Living the dream

[IHavePotential]

My uncle who graduated from his emergency medicine residency three years ago is living the dream. He works 10 shifts per month, 5 in the beginning of the month and 5 in the last week of the month (all 12 hour shifts) he works locums only (texas). For the more than two weeks he has in between his shifts, he travels the world and does a lot of mission trips in Africa! Who else knows someone living this type of lifestyle, do you think its feasible for the long term?

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[IHavePotential]

@GeneralVeers ?

 

[Brigade4Radiant]

Uh yeah its possible to continue living like this if you're a bachelor. If your married with kids you may not be able to travel all the time. I wouldn't call EM lifestyle but there is no other field of medicine that I would trade being an EM doc for.

 

[Angry Birds]

Maybe your uncle can visit your school and give a talk on Parent Career Day.

 

[GeneralVeers]

@GeneralVeers ?

I live this lifestlye. I'm currently in Frankfurt airport flyng back from 3 weeks in Asia. I am working a total of 10 shifts in February as well.

Short term it's doable, but long-term with the various forces in play, I think it will fizzle out. I'm estimating 3-5 years.

 

[Brahnold Bloodaxe]

I live this lifestlye. I'm currently in Frankfurt airport flyng back from 3 weeks in Asia. I am working a total of 10 shifts in February as well.

Short term it's doable, but long-term with the various forces in play, I think it will fizzle out. I'm estimating 3-5 years.

In that case, why are you working only 10 shifts a month? If you are correct, and I believe you are, then you should be making hay while the sun shines. Work them shifts while they still pay well so you don't have to work them when they start paying not so well.

 

[IHavePotential]

I live this lifestlye. I'm currently in Frankfurt airport flyng back from 3 weeks in Asia. I am working a total of 10 shifts in February as well.

Short term it's doable, but long-term with the various forces in play, I think it will fizzle out. I'm estimating 3-5 years.

Damn General Veers, so do you structure your schedule in the beginnings and endings of the month or what? What do you mean by its doable "short term" are you saying the job market won't allow it in the years to come or are you saying you wouldn't want to do this?

In that case, why are you working only 10 shifts a month? If you are correct, and I believe you are, then you should be making hay while the sun shines. Work them shifts while they still pay well so you don't have to work them when they start paying not so well.

well since he is doing locums he must be making more than or equal to the average EM yearly income.... prolly
[10shifts][12hrs][300][12]=400k+

 

[Angry Birds]

Personally, I don't get why everyone likes to travel so much. I hate traveling. When I'm traveling all I can think of is when will I be home?

well since he is doing locums he must be making more than or equal to the average EM yearly income.... prolly
[10shifts][12hrs][300][12]=400k+

$300/hr seems high to me. Shrug.

 

[GonnaBeADoc2222]

In that case, why are you working only 10 shifts a month? If you are correct, and I believe you are, then you should be making hay while the sun shines. Work them shifts while they still pay well so you don't have to work them when they start paying not so well.

He works 10 shifts a month because he doesn't want to work more - duh lol. You can make a million dollars a year in EM if you work 25 shifts / month - doesn't mean you should.

I do a similar thing. Work 10-12 shifts/month as a traveler. Currently at the end of a great ski trip.

 

[RoyBasch]

My uncle who graduated from his emergency medicine residency three years ago is living the dream. He works 10 shifts per month, 5 in the beginning of the month and 5 in the last week of the month (all 12 hour shifts) he works locums only (texas). For the more than two weeks he has in between his shifts, he travels the world and does a lot of mission trips in Africa! Who else knows someone living this type of lifestyle, do you think its feasible for the long term?

I live a similar lifestyle to this. Since graduation from residency I have been out of state almost every month. I travel out of the country about 3 times per year. It is definitely possible as a staff ER physician. What will limit your ability to do so more than work will be your family life. If you are married and especially if you have children it will be a different story. I have no children and my girlfriend also has a flexible career.

Another note: One poster on this board (I forget who, I'm sorry I cannot give credit where credit is due) had a very brilliant quote. They said (I'm paraphrasing) "As an ER physician you will have enough money to get all of the normal stuff (save for retirement, pay off loans, daily expenses) PLUS one 'prize.' This prize can either be a awesome material stuff like a huge house and a fancy car, amazing vacations/travel, or a non-working spouse. You cannot have all 3 of these."

For me I have opted for the travel and vacations. I still live in a small apartment, drive a 10+ year old econobox car, and my girlfriend works full time.

Ultimately it comes down to your priorities. You will have to determine your own balance of work hours, free time off, and expenses. The great thing (and I would say BEST thing) about emergency medicine is that you are free to make this decision and decide. My most miserable partners I would say are those that have financially over-reached and are now working more shifts than they want to cover these additional expenses.

 

[Brahnold Bloodaxe]

He works 10 shifts a month because he doesn't want to work more - duh lol. You can make a million dollars a year in EM if you work 25 shifts / month - doesn't mean you should.

I do a similar thing. Work 10-12 shifts/month as a traveler. Currently at the end of a great ski trip.

Yeah, but he has a pessimistic view of the future compensation of the field and believes the good times will only last for a few more years. Of course everyone would prefer to leisurely work no more than absolutely necessary to support their desired lifestyle, but if you believe the gravy train that allows you to do so is soon going to run dry then shouldn't that prompt you to get while the getting's good?

 

[gutonc]

Yeah, but he has a pessimistic view of the future of the universe.

Fixed that for you.

 

[deleted109597]

Yeah, but he has a pessimistic view of the future compensation of the field and believes the good times will only last for a few more years. Of course everyone would prefer to leisurely work no more than absolutely necessary to support their desired lifestyle, but if you believe the gravy train that allows you to do so is soon going to run dry then shouldn't that prompt you to get while the getting's good?

There's no requirement that he needs to keep up his lifestyle. Maybe he will continue to work the same amount and either not travel as much, or he will do something else.
Not everyone does it for the money.

 

[The White Coat Investor]

My uncle who graduated from his emergency medicine residency three years ago is living the dream. He works 10 shifts per month, 5 in the beginning of the month and 5 in the last week of the month (all 12 hour shifts) he works locums only (texas). For the more than two weeks he has in between his shifts, he travels the world and does a lot of mission trips in Africa! Who else knows someone living this type of lifestyle, do you think its feasible for the long term?

Seems like he's working too much to me. 10 shift x 12 hours/shift = 120 hours. I'm working 11 shifts x 8 hours/shift = 88 hours this month.

Of course, I've put in 23 hours yesterday and today on my other job....

But yea, if you get your student loans paid off and can live comfortable on $200K, you could work half time in EM (8 eights) and "live the dream."

 

[GeneralVeers]

I actually do work a lot of hours. I schedule myself of 8 12 hour locums shifts per which is 96 hours per month, plus I work 3-4 10 hour shifts at my local hospital. So usually I'm in the 120-30 hours/month range. That still gives me 20 days off per month to travel, and do other things. Plus I can pick up the occasional shift if I need extra money or want a bonus.

I used to work full time for a CMG for many years, working 20 shifts per month. I will never work that much again. As someone stated, you could easily make $1 miillion/year in this field working over 20 days per month, but what's the point if you have no time off to enjoy it?

I have no kids, and my SO loves to travel, so it's easy. I do have a big house, but i don't buy jewelry, watches, and I lease my car. Most of my disposable income is spent on travel as I would rather buy experiences than "stuff".

 

[whiplashWhoMD]

What do you guys think of doing locums right out of residency? I had an adviser tell me not to for a few reasons - multiple systems to learn, no mentorship, less backup, harder to get respect from staff when you're always bouncing around. I'm in a dual income/no kids situation, and working 10-12 days then travelling the rest seems very appealing.

 

[RoyBasch]

What do you guys think of doing locums right out of residency? I had an adviser tell me not to for a few reasons - multiple systems to learn, no mentorship, less backup, harder to get respect from staff when you're always bouncing around. I'm in a dual income/no kids situation, and working 10-12 days then travelling the rest seems very appealing.

Generally advise against it. Locums is not a beginner's game. It's generally more challenging. You will have to operate more independently with less back up in more difficult environments. The reason a shop needs locum docs is usually because they are having lots of structural issues in the first place. If it was a good shop they wouldn't need locum docs.

I think after cutting your teeth with 3-5 years of community practice post-residency it's more doable. I think if you have no kids it's not that hard to find an in-town shop where you can do 10-12 shifts a month with a "typical" contract and still carve out 2 weeks per month (or more if you front load the end of one month and back load the end of the next month) in the schedule for fairly extensive traveling. Just make sure you sign on to the minimum number of hours the group will allow. You can always pick up more, it's been pretty rare that I haven't been able to get as many hours as I want because every shift is full and the people with more contracted minimum hours have gotten the first pick.

I would also advise against taking a really long sabbatical (4+ weeks) of traveling within the first few years out of residency because once again; your nascent skills will die fast on the vine if you are not continually applying them and improving them with practice. After a few years and your skill set stabilizes I think you can take longer periods of time off with less concern about how it would effect your practicing ability.

 

[deleted859535]

What do you guys think of doing locums right out of residency? I had an adviser tell me not to for a few reasons - multiple systems to learn, no mentorship, less backup, harder to get respect from staff when you're always bouncing around. I'm in a dual income/no kids situation, and working 10-12 days then travelling the rest seems very appealing.

I wouldn't for the reasons @RoyBasch mentioned above.

 

[MechEDoc]

It is doable, but you must be willing to be very self-sufficient and work in some difficult places. Many of the hospitals are very dysfunctional, nursing support can be highly variable and many of them have subpar skills. Some places I've worked have never been able to successfully start an IV on a dehydrated patient 2 years old or younger. You may find yourself deciding whether or not to give TPA or tenecteplase independently (e.g. the tele-stroke machine is not working or you have no cardiologists).

You are the only person with airway skills in the entire hospital, you might also be the only physician in the hospital as some are staffed only by PAs or NPs at night (PS these mid-levels might not be very good and will try to block reasonable admissions with their insufficient knowledge) and you be living and working in really sh*tty towns with high rates of crime and very few things to do outside of work. Once you factor in travel time your hourly rate will drop significantly. Companies will promise you the moon and then never provide you anything that resembles your initial conversation... Even if you have it documented in the contract, good luck with that! What are you going to do, sue over $10,000-$20,000 of disagreement?

You'll have to decide what battles to fight and which jobs to walk away from. Believe me, there are some bad places. Many people in locums would never want to be hospitalized at the places they work - think about that.

If you are up for a challenge, want adventure, want to see lots of different practice environments, want to challenge yourself and feel that you're up for it - then it can be worth it.

 

[GTP]

I live this lifestlye. I'm currently in Frankfurt airport flyng back from 3 weeks in Asia. I am working a total of 10 shifts in February as well.

Short term it's doable, but long-term with the various forces in play, I think it will fizzle out. I'm estimating 3-5 years.

do the locums people pay for flights from foreign countries?

 

[MechEDoc]

Sometimes. I know of a doc that was being flown to TN from a house in central america, another from Guam (yes - not a foreign country, but pretty far away!).

 

[Groove]

I worked an average of 18x9's/mo last year for a ridiculous amount of money but feel like I overdid it. I took a lot of vacations but when you schedule yourself off for 7 days every other month AND work 18 shifts, it really starts to hurt after awhile. I'm currently trying to decide whats optimal for 2018. I know one guy who works 20 shifts/mo and does a bunch of real estate stuff on the side. I don't know how he does it. Personally, I hate locums. I really dig working with colleagues in double/triple coverage EDs and getting to know your consultants who trust your judgement and never question you. I enjoy getting to know the nursing/ancillary staff really well. Sleeping in my own bed at night. Plus, who would take care of my dog?! I dunno, that kind of convenience is def worth some money to me. However, I totally get why locums is such a big thing and it def affords someone enormous freedom and flexibility.

 

[deleted547339]

I live a similar lifestyle to this. Since graduation from residency I have been out of state almost every month. I travel out of the country about 3 times per year. It is definitely possible as a staff ER physician. What will limit your ability to do so more than work will be your family life. If you are married and especially if you have children it will be a different story. I have no children and my girlfriend also has a flexible career.

Another note: One poster on this board (I forget who, I'm sorry I cannot give credit where credit is due) had a very brilliant quote. They said (I'm paraphrasing) "As an ER physician you will have enough money to get all of the normal stuff (save for retirement, pay off loans, daily expenses) PLUS one 'prize.' This prize can either be a awesome material stuff like a huge house and a fancy car, amazing vacations/travel, or a non-working spouse. You cannot have all 3 of these."

For me I have opted for the travel and vacations. I still live in a small apartment, drive a 10+ year old econobox car, and my girlfriend works full time.

Ultimately it comes down to your priorities. You will have to determine your own balance of work hours, free time off, and expenses. The great thing (and I would say BEST thing) about emergency medicine is that you are free to make this decision and decide. My most miserable partners I would say are those that have financially over-reached and are now working more shifts than they want to cover these additional expenses.

You should be able to do at least 2, if not all 3 of those on an EM salary so long as you live in a low cost of living area. There’s no reason you can’t own a 500k house, go on 1-2 10k trips/year and save 20% for retirement if you make 300k/y. Maybe you’re talking about a mil+ house and a Porsche, and quarterly trips to Europe, but I think you can live pretty good in EM.

 

[Mbekweni]

I worked an average of 18x9's/mo last year for a ridiculous amount of money but feel like I overdid it. I took a lot of vacations but when you schedule yourself off for 7 days every other month AND work 18 shifts, it really starts to hurt after awhile. I'm currently trying to decide whats optimal for 2018. I know one guy who works 20 shifts/mo and does a bunch of real estate stuff on the side. I don't know how he does it. Personally, I hate locums. I really dig working with colleagues in double/triple coverage EDs and getting to know your consultants who trust your judgement and never question you. I enjoy getting to know the nursing/ancillary staff really well. Sleeping in my own bed at night. Plus, who would take care of my dog?! I dunno, that kind of convenience is def worth some money to me. However, I totally get why locums is such a big thing and it def affords someone enormous freedom and flexibility.

I totally agree. I have some peers who are thrilled with their hourly rate while working locums shifts. While their travel expenses for airfare, car rental, hotel and meals are covered they don't cover your time waiting in the airport or car rental line, or the time away from family. How much is that worth? I have found at most a $75-100 per hour differential between getting on an airplane and working locally however usually much less once you account for partnership bonuses etc. You can make that up working 1-2 extra shifts per month while building up partnership hours/buy in that will be more beneficial in the long term as well as work in a more desirable, fun and safe environment.

I have been able to travel for 1-2 weeks per month during my first year out of residency and am actually getting tired of it- having gone to South Africa, Botswana, Bali/Indonesia, Oaxaca, and Costa Rica in the last 8 months or so with trips scheduled to Nicaragua and then Hawaii and Portugal in the coming months. Definitely over-doing it and I kind of regret jumping on all of the travel plans quickly months ago and am ready to just sit at home and go on some local hikes for a while. If it isn't fun to be at home then you likely aren't living/working in the right location. However I do realize that I'm incredibly lucky to be able to do this IF I want to and have the free time and income. Aside from being a little cranky during the recovery from an overnight shift here and there, or working the occasional holiday and missing family time, I'd say EM is certainly the best field I could have imagined. Some people may make more, but the lifestyle flexibility is pretty fantastic.

 

[bravotwozero]

Everyone's different, but I think 15 9hr shifts a month is optimal for most people

 

[EctopicFetus]

Generally advise against it. Locums is not a beginner's game. It's generally more challenging. You will have to operate more independently with less back up in more difficult environments. The reason a shop needs locum docs is usually because they are having lots of structural issues in the first place. If it was a good shop they wouldn't need locum docs.

I think after cutting your teeth with 3-5 years of community practice post-residency it's more doable. I think if you have no kids it's not that hard to find an in-town shop where you can do 10-12 shifts a month with a "typical" contract and still carve out 2 weeks per month (or more if you front load the end of one month and back load the end of the next month) in the schedule for fairly extensive traveling. Just make sure you sign on to the minimum number of hours the group will allow. You can always pick up more, it's been pretty rare that I haven't been able to get as many hours as I want because every shift is full and the people with more contracted minimum hours have gotten the first pick.

I would also advise against taking a really long sabbatical (4+ weeks) of traveling within the first few years out of residency because once again; your nascent skills will die fast on the vine if you are not continually applying them and improving them with practice. After a few years and your skill set stabilizes I think you can take longer periods of time off with less concern about how it would effect your practicing ability.

In addition when you are starving for money you cant play the locums game the right way. You are set up to fail and get abused. once you need to work less and can wait a little or have a steady gig to help run up your rate then you can make $300+ and have real control.

 

[EctopicFetus]

Seems like he's working too much to me. 10 shift x 12 hours/shift = 120 hours. I'm working 11 shifts x 8 hours/shift = 88 hours this month.

Of course, I've put in 23 hours yesterday and today on my other job....

But yea, if you get your student loans paid off and can live comfortable on $200K, you could work half time in EM (8 eights) and "live the dream."

I’m like this.. I work just under an average of 3 8s per week. But I have 4 income streams not including rental properties. They are all sort of related to medicine and my main job.

 

[Alvarez13]

Thanks to a lot of the above posters, I choose locums right out of residency. I love it. Nearing $275/hr on pay, control over my schedule (the majority of months I do not work any nights and I can arrange a week vacation nearly every month), no meetings, lots of travel benefits.

I work 10 hr shifts x 16 days a month and I'm trying to get down to 13-14 days but each time that happens it creates a few openings in the schedule that I end up nabbing a bonus. I can see 160 hrs/mo leading to burn out. My goal is to get the debt under ctrl and purchase a house and then try and scale back.

I think my dream job is 70-80 hrs with a group near where I live and then locums for 1-2 wks per month for a change of pace.

 

[shookwell]

What do you guys think of doing locums right out of residency? I had an adviser tell me not to for a few reasons - multiple systems to learn, no mentorship, less backup, harder to get respect from staff when you're always bouncing around. I'm in a dual income/no kids situation, and working 10-12 days then travelling the rest seems very appealing.

I disagree with most of the answers above. You can do locums right out of residency, especially if you went to a good county program. I did it for about 2 years right out of residency until I decided on a career track for myself (now work full time non-clinical plus 1 shift/week clinical, plus locums whenever I feel like working more). You should just be more selective in places you are willing to work and don't be afraid to walk away, even after 1 shift, if you don't like it or don't feel comfortable there. I was afraid of some of the things mentioned above so I only took locums which did not require a minimum amount of shifts per month but since I asked a lot of questions before credentialing and turned a lot of places down, there was only one place that I walked away from after my first shift.

 

[GonnaBeADoc2222]

I would be EXTREMELY careful about doing straight up locums fresh out of residency. You have to be very discerning. Recruiters are NOT your friends. They just want to fill a spot and get paid. They may lie to you or not even be aware of the resources available or not available at a particular site.

You really need to know the limits of your training. For instance if you had weak orthopedics training (like I did) it might not be a great idea to work at a place where there is zero ortho on call and the nearest transfer center is 150 mi away.

Other HARD stops which would prevent me from working anywhere include:
-No OB on call or far away. Delivering babies? Yeah ok.
-ER doc has to run floor / icu codes or do airway throughout the hospital. Not a chance.

 

[The White Coat Investor]

I think my dream job is 70-80 hrs with a group near where I live and then locums for 1-2 wks per month for a change of pace.

That's a dream job? That sounds like two dream jobs. I mean, I'm hardly one to complain given that I'm working two jobs (about like you describe) right now, but it's not exactly what most people dream about.

 

[The White Coat Investor]

-ER doc has to run floor / icu codes or do airway throughout the hospital. Not a chance.

You're pretty much stuck in ivory towers with that requirement. This is a job requirement in most community hospitals. If the hospitalist is still in house, I'm not there long, but if it is 3 am and the hospitalist isn't around, the code is mine until the intensivist or cardiologist attending shows up. And who doesn't like intubating?

 

[TooMuchResearch]

You're pretty much stuck in ivory towers with that requirement. This is a job requirement in most ivory towers. If the hospitalist is still in house, I'm not there long, but if it is 3 am and the hospitalist isn't around, the code is mine until the intensivist or cardiologist attending shows up. And who doesn't like intubating?

I work in a couple places where I'm the only doctor around after the late afternoon, unless someone knows their patient is about to deliver. Yes, we help on the floor sometimes. It's a valuable service we happily provide.

 

[fahimaz7]

You should be able to do at least 2, if not all 3 of those on an EM salary so long as you live in a low cost of living area. There’s no reason you can’t own a 500k house, go on 1-2 10k trips/year and save 20% for retirement if you make 300k/y. Maybe you’re talking about a mil+ house and a Porsche, and quarterly trips to Europe, but I think you can live pretty good in EM.

Depends on loans. I make 300k/year, wife doesn't work, 700k house, and 300k total loans (between the two of us). 2 kids. It's the pits. Hell, my water bill for the yard tops $600 in the summer (damn high desert living).

Now if I didn't have student loans to worry about that would pad things quite nicely.

 

[GonnaBeADoc2222]

You're pretty much stuck in ivory towers with that requirement. This is a job requirement in most ivory towers. If the hospitalist is still in house, I'm not there long, but if it is 3 am and the hospitalist isn't around, the code is mine until the intensivist or cardiologist attending shows up. And who doesn't like intubating?

I love intubating.

I completely understand doing this if the ER is double (or more) staffed, but the problem arises when the ER is single coverage. What happens when its 3am and an unstable trauma arrives in the ED while you're 7 floors away running an ICU code?

The care of ED patients should not suffer and the ER doc's liability exposure should not be increased simply because the hospital doesn't care to appropriately staff its facility.

 

[WilcoWorld]

Depends on loans. I make 300k/year, wife doesn't work, 700k house, and 300k total loans (between the two of us). 2 kids. It's the pits. Hell, my water bill for the yard tops $600 in the summer (damn high desert living).

Now if I didn't have student loans to worry about that would pad things quite nicely.

I've got some advice for you: cacti + drip irrigation. It makes for a no-hassle, beautiful high desert yard as long as your neighborhood association allows it.

 

[GeneralVeers]

I ONLY work in places where the ED doc runs floor/ICU codes and intubates. Hospitals with this setup represent probably 80% of community hospitals. Employment options would be very limited if this was a hard stop for me.

What I won't do is work somewhere that I would be expected to deliver babies. My training at this point in my career is not adequate to deliver the shoulder dystocia, breech presentation baby, or repair a grade 4 vaginal tear after a delivery. The liability is just too high.

 

[RoyBasch]

I ONLY work in places where the ED doc runs floor/ICU codes and intubates. Hospitals with this setup represent probably 80% of community hospitals. Employment options would be very limited if this was a hard stop for me.

What I won't do is work somewhere that I would be expected to deliver babies. My training at this point in my career is not adequate to deliver the shoulder dystocia, breech presentation baby, or repair a grade 4 vaginal tear after a delivery. The liability is just too high.

I agree with Veers 100%. If you exclude places where you will be responsible for floor codes, that will be a lot of places. This is true the vast majority of community hospitals.

Agree that I really don't ever wanna be somewhere without OB in house for precipitous delivery. When I was looking for jobs this was a full stop for me. (No in house OB = not going to consider it).

 

[deleted547339]

I ONLY work in places where the ED doc runs floor/ICU codes and intubates. Hospitals with this setup represent probably 80% of community hospitals. Employment options would be very limited if this was a hard stop for me.

What I won't do is work somewhere that I would be expected to deliver babies. My training at this point in my career is not adequate to deliver the shoulder dystocia, breech presentation baby, or repair a grade 4 vaginal tear after a delivery. The liability is just too high.

Do you think that you’re required to repair a tear if you deliver the baby? Serious question. My understanding is that it would be reasonable to ship that.

 

[GeneralVeers]

Do you think that you’re required to repair a tear if you deliver the baby? Serious question. My understanding is that it would be reasonable to ship that.

I probably could stop the bleeding, but it would look ugly. Again this is not what I'm trained to do, and the future liability from dyspareunia and cosmetic issues would be problematic.

 

[TooMuchResearch]

I agree with Veers 100%. If you exclude places where you will be responsible for floor codes, that will be a lot of places. This is true the vast majority of community hospitals.

Agree that I really don't ever wanna be somewhere without OB in house for precipitous delivery. When I was looking for jobs this was a full stop for me. (No in house OB = not going to consider it).

Sometimes our OB/FP doesn't show up in time, and we help, I've delivered a baby in L&D at the place I'm at tonight. They take over immediately on arrival and do any repairs.

 

[RoyBasch]

Sometimes our OB/FP doesn't show up in time, and we help, I've delivered a baby in L&D at the place I'm at tonight. They take over immediately on arrival and do any repairs.

This was a hard stop for me. The facilities I work at have OB in house, not just on call.

 

[Hercules]

This was a hard stop for me. The facilities I work at have OB in house, not just on call.

This should absolutely be a hard stop. Not having OB is vastly different and a lot higher liability than not having an intensivist in house. I did one moonlighting shift at a small rural ED that told me after I got there that I was responsible for L&D as well as the ED. They had no in-house OB’s and no official on-call OB. Family practice docs delivered their patients there and they told me that they could usually get an OB to come in if needed but no guarantees. I almost left on the spot, but sucked it up with fingers crossed for my 12 hr shift and then explained I would never be back and that it was incredibly dishonest to not disclose the L&D coverage ahead of time.


Sent from my iPhone using SDN mobile

 

[BoardingDoc]

I ONLY work in places where the ED doc runs floor/ICU codes and intubates. Hospitals with this setup represent probably 80% of community hospitals. Employment options would be very limited if this was a hard stop for me.

What I won't do is work somewhere that I would be expected to deliver babies. My training at this point in my career is not adequate to deliver the shoulder dystocia, breech presentation baby, or repair a grade 4 vaginal tear after a delivery. The liability is just too high.

How would you feel about a hospital which doesn't have OB period? E.g. A place where ems would be aware there is no OB coverage at all and that you'll be transferring literally every patient who comes in with a pregnancy related complaint?

 

[emergentmd]

Been doing Locums 2 yrs.
Have done the fly/drive to far locums for $600/hr - Worse hospital I have been in and I have been in alot.
Have done drive short distance Locums for $300/hr
Have done local freestanding for $170/hr.
Have done nice local community for $225/hr

The more you make, the crappier the place. I stopped doing the $600/hr place just b/c it takes me 2 dys to do 1 shift. I rather do 2 shifts at short locums or 24hr FSED.

Travel is $$ to me.

If you have no kids, Locums is great. I wished I did that before kids. Once you have kids, its difficult leaving for more than 2 dys at a time b/c you start to lose connection to your kids/family.

 

[GeneralVeers]

I also don't do ICU procedures except intubation. That's a nonstarter for me as well. If the ICU coverage is so weak/lazy that they can't put in their own chest tubes or central lines I won't work there. I am usually much too busy to leave the ED to do non-emergent procedures on patients I don't know that exposes me to liability.

 

[slurpy15]

Generally advise against it. Locums is not a beginner's game. It's generally more challenging. You will have to operate more independently with less back up in more difficult environments. The reason a shop needs locum docs is usually because they are having lots of structural issues in the first place. If it was a good shop they wouldn't need locum docs.

I think after cutting your teeth with 3-5 years of community practice post-residency it's more doable. I think if you have no kids it's not that hard to find an in-town shop where you can do 10-12 shifts a month with a "typical" contract and still carve out 2 weeks per month (or more if you front load the end of one month and back load the end of the next month) in the schedule for fairly extensive traveling. Just make sure you sign on to the minimum number of hours the group will allow. You can always pick up more, it's been pretty rare that I haven't been able to get as many hours as I want because every shift is full and the people with more contracted minimum hours have gotten the first pick.

I would also advise against taking a really long sabbatical (4+ weeks) of traveling within the first few years out of residency because once again; your nascent skills will die fast on the vine if you are not continually applying them and improving them with practice. After a few years and your skill set stabilizes I think you can take longer periods of time off with less concern about how it would effect your practicing ability.

I did locums pretty soon after residency. It was a fantastic learning experience because pathology really varies with geography and I learned all about different parts of the country that I would never have seen otherwise. Locums salaries were a bit lower a few years back, though, and when I still had loans it was hard dealing with the uncertainty and even harder to negotiate because I really, really needed to work. Jobs not in the NE seemed way better, and I particularly enjoyed the IHS even though the salary was low.

One day I woke up and had no idea where I was, and decided it was time to stop.