Is locums a good choice for a new Grad?

[Noyac]

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Here's the poll:

1 yes

2 no

 

[BLADEMDA]

Here's the poll:

1 yes

2 no

My answer is it depends on your long term goals and the length of the locums. If you want a carerer geater than ten years then locums is NOT your best choice for more than 18-24 months.

Blade

 

[huron]

Most new graduates only work for a year in their first job. I suspect that that is because they do not know what to look for in a job. The New Graduate invariably make a bad choice either; 1) They get suckered into the partnership lie at a group that wants cheap labor with the empty promise of partnership they will never be offered, 2) They work for the imaginary bonus lie at an anesthesia management company where after working for a year they never get the promised bonus and quit. 3) They take an employed job at a hospital work endless hours and too frequent call get burnt out and quit.

Locums gives a New Graduate the opportunity to work at a number of places talk to the current employees and find the job that is right for them. Physicians with some Locum experience may be seen as undesirable by the undesirable types of employers mentioned above because they know that if the job, the pay or the working conditions deteriorate they can call the locums agency and be working somewhere else in less than 30 days. If you are competent you will be offered a permanent position at least half of the locations that are assigned as locums physician.

 

[BLADEMDA]

Most new graduates only work for a year in their first job. I suspect that that is because they do not know what to look for in a job. The New Graduate invariably make a bad choice either; 1) They get suckered into the partnership lie at a group that wants cheap labor with the empty promise of partnership they will never be offered, 2) They work for the imaginary bonus lie at an anesthesia management company where after working for a year they never get the promised bonus and quit. 3) They take an employed job at a hospital work endless hours and too frequent call get burnt out and quit.

Locums gives a New Graduate the opportunity to work at a number of places talk to the current employees and find the job that is right for them. Physicians with some Locum experience may be seen as undesirable by the undesirable types of employers mentioned above because they know that if the job, the pay or the working conditions deteriorate they can call the locums agency and be working somewhere else in less than 30 days. If you are competent you will be offered a permanent position at least half of the locations that are assigned as locums physician.

How does your post disagree with mine? I was making the statement that locums is FINE for 18-24 months. However, a LONG TERM career as a Locums is not the best choice.

Blade

 

[johankriek]

How does your post disagree with mine? I was making the statement that locums is FINE for 18-24 months. However, a LONG TERM career as a Locums is not the best choice.

Blade

why isnt locums fine for longer than 24 months...

 

[Noyac]

Locums can be a rough gig. The surgeons never really know you and always are watching your every move. The nurses don't trust you as much as they trust the regular docs. The group will frequently give you the disaster case so if anything goes wrong they can say, " well it was a locums." Your speed will frequently be well behind the regular anesthesiologists because yo will not be as familiar with the blocks area, what the nurses can do when assisting you, the paper work, the surgeons preference. The list goes on.

Its not a good choice in my opinion unless it is for a short time.

 

[Sevo]

Locums is "acceptable" if you're straight out of residency. However, you're given the evil eye by everyone -- anesthesiologists, surgeons, nurses, et al -- if you're far into your career and you decided to suddenly go the locums route. The usual suspicions all come to fore -- why can't this guy hold down a permanent job in this job market? Does he have something in his past? Is he a slacker? Temps and travelers aren't highly regarded at all in the medical world; even the good ones.

On the other side of the coin, most of the job sites for locums aren't exactly stellar. There's usually a good reason why a group is short-handed or a hospital can't attract permanent anesthesiologists (unless you're subbing in for a two man group). Bad location, nasty surgeons, bad payer mix, terrible working conditions, et al. Unfortunately the correct answer never really is "a nationwide shortage of anesthesiologists."

 

[VolatileAgent]

If you are competent you will be offered a permanent position at least half of the locations that are assigned as locums physician.

better not sign the contract if it has a "covenant not to compete" then...

 

[huron]

better not sign the contract if it has a "covenant not to compete" then...

I do not understand your comment,

"non compete" clauses are in every locums contract I have ever seen, some are down right ridiculous, I.E. you cannot take a job in the same city or within 30 miles for two years. While I doubt the locum agency would be able to enforce in court any thing greater that requiring you to pay their fee if you a take a job a the hospital or hospital system you were placed in a locums position by the locums agency. The placement fee is usually about 25K about the same fee as a recruiter would charge. Most employers will gladly pay the fee if you decide to take a permanent position. Locum is expensive for the emplyer since the locums agency charges a hefty fee, one employer told me that if I was employed as permanent employee for as little as three months they would easily be able to cover the placement fee and still pay me the same as I was paid by the locums agency.


This is something you should keep in mind since I have seen particularly nasty employers recruit new graduates for a permanent position, only to fire them in three months after the partners have all taken their summer vacations. Thus saving the group the cost of hiring locums to cover vacations and depending on the contract dumping the cost of tail insurance on the newly fired employee. Don't take a job until you know who you are working for and have investigated how they treat their current and former employees.


Illegitimi non carborundum

 

[johankriek]

If you want a carerer geater than ten years then locums is NOT your best choice for more than 18-24 months.

Blade

wow..........pretty blanket statement there..

 

[The_Sensei]

Illegitimi non carborundum

Indeed! I NEVER let the bastards get me down.....

 

[VentdependenT]

HIJACK:

People are talking me out of CV. What do yall think?

 

[2ndyear]

I had wanted to do cardiac, when I started this gig I was gung ho critical care-cardiac combo. No more. I did the anes SICU rotation and found that anes SICU fellows basically either go to practice general anes or stay in SICU academia. Heart fellowed people that I have seen go on seem to get jobs where they will do private practice hearts, but also a significant amount of general, OB, even peds. I guess it's not worth the year right now to expand my skill set to include a surgery that is not universal, ie not every group does hearts and not every group that does hearts needs CV trained people. While learning TEE would be great for big cases, not all of our 'big case'/liver transplant, etc attendings are TEE certified and they get by just fine. I'll probably never do another liver after residency and while TEE might help in the occasional AAA or something I can do without it. Pain gets you an entirely different set of skills applicable in an entirely different setting, if you so desire. With the set ups of some groups, it seems you can do pain and as much/little anesthesia as you want. Seems like a good choice if you like pain.

 

[The_Sensei]

HIJACK:

People are talking me out of CV. What do yall think?

I think you should listen to them. Waste of time in my opinion...

 

[Noyac]

I think you should listen to them. Waste of time in my opinion...

Ditto.

 

[bullard]

HIJACK #2:

I talked myself out of CV already. I am having a tougher time talking myself out of critical care. What do the elders think?

 

[Noyac]

HIJACK #2:

I talked myself out of CV already. I am having a tougher time talking myself out of critical care. What do the elders think?

CC is a good fellowship and will beef up your CV but there are very few anesthesiologists out there doing CC that I have noticed ( Mil is the only one I know). Too much money in the OR and the hours are far better. If you want to remain academic then you will see more anesthesiologists in the ICU.

I think CC and Pain are the only 2 fellowships I would consider. Unless I wanted to go somewhere were they do hearts and only take fellowship trained anesthesiologists. Everyone has their circumstances and my comments are just general comments and just my take on the situation.

 

[VentdependenT]

Ahh yes, happy 4th of july people.

To my chagrin I walked in this morning ON CALL and found a little friend waiting for me in the ICU. Dissecting ascending thoracic aortic root....how wonderful.

I basically blindly intubated this portly gentleman with my mac 4, squiggled in the echo, and off to the races.

We hooked up bypass to the Right Carotid, floated swan via Left IJ. Right radial and femoral a-lines to compare the flows. We even threw on one of those useless cerebral oximeters for good measure. sweet!

Thing is proximal enough to hopefully forego circ-arrest.

Ahhhhhhhh...........s$%t. Enjoy the bbq's and beers for this resident.

Vent

 

[johankriek]

Ahh yes, happy 4th of july people.

To my chagrin I walked in this morning ON CALL and found a little friend waiting for me in the ICU. Dissecting ascending thoracic aortic root....how wonderful.

I basically blindly intubated this portly gentleman with my mac 4, squiggled in the echo, and off to the races.

We hooked up bypass to the Right Carotid, floated swan via Left IJ. Right radial and femoral a-lines to compare the flows. We even threw on one of those useless cerebral oximeters for good measure. sweet!

Thing is proximal enough to hopefully forego circ-arrest.

Ahhhhhhhh...........s$%t. Enjoy the bbq's and beers for this resident.

Vent

hopefully the guy doesnt stroke out

you should circ arrest for this..

thats a nice case.. ascendings are easier then descending aneurysms

 

[urgewrx]

Ahh yes, happy 4th of july people.

To my chagrin I walked in this morning ON CALL and found a little friend waiting for me in the ICU. Dissecting ascending thoracic aortic root....how wonderful.

I basically blindly intubated this portly gentleman with my mac 4, squiggled in the echo, and off to the races.

We hooked up bypass to the Right Carotid, floated swan via Left IJ. Right radial and femoral a-lines to compare the flows. We even threw on one of those useless cerebral oximeters for good measure. sweet!

Thing is proximal enough to hopefully forego circ-arrest.

Ahhhhhhhh...........s$%t. Enjoy the bbq's and beers for this resident.

Vent

A few questions pop into mind:

1 Why are you doing the case instead of the cardiac call?
2 If you are cardiac call, why were you in-house to begin with?
3 Or, is General Anesth people doing cardiac on week-ends/holidays?
4 Did you go on Full CPB through the right carotid? Or cannulated femoral too? >I know it's not your decision, I'm just interested.
5 Why did they cannulate carotid if think they can do it without circ arrest?
6 Shouldn't you be taking care of the pt, instead of posting here?

 

[urgewrx]

you should circ arrest for this..

Stop it. There is no "should".

You "could" circ arrest for this...

 

[VentdependenT]

1 Why are you doing the case instead of the cardiac call?
senior resident IS cardiac call.

2 If you are cardiac call, why were you in-house to begin with?
see above

3 Or, is General Anesth people doing cardiac on week-ends/holidays?
there is a cardiac oncall attending which comes in, if not oncall inhouse already.

4 Did you go on Full CPB through the right carotid? Or cannulated femoral
Through right carotid

5 Why did they cannulate carotid if think they can do it without circ arrest?
what else do you want them to do?

6 Shouldn't you be taking care of the pt, instead of posting here?
Because I was on break during bypass and I already had my cigarette. Still had time on the clock. How thoughtful of me eh?

 

[urgewrx]

1 Why are you doing the case instead of the cardiac call?
senior resident IS cardiac call.

Interesting. Everywhere I had known before had a separate cardiac beeper-call resident.

4 Did you go on Full CPB through the right carotid? Or cannulated femoral
Through right carotid

5 Why did they cannulate carotid if think they can do it without circ arrest?
what else do you want them to do?

I'm concerned about the shearing forces of blowing 4L/min on a small vessel so close to the brain. Almost everybody develops some sort of plaque on the carotids as they age. In this case it is so close to the brain that it's a setup for stroke. The pressure applied on the carotid to maintain a 60mmhg femoral pressure must have been quite high. I suspect somewhere between 100-150mmhg. If they are not going on circ arrest they could have cannulated the aorta like any good ol' pump CABG.

 

[VentdependenT]

No seperate cardiac beeper call. We have a transplant call.

No way to tell what the exact pressure in the carotid is I guess but the perfusion dudes have control over the flow. Best we could estimate was to correlate R radial A-line with Femoral A-line. Even the whole time.

How much different would the pressures be in the R-radial vs the Carotid? Dunno but I would venture to say not much.

Plaques eh? Yup, definitely a concern. No duplex that I know of but what you gonna do. ASA 5E don't get no duplex.