with my family for a month to Italy. We've all got time off but I can't go because I'm on call on Christmas." You can just get rid of that. Say, "You know what? Not working on December. I'll just work February and March and maybe April and I'll do September." And in the locums world, there's no stigma to doing that.

Andrew: When you're in the day-to-day, it's like, "Gee Doctor Wilner, you don't work full-time." It used to bother me as kind of a high-performing guy with high expectations of myself. And after a while, I realized that those people didn't know what they were talking about.

John: Right, right. They don't know what balance is.

Andrew: Right. So then the last group is after residency. And it was very interesting about that. There were two completely different opinions. One was residents don't know enough. You've just finished your fellowship or you're right out of residency, it can be pretty tough to get dropped in as the only neurologist in a community hospital. And you don't know who to ask. You don't know which consultant is really reliable. Who's telling you the right thing. So you have to be a very confident new graduate to do locums because it's quite likely that you're not going to be in an academic institution with others at your level or higher. You may just be the lone warrior out there and you've got to figure it out. And I think that could be overwhelming. That was the opinion of some of the doctors.

Andrew: On the other hand, I had at least two who told me that it was the most wonderful thing in the world. They knew what they were doing, they really didn't know what kind of practice they wanted. So they practiced in California, they practiced in Texas, they practiced in big clinics and volunteer clinics with indigene people, with American Indians, and they kind of figured out what they really, really liked. And were ready then to apply for the job they knew would be a better fit, for the permanent job.

John: Right.

Andrew: So that's the other tool of locums. I think when you say locums, people think, oh so you want a career of locums? Like me, I had a career of locums for a while, but it also allowed me to figure out that I really like teaching, I really like really sick people who don't have insurance. So I ended up, now I am an associate professor at the University of Tennessee in Memphis in a city hospital with just that combination. And I couldn't be any happier.

John: That's fantastic. We're going to run out of time here, so I wonder if you could walk us through in the last five minutes or so, the process that you followed to write the most recent book and publish it. Because I think it was done in a slightly different way than perhaps your earlier books were approached.

Andrew: Well, writing a book, I don't recommend it unless it's something you really, really want to do. Because it takes a lot longer than you think. But to answer your question, my first two books were published by traditional publishers and they have their process. Bullets and Brains that I published, actually I self-published it, because all of those essays had previously been published on Medscape. It was a collection. And I couldn't get a traditional publisher interested in publishing something that was basically already out there, although not in really any collected form. And I also updated all these essays. So I thought it was worthy of a book.

Andrew: So when it came time to write my latest book, The Locum Life, A Physician's Guide to Locum Tenens. I explored the market, who would want to buy this. It's not for people to buy it at checkout at the supermarket, it's only for physicians who are interested in exploring this path. It's kind of a guidebook. And I looked into traditional publishers and I didn't think it was really going to sell enough copies to get them all excited about it. And I had already self-published a book, that was with CreateSpace. And CreateSpace no longer does that.

Andrew: So I discovered Lulu which is one of the largest self-publishing companies. And basically, they just print it. They'll edit it if you want. I didn't have them edit it, I'm a professional writer and I'm used to editing. So I edited it myself. I had the cover designed by an artist, who I met when I was doing locum tenens.

John: Very good.

Andrew: She was doing paintings of her husband's adventure at the hospital. He kept coming in and out and she would draw and paint whenever he was admitted. And she had an exhibit and I thought her style was just wonderful. So I contracted with her, she did the cover, I wrote the text and then Lulu puts it together and gets your ISBN number and makes sure that it's up on Amazon and Barnes and Noble. So the beauty of that process is the only person you've got to wrestle with is yourself. So you want 20 chapters? It can have 20. You want 10? It can have 10. When you work with a traditional publisher, you get an editor or a team of editors and they all have their own ideas about how it should be done. I'm just one of these self-directed individuals.

Andrew: Doing it myself plus I didn't think the traditional publishers, even if they did accept it, would put their weight behind it to market it. Figured I'll just market it on my own, people know who I am. They know about locums. If they're interested, they'll buy the book. And it'll give me a forum, a platform where I can put everything I know that's useful about locums into a nice guidebook. So that's why I did it self-published.

John: Now just for some other tactics. As a writer, what kind of philosophy do you follow? Do you say okay, I'm going to put aside three hours a day every day for ad infinitum, or how do you manage yourself in terms of giving something like this together?

Andrew: That is a great question. If you're a creative person, a writer or an artist or a dancer or a singer, the chances are you're not going to be able to make your living doing what it is you really love. I'm lucky in that I also love doing medicine. But chances are, it can't be your number one priority.

Andrew: And then the other thing that goes with that is most people you know, who are not creative people, have no idea why you want to waste your time doing it.

John: I see, yeah.

Andrew: So you don't get much support. You're not going to get any support from your workplace, kind of like my partners when I was pursuing academics. "Why?" And then it's going to be very tough to get support from those around you, unless they really love you and they see that this is something that's so important to you, they don't really know why, but ... So it is very, very hard to carve out the time. I've discovered that, I used to stay up from 10:00pm to 2:00am was my best writing time.

John: Okay.

Andrew: Which is incompatible with having a regular job and being married and having a baby. So now I find that I get up very early. I get some help with that from my newborn son. And get breakfast together and then go hide for a few hours in my office on my off-week. That's what I'm doing right now. And I close the door, and I answer my emails and then I start hacking away at something that hopefully will be worth reading sometime soon in the future.

John: Now one other question about that. This is really because a lot of the things we do here are how-to? So I want to get real practical. But you've got 20 chapters in the book and by the way, let me stop here and say that I've read the book from front-to-back, it is excellent book. It's very comprehensive, it's very well-organized and I could tell you're a professional writer. Because it's easy-to-read, it's enjoyable to read. So I'm just going to put that out there for you, the listeners, if you're interested in locums, you definitely want to get this book.

John: But with the 20 chapters, so do you create the 20 chapters ahead of time? Say, okay these are the 20 things I want to hit and then you can kind of come back within each and chunk it out, or do you start at the beginning and just start writing? How do you approach that?

Andrew: That's a great question. Some people can probably do that. I can't. In fact, so what I did was, as I was thinking about this, gee, this would be a great book, I would start jotting down topics. What do I need to talk about? What's important? At one point, I had about 100 chapters that were going to be topics.

John: Oh boy.

Andrew: Like the DEA thing I talked about. We didn't talk much about credentialing and licensing and then experiences getting the job and how to show up and there's a lot in the book about travel and running your own business and how to deal with malpractice and being an independent contractor and taxes. So I would start, say, oh this would be a chapter, and then I would start writing those chapters as isolated things. And I'd have to do a lot of research about malpractice, what are the options? Or for example, I learned that 80% of locum tenens positions use agencies, but 20% just contract directly. And I've done it actually both ways, but I didn't want it to be just a book about my experiences. I wanted to be able to generalize to everyone. So I just kept writing chapter here, chapter there, chapter ... and then I'd say, "Those two chapters, I've got this one about licensing and this one about credentialing and this one about DEA, those could all go together."

John: Right.

Andrew: So first I had to put it all out there and then I said, "Maybe I want to interview some other guys." I called some of the locums companies and said, "Hey, can you give me some names of docs who might want to talk about their experiences?" And people that I've met on my own experiences and I would do email exchanges or talk on the phone like we're doing and record an interview. And I said, "maybe that ought to be." So some of those I would plant in different chapters. So-and-so did this for his credentialing or had this experience or this is what they do with their 401K. And then I said, "That could be a whole chapter." So that became Chapter 20.

Andrew: So for me, same with fiction writing. I think there are guys that write mystery novels and they already know how it ends and they just block it all out. I kind of have to learn as I go.

John: Okay, no, that makes sense. Certain things occur to you in the middle of writing about another topic that relates to something else, "Oh, I've got to do a little more detail on that." That makes perfect sense. So you know what? We are going to run out of time here.

John: So I want you, if you could at this point, tell us how we can follow you if we want to follow you. Where's the best place to purchase your book? And information like that.

Andrew: The book is available at Amazon and Barnes and Noble and all major booksellers. But the best place is to come to andrewwilner.com. www.andrewwilner.com. Andrew Wilner is one word. Because a couple months ago, when the book was going to come out, I said, "You know, I ought to make a new website about Andrew Wilner as an author." If you search Andrew Wilner MD, you'll find some websites out there as Andrew Wilner as physician and Andrew Wilner as medic. We didn't talk about this but medical missionary in the Philippines and underwater, all these other things.

John: Videographer, right?

Andrew: Yep. I said, "We need an Andrew Wilner author site." So there's now an Andrew Wilner author site with all my books and I've created a blog, in addition to my Medscape blog, now I have my own blog and I blog about writing and locum tenens. There's a thing you can click on there on the website to get the book at a discount, right direct from the publisher.

John: Okay, at andrewwilner.com. That's where we find that.

Andrew: And you can also contact me. I try and respond to emails and if somebody has a legitimate question, I will do my very, very best to respond and provide some guidance on these topics.

John: Which email shall we use for that?

Andrew: Right at the website. Just go right to the website and there's a contact me. I'm happy to respond.

John: Very good. I'll put all those links in the show notes and anything that came up during the interview. So I'm going to give you a last chance here to give us any last bit of advice about locums or about writing or both? For the audience here that's been with us.

Andrew: They're both options. I think people tend to get into a rut. And they shouldn't be afraid to try locums for sure. And when you write, there's a lot of blog opportunities now, with KevinMD and Doximity. And writing is something that people are ... they find therapeutic or it's just fun thing to do. And I write because I learn. When you put something, it's like you want to learn something? Teach it, right?

John: Yep. That's true.

Andrew: [crosstalk 00:28:09] to paper, you say, "Oh, I don't really know that. Let me go find that out." And it's kind of fun. So I would say, don't be afraid to experiment.

John: Awesome, that's great advice. No, and I really like speaking with physicians like yourself who maybe earlier than some of us, came to understand that you always have options and if you're not happy in what you're doing, then you should definitely explore those. That's an excellent inspiration for us.

Andrew: Thanks very much, it's been great to speak with you.

John: Okay, Andrew, then with that, I will say goodbye and I hope to chat with you again sometime in the future.

Andrew: It was my pleasure.

076 Combined Tracks Jurica Wilner for Transcript... (Completed 02/20/19)

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