Locums

[maceo]

Follow Zippy's advice and see where it gets you. You won't be bad off but would you be in a better position had you gone to a good group whether you stay with them or not? I say YES. After two years of locums work when compared to two years in a good practice it is my opinion that the locums person will be way behind in experience in everything from anesthesia, to contracts, to politics, to everyday workings of an OR and a strong group. Even a poor group can teach you more, even if it is how not to handle issues.

you are entitled to your opinion.. I vehemently disagree with it however.
Not everyone wants to be like you. news flash

I bet you are voting for mccain/palin ticket. because they are the ONLY ones who can save the country. I bet you also watch Sean Hannity. "YOure a great american"

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[Bertelman]

you are entitled to your opinion.. I vehemently disagree with it however.
Not everyone wants to be like you. news flash

I bet you are voting for mccain/palin ticket. because they are the ONLY ones who can save the country. I bet you also watch Sean Hannity. "YOure a great american"

I wasn't sure it was possible, but this thread definitely just took a turn for the worse...

 

[OB1🤙]

I wasn't sure it was possible, but this thread definitely just took a turn for the worse...

Seriously, WTF.

 

[militarymd]

So you never did a week or weekend here and there for a couple extra bucks when the Navy was paying you $100k per year?

nope...not one single locums dollar...I'm was and still is frugal....I hate EVERYONE who is in over their head right now....and have to be bailed out with MY tax dollar.

 

[militarymd]

you are entitled to your opinion.. I vehemently disagree with it however.
Not everyone wants to be like you. news flash

I bet you are voting for mccain/palin ticket. because they are the ONLY ones who can save the country. I bet you also watch Sean Hannity. "YOure a great american"

Just as I suspected....You are a COMMUNIST who believes in brainwashing the public...and censorship.

 

[maceo]

Just as I suspected....You are a COMMUNIST who believes in brainwashing the public...and censorship.

look in the mirror and tell me who is communist

 

[radslooking]

I wasn't sure it was possible, but this thread definitely just took a turn for the worse...

lol. oh by the way, if you guys all think like this, you're going to be terrible doctors.

And, uh, this is what Hitler did in Germany too.

 

[radslooking]

nope...not one single locums dollar...I'm was and still is frugal....I hate EVERYONE who is in over their head right now....and have to be bailed out with MY tax dollar.

Isn't that the truth? I am frustrated because I've tried to live frugally through my life, now I have to bail out people who got terribly in over their head, as well as greedy mortgage sellers.

Punish all the people who have been doing it right. Not fair.

 

[Noyac]

you are entitled to your opinion.. I vehemently disagree with it however.
Not everyone wants to be like you. news flash

I bet you are voting for mccain/palin ticket. because they are the ONLY ones who can save the country. I bet you also watch Sean Hannity. "YOure a great american"

Dude, you just went from rather amusing to totally ridiculous.

Calling me a McCain supporter is like me calling you a Yankee fan (I'm sure you don't understand).


As far as you doing locums for 8 months, well thats great but I knew you did this already. What I don't know is, did you come to my practice?

What I don't understand is how you got so defensive here when I described my experience. It's my experience and not yours. But you have taken it personal for some reason (care to explain, too close to home for you?). You have resorted to attacking my character, why?

BTW, you are not like me. And I am sure we are both happy about that one. I would at least come up with something original IF I were to try to insult someone. Try to be an adult here and discuss the issues and end this ridiculous bantering.

 

[Arch Guillotti]

The political reference is kinda off kilter. We have plenty of threads on politics if that's what you want to discuss

 

[Arch Guillotti]

I wasn't sure it was possible, but this thread definitely just took a turn for the worse...

I am reminded of a death roll with an alligator.

 

[Bertelman]

lol. oh by the way, if you guys all think like this, you're going to be terrible doctors.

And, uh, this is what Hitler did in Germany too.

Nice.

 

[Bertelman]

I am reminded of a death roll with an alligator.

[YOUTUBE]i614psU1pwo[/YOUTUBE]

 

[militarymd]

you are entitled to your opinion.. I vehemently disagree with it however.
Not everyone wants to be like you. news flash

I bet you are voting for mccain/palin ticket. because they are the ONLY ones who can save the country. I bet you also watch Sean Hannity. "YOure a great american"

Just as I suspected....You are a COMMUNIST who believes in brainwashing the public...and censorship.

look in the mirror and tell me who is communist

That seals the deal....you have a screw LOOSE.

You REALLY think I believe in Communisum/big government/CENSORSHIP....with BIG Brother watching you all the time....kind of like this forum ...where the citizens can REPORT you for things..and have you CENSORED???????

Obviously you don't believe in the American way...mom and pop groups working for themselves...but in the Locums way...where you work for a Big Brother type organzation where excellence and hard work is not important...just someone to punch the clock.

I'm not saying that there is anything wrong with being a commmunist....at least admit it.

 

[Southpaw]

you are entitled to your opinion.. I vehemently disagree with it however.
Not everyone wants to be like you. news flash

I bet you are voting for mccain/palin ticket. because they are the ONLY ones who can save the country. I bet you also watch Sean Hannity. "YOure a great american"

keep posting. you're proving Noyac's point.

 

[periopdoc]

lol. oh by the way, if you guys all think like this, you're going to be terrible doctors.

And, uh, this is what Hitler did in Germany too.

http://en.wikipedia.org/wiki/Reductio_ad_Hitlerum

 

[Bertelman]

http://en.wikipedia.org/wiki/Reductio_ad_Hitlerum

http://en.wikipedia.org/wiki/Godwin's_Law

* he upped the ante by invoking both Godwin's and Burnett's law.

 

[maceo]

keep posting. you're proving Noyac's point.

noyac doesnt have a point. except to self righteously assert his opinion.

 

[maceo]

That seals the deal....you have a screw LOOSE.

You REALLY think I believe in Communisum/big government/CENSORSHIP....with BIG Brother watching you all the time....kind of like this forum ...where the citizens can REPORT you for things..and have you CENSORED???????

Obviously you don't believe in the American way...mom and pop groups working for themselves...but in the Locums way...where you work for a Big Brother type organzation where excellence and hard work is not important...just someone to punch the clock.

I'm not saying that there is anything wrong with being a commmunist....at least admit it.

I dont have a screw loose. You have a screw loose.

 

[Southpaw]

noyac doesnt have a point. except to self righteously assert his opinion.

Now you're just being disingenuous. He has a point and he posted it when he started the thead.

I have never seen a locums come into my hospital that could compare to the quality of my group. Now without boasting too much, we have a group that is some of the best of the best. Everyone was a chief resident in their residency with the exception of a few. Everyone here was the top performer of their group prior to coming here. Everyone has a great personality.

He is giving residents advice based on his personal experience. You don't have to like it, you don't have to agree with it, but when you go all Michael Moore on us with your lunatic political rants it LESSENS YOUR point. Simply disagree in a respectful manner and move on.

 

[pgg]

I dont have a screw loose. You have a screw loose.

• I know you are but what am I?
• Nyah nyah.
• I'm rubber you're glue whatever you say bounces of me and sticks to you.
• Phhhthtttbbbltt.

There, that about covers your next 4 posts.

I'm here to help. If you need further assistance, I'll consult my 2nd grader and get back to you.

 

[militarymd]

• I know you are but what am I?
• Nyah nyah.
• I'm rubber you're glue whatever you say bounces of me and sticks to you.
• Phhhthtttbbbltt.

There, that about covers your next 4 posts.

I'm here to help. If you need further assistance, I'll consult my 2nd grader and get back to you.

I couldn't help smiling when I read this.

 

[maceo]

Now you're just being disingenuous. He has a point and he posted it when he started the thead.



He is giving residents advice based on his personal experience. You don't have to like it, you don't have to agree with it, but when you go all Michael Moore on us with your lunatic political rants it LESSENS YOUR point. Simply disagree in a respectful manner and move on.

Its stupid advice... i dont care what experience it's based on. go ahead follow everything he says I dont care.. take everything he says as gospel. Im telling you not everyone fits his model and for some residents locums would be perfect. and i was kidding about making fun of his political stance. . I dont care if he votes for mccain/palin. I actually kinda like palin, she is kinda cute in a joe sixpack kinda way. and the maverick aint so bad himself.

 

[Noyac]

So at the risk of opening up an old thread and getting maceo started again I decided it was better than a whole new thread on the same topic.

But our recent locums was on call the other night and had to call in one of my partners to do a Thoracic Epidural. He has been one of our average locums over the past year. But we now find out he can't or doesn't do thoracic epidurals. So I'm gonna go back to my original point. Be aware who you associate yourself with. If you do locums it is very likely you will be looked at as inferior.

 

[DrRobert]

But our recent locums was on call the other night and had to call in one of my partners to do a Thoracic Epidural.

I don't see how this incident should be used to judge someone's ability as a physician.

First of all, thoracic epidurals are not that common. Depending on where you trained as a resident, someone might graduate having done zero or a couple.

Having done a few myself, I think they can be very challenging. Even some of our stellar CT attendings who have done hundreds of them can struggle, sometimes abandoning the procedure all together.

Hell - we've all done thousands of IVs, and sometimes you even need help getting one of those in a patient.


While I agree that our specialty is procedure-based, a physician should not be judged so heavily on their technical skills. I mean there are nurses out there that can school even the most skilled physicians in some procedures.

And lets face it, not every physician is going to possess the natural ability to become good at procedures. I know a couple attendings who are great anesthesiologists but are not the best with procedures.

 

[mille125]

I don't see how this incident should be used to judge someone's ability as a physician.

First of all, thoracic epidurals are not that common. Depending on where you trained as a resident, someone might graduate having done zero or a couple.

Having done a few myself, I think they can be very challenging. Even some of our stellar CT attendings who have done hundreds of them can struggle, sometimes abandoning the procedure all together.

Hell - we've all done thousands of IVs, and sometimes you even need help getting one of those in a patient.


While I agree that our specialty is procedure-based, a physician should not be judged so heavily on their technical skills. I mean there are nurses out there that can school even the most skilled physicians in some procedures.

And lets face it, not every physician is going to possess the natural ability to become good at procedures. I know a couple attendings who are great anesthesiologists but are not the best with procedures.

I beg to differ. ALL residents should be able to perform thoracic epidurals after graduation...period...end of story. It is true that we may all struggle with procedures from time to time but this procedure is well within the realm of residency training. I equate this to the surgeon who cant do a hernia operation, the family doc who cant do a trigger point injection, or the pulmonologist who cant do a bronch. It is true that this alone does not equate to decreased intelligence. However, it makes you wonder where they trained and why they are uncomfortable with something that 99.9% of graduating docs can do and in many cases with something that first years are comfortable with.

 

[thegasman]

So at the risk of opening up an old thread and getting maceo started again I decided it was better than a whole new thread on the same topic.

But our recent locums was on call the other night and had to call in one of my partners to do a Thoracic Epidural. He has been one of our average locums over the past year. But we now find out he can't or doesn't do thoracic epidurals. So I'm gonna go back to my original point. Be aware who you associate yourself with. If you do locums it is very likely you will be looked at as inferior.

I agree with your point about this particular locums if he really won't do a thoracic epidural. But there is no shame in asking for help if you struggle with a procedure from time to time. If it is a regular thing then that is a red flag. I have been at my gig for 6 months and have asked for help from senior partners twice. Once for an iv and once for an a-line. Both times they struggled at least as much as me. I eventually got the iv, and the partner got the aline (brachial). I don't think they thought any less of me for asking for help. So did the guy try the epidural and he couldn't get it? Or he just won't do them? There is a difference.

 

[Noyac]

I agree with your point about this particular locums if he really won't do a thoracic epidural. But there is no shame in asking for help if you struggle with a procedure from time to time. If it is a regular thing then that is a red flag. I have been at my gig for 6 months and have asked for help from senior partners twice. Once for an iv and once for an a-line. Both times they struggled at least as much as me. I eventually got the iv, and the partner got the aline (brachial). I don't think they thought any less of me for asking for help. So did the guy try the epidural and he couldn't get it? Or he just won't do them? There is a difference.

He never tried. He just doesn't do them. And mille is right. Everyone these days should be able to do this procedure. And everyone will struggle from time to time w/c is fine. That's not what I'm criticizing.

Some of you are missing the point. I'm not focusing on this particular locums person. I'm just saying that this seems to be an unfortunate trend among locums (at least the ones we get who come highly recommended) and therefore, I ask you why would anyone want to associate yourself with this population right out of residency?

 

[2ndyear]

Thoracic epidural should be a basic skill. I'm comfortable with all of the cases at my current gig. But lets say I did do some locums work on the side (and I may). Most likely it would be at a larger place. I had very solid training, but I still would think twice about doing some cases. Namely hearts and neonates. I don't want to sound weak, but having not done these yet as an attending makes me not want to jump in a case in the middle of the night on a 28 weeker with NEC. Or a crash onto bypass heart. If in the future I decide to join a practice that does hearts or neonates, I would imagine there would be some sort of easing into them, right? I'm not opposed to them, just wondering.

 

[entactogen]

I'm a recent graduate and have a full time position at a hospital currently. I wanted time to get all my testing out of the way before i started locums. I am still definitely looking to do locums in the near future and many of my attendings at my residency all knew that and definitely tried to discourage me, giving me the same reasons that Noyac did. They stated that most are doing locums because they have to (meaning they can't find a job) and the minority do it because of travel/fun. Thus, the majority give the the locum participants a bad name and my attendings even said some groups will not even consider you if you have locums on your CV.

I find it very disheartening that the situation is like this because despite of all of that, and i have thought about it quite a lot, I still am aiming to start locums some time next year. And the reasons as one of the previous posters pointed out is mainly travel and freedom. Of course my colleagues suggested that I find a job with 9 or 10 weeks of vacation. Of course that would be nice, but its not only travel, but actually living in a new city/town and meeting new people that I love to experience. And being single currently and still fairly young, I believe now is the time for me to pursue it. And as many people I do talk to that discourage me from doing it, the same number of people also tell me that if they were younger and untied that they would also pursue such a lifestyle.

Of course, it is unfortunate that my decision will throw me in the lion's den in the future. I hope that one day, when I am ready to settle down, that my CV will have at least some consideration to an open minded group. But its the nature of the beast I guess. Though in the end, you only live once.

 

[maceo]

hey noyac,

I agree this locums sucks. All locums sucks. If anyone does locums they should have their head examined.


Why the hell was he doing a thoracic epidural that late at night. I dont do thoracic epidurals or any regional for that matter after 7 pm. Period. everyone gets a tube.


If anyone called me about a thoracic epidural,.. it would be dr maceo can you come in to do a thoracic. .epidu..... dial tone..............

 

[Noyac]

hey noyac,

I agree this locums sucks. All locums sucks. If anyone does locums they should have their head examined.


Why the hell was he doing a thoracic epidural that late at night. I dont do thoracic epidurals or any regional for that matter after 7 pm. Period. everyone gets a tube.


If anyone called me about a thoracic epidural,.. it would be dr maceo can you come in to do a thoracic. .epidu..... dial tone..............

Yea, I would expect nothing else from you.

Can you not think of any reason to do an after hours thoracic epidural? This one was on saturday in the afternoon.

 

[Arch Guillotti]

I dont do thoracic epidurals or any regional for that matter after 7 pm. Period. everyone gets a tube.

Uh that is pretty dogmatic. There are occasions when a pt. can really benefit from regional. Using a strict time cut off sounds kinda weak to me.

 

[Arch Guillotti]

If I were to ever do locums I would expect myself to be facile in everything possible. Now there are some things that I am better at than others and I would expect that many people are this way (except for a chosen few on this board).

Thoracic epidurals can be a pain in the arse but I would consider the skill to be very basic and would expect anybody worth a crap to be a ble to place a straightforward one.

The only exception I can think of is someone who simply wasn't trained to do them in residency (old schoolers) because there are a few of these folks around. One of the best anesthesiologists I know isn't really trained in them. He is a guy I would absolutely trusts with my life any time. But he is a little bit of a dinosaur and is in academics for life so since he wasn't trained during residency to do thoracics and residents have been doing all the regional for his cases for many years he is sort of deficient in this one little area. But he isn't out there doing locums.

 

[maceo]

Yea, I would expect nothing else from you.

Can you not think of any reason to do an after hours thoracic epidural? This one was on saturday in the afternoon.

if youre doing a case on a saturday afternoon, something is fishy. I have to reduce my risk exposure somehow.

 

[maceo]

Uh that is pretty dogmatic. There are occasions when a pt. can really benefit from regional. Using a strict time cut off sounds kinda weak to me.

listen partner, ive been doing my own cases day in and day out 10-12 hours a day for almost seven years. you gotta have some standards. if the surgeons are doing cases at night they are generally up to no good.. there is pus, infection bleeding.. whatever.. something bad. you dont do no epidural in those conditions.. you put a tube in and you watch em closely. save your fancy epidural for tues morning. mmmkkkkk

 

[Noyac]

listen partner, ive been doing my own cases day in and day out 10-12 hours a day for almost seven years. you gotta have some standards. if the surgeons are doing cases at night they are generally up to no good.. there is pus, infection bleeding.. whatever.. something bad. you dont do no epidural in those conditions.. you put a tube in and you watch em closely. save your fancy epidural for tues morning. mmmkkkkk

Your not getting it.

 

[maceo]

Your not getting it.

neither are you

 

[Planktonmd]

If I was doing locums my approach to everything would be a cautious one and my first priority would be to minimize my exposure to liability.
There are many things that I do routinely right now that I wouldn't do if I was doing locums.
When you are an outsider you are always treated with suspicion and you will be crucified for things the local guys would usually get away with.
This is why I don't do locums.

 

[maceo]

There are many things that I do routinely right now that I wouldn't do if I was doing locums.
.

like what?

 

[Planktonmd]

like what?

Basically any regional or nerve block that is not absolutely necessary.

 

[Noyac]

neither are you

Fair enough.

But have you ever placed a T. Epidural for someone that wasn't going to surgery, ie. multiple rib fxs? Would you not place one in an attempt to help keep the pt off the vent?

 

[maceo]

Fair enough.

But have you ever placed a T. Epidural for someone that wasn't going to surgery, ie. multiple rib fxs? Would you not place one in an attempt to help keep the pt off the vent?

of course i have.. Thoracic epidurals are easy and fun to do. I do the hanging drop method. sweet. just gotta know when to do them and when NOT to do them.

 

[Arch Guillotti]

of course i have.. Thoracic epidurals are easy and fun to do. I do the hanging drop method. sweet. just gotta know when to do them and when NOT to do them.

but not after 7 pm

 

[Noyac]

of course i have.. Thoracic epidurals are easy and fun to do. I do the hanging drop method. sweet. just gotta know when to do them and when NOT to do them.

Seriously, you are not getting it.

I'm not asking you how you do your T Epid's.

You are assuming that the T epid was for a surgical case, it was not.

Do I have to explain every little detail to you? I won't.

 

[maceo]

Seriously, you are not getting it.

I'm not asking you how you do your T Epid's.

You are assuming that the T epid was for a surgical case, it was not.

Do I have to explain every little detail to you? I won't.

ok. whatever you say!

 

[zippy2u]

Ahh, brings to mind the ole' "triple night donut show down at the mom and pop community hospital." Let an old locum shark play it out for ya... $250 to carry the beeper and you're on call. $ 250 to step foot in the hospital. $200/hr for an hour's time and this will take an hour. Bring a dozen o' donuts for the floor nurses to keep them happy. L1-L2 epidural threaded up to T10 or so. Duramorph 4-5 mgs. 0.5% marcaine with epi (3-5ccs each level) intercostal blocks. Pulse ox at bedside. Above will be repeated for 2 more nights including the donuts. Everybody has a smile on their face and the shark has just skated with $2100 for less than 3 hours of work---$$$$sweet! Yup, Zippy the Road Warrior has struck again... Regards, ----Zip

 

[fastosprintini]

kinda fun to follow the agonizing over the relative merit of locums....
we, however have a somewhat different problem with them: we are a small hospital in the middle of nowhere, the locums we employ are difficult to get and they are painfully aware of this fact.
while they are all competent people, they refuse to work nights, weekends, demand (DEMAND!!) that they are early out at full pay etc, etc.
sadly we are stuck with them , but i feel better already venting....
fasto

 

[maceo]

Ahh, brings to mind the ole' "triple night donut show down at the mom and pop community hospital." Let an old locum shark play it out for ya... $250 to carry the beeper and you're on call. $ 250 to step foot in the hospital. $200/hr for an hour's time and this will take an hour. Bring a dozen o' donuts for the floor nurses to keep them happy. L1-L2 epidural threaded up to T10 or so. Duramorph 4-5 mgs. 0.5% marcaine with epi (3-5ccs each level) intercostal blocks. Pulse ox at bedside. Above will be repeated for 2 more nights including the donuts. Everybody has a smile on their face and the shark has just skated with $2100 for less than 3 hours of work---$$$$sweet! Yup, Zippy the Road Warrior has struck again... Regards, ----Zip

nuff said huh noy?

 

[Noyac]

nuff said huh noy?

Still not getting it are you.

He placed the epidural.

But thats alright, I understand you are looking for any opportunity to take a shot at me. Unfortunately, you are completely unsuccessful.