doctadre

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i've decided to do some locums after i graduate this summer. i know that it's frowned upon but i think it may be the best option i have at the moment given my situation.

for those who are familiar with the process, which company is best to use? from google, i see www.locumtenens.com and www.nationalanesthesia.com. is one better than the other? are there other companies that are better? should i just sign up with one or should i just sign up with all of them?

thanks in advance. any help would be apprecited.
 

IlDestriero

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See which one offers better malpractice coverage. Good luck. You should know that some locums guys get all the stool dumped on them that the other guys don't want to do. Before you take a job, talk to someone who has gone to that facility before. If no one has gone there, ask the guys there some direct questions. Of course, they're probably the minority.
 
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Good point about the malpractice coverage. Also, try and go with one that stays with you throughout your placement. Some out there send you off and you never hear from them again.
Consider going overseas. AU and NZ are exciting and look great on a CV.
 

maceo

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i've decided to do some locums after i graduate this summer. i know that it's frowned upon but i think it may be the best option i have at the moment given my situation.

for those who are familiar with the process, which company is best to use? from google, i see www.locumtenens.com and www.nationalanesthesia.com. is one better than the other? are there other companies that are better? should i just sign up with one or should i just sign up with all of them?

thanks in advance. any help would be apprecited.
why is it frowned upon?
 
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Great question. I started a discussion myself and asked the same question. I'd think it would be a good thing because you can experience other cultures (if you go outside of the States) and experience other health care facilities.
I'd love to know how other people feel about it.
 

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Great question. I started a discussion myself and asked the same question. I'd think it would be a good thing because you can experience other cultures (if you go outside of the States) and experience other health care facilities.
I'd love to know how other people feel about it.
There have been threads on here before where various PP physicians had expressed their beliefs, based on their own experiences w/ locums physicians, that their skills, work ethic, and overall performance were inferior (why else would they doing locums, instead of landing a real job?). There was a lot of back and forth and, ultimately, like most things, the truth lies somewhere in the middle. You could probably search for the thread and get the details easily (details which consist mostly of the opinions of a few random, anonymous internet posters, no disrespect intended).
 

sevoflurane

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i've decided to do some locums after i graduate this summer. i know that it's frowned upon but i think it may be the best option i have at the moment given my situation.

for those who are familiar with the process, which company is best to use? from google, i see www.locumtenens.com and www.nationalanesthesia.com. is one better than the other? are there other companies that are better? should i just sign up with one or should i just sign up with all of them?

thanks in advance. any help would be apprecited.
Have you considered contracting directly with the group/hospital? This will give you the best bang for your buck. You cut out the middle man. We don't use locums any more, but when we did (and found a locums we were comfortable with), we'd pay him $1500 for 7-3pm. $250/hr after 3pm. $250 for call. So a 12 hr shift would get you $2500 without call. $2750 with call if you were't called out after 7:00pm. 4K/call wasn't unusual if you were "busy".

I don't know what other locums companies pay, but the locums who passed through here were very happy not to be involved with a locums company + taking home a little extra.

Just a thought.
 

sevoflurane

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On the other hand, working for a locums company gives you support if you were to need it. i.e.: if you end up working for a shady group that isn't giving you what you are owed. (I'm sure this situation has happned, but I don't know it's frequency).
 

aneftp

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Have you considered contracting directly with the group/hospital? This will give you the best bang for your buck. You cut out the middle man. We don't use locums any more, but when we did (and found a locums we were comfortable with), we'd pay him $1500 for 7-3pm. $250/hr after 3pm. $250 for call. So a 12 hr shift would get you $2500 without call. $2750 with call if you were't called out after 7:00pm. 4K/call wasn't unusual if you were "busy".

I don't know what other locums companies pay, but the locums who passed through here were very happy not to be involved with a locums company + taking home a little extra.

Just a thought.

While I agree it's best to get rid of the middle guys (the locums companies), they still serve a valuable purpose (timely payment, providing lodging expenses, car rentals).

As for your group paying $1500/8 hours, $250/hr OT, was that pay to a local locums, or an out of the area locums where you needed to provide lodging, malpractice etc?

That being said, I would NOT recommend locums for a brand new grad, especially with the anesthesia market being as "tight" as it is already. Many "pure locums" companies want straight board certification and not just board eligibility. I would recommend that you work full time for at least 6 -12 months to get some experience and than start looking. Personally I had worked for 3 years prior to doing locums in a busy level one hospital.

The anesthesia locums market has changed dramatically in the past couple of years. When I did locums for a 18 month period (2007-mid 2008), I could still name my price and location. Now when I look around, there are hardly any desirable opportunities and the pay rate has gone down. It used to be that you could routinely get $1600/8 hours plus OT Plus lodging/car expenses. Now you may get $1200/8 hr or they say $1400/8 but you have to provide your own lodging.

As for locums companies, I met a guy with 40 years experience and he says the majority of these locums companies are run by the same people. They come and go and recycle themselves under different names (although they are run by the exact same people). I won't name the companies in a public forum but many of them have been mentioned before.

One last word of advice if you are determine to do locums and expecially in this tight market. Be prepared for long stretches where you may not find work. It's ok with you don't have major expenses (family, house payments etc). And get medical license in at least a couple of the "major" states like Florida, California, or Texas and then add a less desirable state (but with lots of locums opportunities like Pennsylvania or something like that.
 

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The arguments for and against locums have been hashed out here in the past.

I think that locums companies are a rip-off. They pocket money off of us without really doing a whole lot. I like when they promise you 24/7 access to their "associates". The going rate seems to be $1200 or so for an 8 hour day with malpractice included. I think a fair rate is 2K or so for a busy 8 hour day supervising, also with malpractice included.

The recruiters that work for them are a dime a dozen with loads of turnover and little to no knowledge of what anesthesiology really entails.
 

sevoflurane

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That being said, I would NOT recommend locums for a brand new grad, especially with the anesthesia market being as "tight" as it is already. Many "pure locums" companies want straight board certification and not just board eligibility. I would recommend that you work full time for at least 6 -12 months to get some experience and than start looking. Personally I had worked for 3 years prior to doing locums in a busy level one hospital.
Couldn't agree more, unless taking a locums job is out of necessity.

Regarding our locums guy: he already had license/malpractice in our state and also provided his own lodging at a disc. hosp. rate of $250/week. He lived 3 hrs. away so we gave him a small stipend for that. Pretty good deal for both of us... I think.

Cardiac locums earned more (and actually did a lot less). Thankfully we only needed them a couple of times.

Our job was not supervising. As Arch pointed out, I can imagine running 4 rooms would earn you more vs. doing your own cases. Doing a AAA and a couple of gallbladders vs running 4 rooms in an unfamiliar environment? Give me the no supervison room any day.
 

sevoflurane

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In actuality, we would give our locums guy the cysto train, eswl, hernias, gallbladders, mri, ect.... easy cases. Sometimes they would pick up more interesting cases when on call, but for the most part, ct/vascular/peds/ortho cases we would do ourselves. There is truth in what aneftp says. You tend to get boring cases. Some groups I would imagine would give you sick arse patients as well. We didn't do this to our surgeons until we were confidant our locums was capable.
 

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Having done locums recently, I can say that its tough to have regular work. The market is not very good right now. Regarding contracting with the hospital directly, realize that you will likely have to carry your own malpractice, and rates for different states are radically different. I'm not sure what other other paperwork would be involved to do this either.

And no locums company is really that good. They all will hound you if they need to fill a position, but they will be impossible to get a hold of if you need something from them. Like someone said, there is a ton of turnover with the recruiters and you wont talk to the same person twice.

If you don't want to be tied down to a job just yet, it's not a bad gig, but plan well ahead, and carry several state licenses.
 

maceo

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Having done locums recently, I can say that its tough to have regular work. The market is not very good right now. Regarding contracting with the hospital directly, realize that you will likely have to carry your own malpractice, and rates for different states are radically different. I'm not sure what other other paperwork would be involved to do this either.

And no locums company is really that good. They all will hound you if they need to fill a position, but they will be impossible to get a hold of if you need something from them. Like someone said, there is a ton of turnover with the recruiters and you wont talk to the same person twice.

If you don't want to be tied down to a job just yet, it's not a bad gig, but plan well ahead, and carry several state licenses.
very good advice.. the recruiters are generally all scum
 
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I think recent grads should look at a locum as an opportunity to decompress, make some money, travel, and most important, practice medicine. Saying it's not a "real job" is not altogether on point considering the kind of work you do. Sure the hours may be fewer, but that just means more time with family and opportunity to travel. When you consider the time and effort we've all put into our schooling the last decade, a six month, or year long locum is nothing.
I will say this, if I had my choice, I'd definitely go overseas rather than staying in the U.S. It is summer in Australia and New Zealand right now!
 

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Another possibility is the billing companies. At least in Southern California, some billing companies hear the first word about job openings and about needs for locums and they do not charge for placement: they just expect you to bill with them the cases you did in that facility. When I started working in private practice in 1982, I got my leads from them. For a year and a half I went from hospital to hospital working one day here, one day there, sometimes a whole week or two at one place, etc.

There were all kinds of groups. Some gave me all the garbage to do, and didn't even try to hide it; they told me point blank that they were going to take the best cases for themselves and give me the ones they didn't like. At one hospital they told me literally that I couldn't do a certain case because it had private insurance. Others were kinder and gave me better cases. Finally at one place they treated me like one of the group and eventually asked me to stay with them. I remember that one of the senior members would choose the best cases and then quietly call me to take over his room, so the others would not steal them from me. I ended up staying with them 22 years, until the hospital merged with another institution and the group dissolved.

So the moral of the story is, you can find all sorts of people out there. Some will take advantage of you, others will help you. It is a good way of being exposed to different types of practice and getting to know people. If you are going to do this, make the best of it; show your best side wherever you go, show good work ethics, and make friends.
 

maceo

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. For a year and a half I went from hospital to hospital working one day here, one day there, sometimes a whole week or two at one place, etc.
.
thats what i did and thats what i still do.. its hard life though i must tell you that.

The situtation in southern california is about to explode because the reimbursements are in the toilet.
 

IlDestriero

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thats what i did and thats what i still do.. its hard life though i must tell you that.

The situtation in southern california is about to explode because the reimbursements are in the toilet.
And going down! More MediCal cuts will come.
One of my friends is on the faculty of one SoCal medical school. The chairman made a big deal about a change to the way they get paid, raises, fairness, etc. They got about 10% more $$, and between increased efficiency and some more hours, they work about 10% more/harder. Great deal! I wonder why it took so long to recruit a couple new quality people.
 

maceo

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This doesn't sound pleasant at all. Why are you taking this route?
initially i came ou there because i wanted nothing to do with supervision of crnas. this also gave me great deal ofautonomy. and it still does.
 
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doctadre

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wow. i didn't realize that the locums market is so tough right now. i guess i might have to reconsider this decision...

sergio, i sent you a PM about the billing companies
 

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The entire anesthesia job market is tight, not just the locums market. The pendulum has swung the other way, kids.
 

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I had a great experience with Rhino Medical Services doing locums. I'm not sure how many gigs they have to offer presently, but I would look to them again if I decide to do another locums assignment.
 

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. . . but, you've got to have the right temperament and situation to get the most out of it.
I did locums for a year, straight out of residency, and it was the BEST thing I could have done. For me.
My wife was teaching overseas for a year and we weren't set on a place to settle down yet. I had a lot of job offers, but until you've really gotten out, into the work force, academic institutions are all you've known.
I was, essentially, single. I put all my stuff into storage, and was willing to go anywhere, so I cherry picked my hospitals and situations.
I worked at awesome hospitals, form tiny community based practices, to large regional centers, and learned a TON.
It was the best practice I could have had for the oral boards, because each job required me to be able to walk into a hospital, look at a list of cases for the next day, and be able to mentally run through the entire case, the issues I'd have to anticipate, and the equipment I'd want available.

I took a month off to travel to Africa, two weeks to go to a couple music festivals, another month to hit Australia and Africa again, and traveled across the US.

Can locums look bad on a C.V.? Sure, if you make it look like you couldn't get a job and HAD to do locums, but if you sell it as a time you took to experience different hospital settings and garner a greater breadth of experience, plus get over the "new attending jitters", you're rocking.
and truthfully, it makes a huge difference. No matter what practice you walk into, when it's your first step out of residency, you're going to make some rookie mistakes. It's inevitable.
I cut my teeth at the various places I did locums at, and after my first two positions, I felt solid, and when I signed on for my first job, I walked in as an attending, not a recent grad (first impressions make a big difference, especially if you're going private practice).

But, again, you've got to have the stomach for it. It's a bit nerve fraying the first week, when you're in a strange setting and feel like you're fending for your own.
Plus, you've got to learn how to pick out the bad locums gigs.

Here's the general philosophy. There's three settings that need locums:
Bad hospital: they're perpetually in need of locums, and are often hiring more than one at a time. There's inherently something wrong with this place, stay away. If you're thinking about applying to a locums gig in the middle of "fantastic large urban metropolis where everyone's already trying to work," it's probably a train wreck.

good hospital, bad location: This is the money shot. These are generally great places, but because they're more out of the way, have trouble attracting long term people to stay and staff the hospital. These can be cities of 100,000+, but still have trouble, just because of the location. They make great locums jobs, and that's where I spent most of my time.

Good Hospital, Good location: these are very rare, and usually just because someone's on maternity, disability, or extended vacation. Good hospitals in good locations never have to advertise for jobs, they've always got a line of people in waiting. If you're doing locums there, it'll likely only be temporary (but could always turn into a permanent position if they really like you).
They're few and far between though.

Agency vs doing it yourself?
If you're looking at doing it more long term or on your vacations: do it yourself.
If you're looking short term, want to take lots of trips, and don't want to worry about the organizing: get an agent.

I know someone's going to respond to this and say that locums looks like a black mark on your C.V., and to be fair, if your resume is kinda iffy then it probably will, and if your resume isn't that great, then you may struggle as a new grad with locums, so it's probably not your gig anyway.

I'd personally recommend locums to anyone graduating who has the right skills and mindset. It gives you a chance to do something they can't teach in residency, and that is learn to work in a diversity of settings, and how to practice anesthesia, not practice it just the way they did at your institution.

All I can say is, look around at all the people who've graduated a few years ahead of you and see how many of them worked themselves to the bone as part of a partnership track and are now looking for a new place because they hate their group, or the hospital, or were strung along, but didn't have the perspective at the time to realize what they were signing up for?

Locums was educational, and I banked a lot of cash too.
 
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ecf1975do

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I totally agree with C.P.
I did locums for 2 years after finishing residency by choice. Not sure where
I wanted to settle down and wanted to see different parts of the country. Got great experience working at different hospitals, was in control of my schedule (if I wanted to take vacation I could whenever I wanted, however long I wanted, but I didnt get paid), and more importantly
I got to know more about myself and the right questions to ask and what to look for in a private practice job/partnership track.

Do I regret doing the locums right out of residency? Hell no. Made some good money and saw what to look for in a good anesthesia group. Is it a black mark on the CV? I dont think so, maybe if you do it for many years, a future employer might question your stability. Having 10 different locums gigs in 7 years is a alot different than 10 different perm jobs in 7 years...

PM me if you have any questions
 
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doctadre

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after reading the last two posts, maybe i'll consider locums again. :)

for those that have done locums, how would you do it WITHOUT an agency? i'm not familiar with the process so it seems to me that doing with an agency would be easier. if you do it on your own, what type of stuff (contract, malpractice, etc.) do you have to take care? if it isn't that complicated, i'd consider doing it myself. thanks.
 

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after reading the last two posts, maybe i'll consider locums again. :)

for those that have done locums, how would you do it WITHOUT an agency? i'm not familiar with the process so it seems to me that doing with an agency would be easier. if you do it on your own, what type of stuff (contract, malpractice, etc.) do you have to take care? if it isn't that complicated, i'd consider doing it myself. thanks.
I'm serving out a military obligation, but I do some locums on the side, not through an agency.

I used Google to find contact information for physician recruiting and HR at hospitals near the town I was moving to, then called or emailed them asking if the anesthesia group was hiring or in need of vacation coverage. They all quickly put me in contact with the anesthesia groups, I emailed out CVs and cover letters, arranged to meet with them, and ultimately signed contracts with two. I've been working at a couple hospitals here for the last 18 months or so and in that time other opportunities have been offered just word of mouth.

Everyone involved is happy to cut out the headhunters' fees. I get paid well and naturally I assume the group is making money off me.

It was surprisingly easy. I suppose it helped that I was looking for work in a rural underserved area. I'm not exactly a smooth talking social butterfly but I got the impression that any normal human being without any overt psychopathology could've done the same thing I did.

I get paid monthly by 1099, no benefits. (I get full benefits from the military already so that's not such a huge disadvantage.) SEP IRA for tax advantaged retirement savings from the 1099 income. I have my own malpractice policy through The Doctors Company.
 

aneftp

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Again. I hate to warn people. Yes those 2 posters did locums straight out of residency and love it.

But the times are much more different now. Unless you can get posters on this board claiming they just did locums long term for the past 12 months, having someone post their locums experience 3-5 years ago is much different than the environment we are in now.

The locums market is very tight. Few and far jobs in between.

I did locums for a couple of years myself (2007-2008) but I had Ben out of residency since 2004 working at major level 1 trauma center.

I am not talking about the experience of locums. I love being able to travel. I am talking about the overall locums job market. It is very tight these days. Some locums jobs won't take you unless you are board certified (quite impossible to be board certified) when you just finished residency. If given a choice in the tight market, a hospital will choose an experienced doctor over a junior doctor straight out of residency as a locums.

So unless you have lots of money in reserve or single with very little expenses be prepared for long stretches of now work in this current market condition.