locum surgeon...what's the catch?

[PostCall]

there's a surgeon at our hospital who does trauma calls only. sometimes he does 24 hour call and sometimes he does 12 hour overnight call a few days a week. i'd never seen him do planned elective cases during the day or do clinic like the other attendings. turns out he finished residency a few years ago and is something they call a locum. so basically he responds to traumas and operates on any trauma patient that need surgery and also covers the floor during his shift. the thing is we got a whole bunch of residents who do all the floor work anyway so he mostly only deals with the traumas coming in. it seems like a decent gig if you're interested in pure trauma...shiftwork, no clinic, residents doing the floorwork. but there's got to be a catch right?

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[Winged Scapula]

What's the catch? A little something called job security.

 

[PostCall]

What's the catch? A little something called job security.

how so? doing a quick web search turns up a ton of jobs for locum surgeons and recruiters/locum agencies.

 

[JackADeli]

there's a surgeon at our hospital who does trauma calls only. ...i'd never seen him do planned elective cases during the day or do clinic like the other attendings. ...residents who do all the floor work anyway so he mostly only deals with the traumas coming in. ...

Yes it is shift work...
Sounds like plenty of liability, loss of basic skills as you are not as a general surgeon doing much Lap appy, lap chole, inguinal hernia, etc... if all you do is cross-cover and trauma. Most trauma in most places is non-operative as well.
He has limited ability to gauge his improvement as no clinic means follow-up by word of mouth....
Yes, plenty of locums work out there... it does not lead to long term stable practice per se nor does it lead to a whole lot of career development if practiced for any period in the way you describe.

I guess you can view locums work at better paid "moonlighting".

 

[docmartin252]

I know at least with EM, these guys get paid quite well and compensated for travel, living, etc. So while the incentive might be nice, like the others have said, the risk may not be worth the gain.

 

[JackADeli]

...EM, ...paid quite well and compensated for travel, living, etc. ...

They generally do not have a "clinic" type profession or maybe you can regard their ER as a continuous "outpatient clinic". EM can see their bread and butter as a locums. I dare say an EM doc that travels to different geographic locations may observe new and unique emergency pathologies.

GenSurg on the otherhand needs consistent and deliberate technical practice which is not achieved by being the "moonlighter" or "crosscover" locums dealing predominantly with drunks that go bump in the night... and even has a good deal of management occur behind the scenes by residents.

 

[PostCall]

this is at a level 1 center with lots of operative trauma so it's not like he's rarely going to the OR.

 

[smq123]

this is at a level 1 center with lots of operative trauma so it's not like he's rarely going to the OR.

It seems like you've already convinced yourself that the locum position is a GREAT position... 😕

it seems like a decent gig if you're interested in pure trauma...shiftwork, no clinic, residents doing the floorwork. but there's got to be a catch right?

Some things to ask him:

- Who takes care of his malpractice? I'm going to assume the hospital, but you never know. Plus, does the hospital also cover malpractice tail?

- Is he content to stay in that kind of shift-work job forever? Is there any possibility of climbing the academic ladder (becoming assistant professor, etc.)? Will it close the doors to his chances of opening private practice, should he want to do that?

- Is there any chance of improvement? New techniques and guidelines come out all the time. If he's only doing shift work, and not really maintaining a firm niche in the department, is he going to keep up with that? Or is he going to become one of those dinosaurs that practices surgery 20 years out of date?

- Is he receiving all the benefits that all other physicians at that hospital are receiving? Is he receiving full health care coverage, a 401K account, etc.?

 

[tussy]

I did locum work for a few months after I finished fellowship; it was good to make lots of cash to help pay down the loans but it is miserable work. Call is gross - all the gross cases that nobody wants to do. Elective cases are so much more pleasant. Also, your life is totally unpredictable and thankless. it's a great temporary gig, but can't imagine doing it long term.

 

[PostCall]

Call is gross - all the gross cases that nobody wants to do.

are u talking about trauma call? because the cases he gets are no different than the ones other surgeons get when they're on call.

Also, your life is totally unpredictable and thankless. it's a great temporary gig, but can't imagine doing it long term.

can u explain more. his schedule seems predictable, 24 or 12 hour overnight call few times a week.

 

[Winged Scapula]

how so? doing a quick web search turns up a ton of jobs for locum surgeons and recruiters/locum agencies.

Its not that there aren't jobs out there. And I am sure recruiters will try and sell you anything without telling you the drawbacks.

Many of these positions are:

- a specific limited period of time; I don't know about you, but I'd like to know where I'm living in 3 months. These are best suited to the single without pets, spouses or children.

- these jobs tend to be offered when a contracted surgeon is on vacation, sick leave or they want someone full time but don't want to pay the benefits, etc.

etc.

Others have basically detailed the problems above. In general, IMHO, locums is a good choice for someone who wants to experience different parts of the country, is single and wants to take some time before making a decision about where to live and what to do with his practice. Not practical or desirable for developing a practice or as a surgeon.

 

[mercaptovizadeh]

Its not that there aren't jobs out there. And I am sure recruiters will try and sell you anything without telling you the drawbacks.

Many of these positions are:

- a specific limited period of time; I don't know about you, but I'd like to know where I'm living in 3 months. These are best suited to the single without pets, spouses or children.

- these jobs tend to be offered when a contracted surgeon is on vacation, sick leave or they want someone full time but don't want to pay the benefits, etc.

etc.

Others have basically detailed the problems above. In general, IMHO, locums is a good choice for someone who wants to experience different parts of the country, is single and wants to take some time before making a decision about where to live and what to do with his practice. Not practical or desirable for developing a practice or as a surgeon.

Do you feel that the negativeness of locums is heavier for surgeons than for some other specialties, like IM, EM, anesthesia, because the mechanical skills have to be maintained regularly?

I can definitely see the advantages of locums in general (vacation time between gigs, seeing different areas of the country, etc.) and the disadvantages (bad for someone married or in a serious relationship, not very good for career advancement).

 

[Winged Scapula]

Do you feel that the negativeness of locums is heavier for surgeons than for some other specialties, like IM, EM, anesthesia, because the mechanical skills have to be maintained regularly?

I can definitely see the advantages of locums in general (vacation time between gigs, seeing different areas of the country, etc.) and the disadvantages (bad for someone married or in a serious relationship, not very good for career advancement).

I do.

The others above have detailed those concerns pretty thoroughly. In addition, doing locums doesn't allow you to have adequate follow-up...this was one of the revelations as an attending (that you don't see the natural healing process of your wounds, etc. as a resident).

EM and Anesthesia have mechanical skills that have to be maintained but in general, especially for the former, you are going to get that during your shifts.

 

[tussy]

are u talking about trauma call? because the cases he gets are no different than the ones other surgeons get when they're on call.




can u explain more. his schedule seems predictable, 24 or 12 hour overnight call few times a week.

I was taking gen surg and trauma call, but on call cases are a small proportion of most surgeon's practice, but a large part of a locums (the grossest cases and worst patients are the ones you pick up on call).

I wasn't doing shifts - that seems like a better deal. I did call every third night but was stuck with the patients I picked up on call. At one point I had about 40 inpatients on my inpatient census.

 

[ESU_MD]

I think that overall- locums surgeons are frowned upon by our main profesional group- the american college of surgeons who condemn "itinerant surgery" I think you could not be inducted as a full fellow if you only do locums.

 

[Winged Scapula]

I think that overall- locums surgeons are frowned upon by our main profesional group- the american college of surgeons who condemn "itinerant surgery" I think you could not be inducted as a full fellow if you only do locums.

Requirements for FACS:

http://www.facs.org/memberservices/2bfacs.html

I think the requirement that might apply to locums is to have a staff appointment at a hospital. Locums would probably only have Courtesy Privileges to Admit and Treat patients but might not be members of medical staff.

I'll have to ask around to see if that's the case.

 

[PostCall]

"itinerant surgery"

i didn't know what that means so i did a little web searching and it's a surgeon who operates and leaves the postop to another doctor. is that even allowed? i thought the surgeon who does the operation is responsible postop for like 90 days or something.

 

[Winged Scapula]

i didn't know what that means so i did a little web searching and it's a surgeon who operates and leaves the postop to another doctor. is that even allowed? i thought the surgeon who does the operation is responsible postop for like 90 days or something.

Only if you bill a certain code which includes post-op care.

Locums have to use a different billing code for any procedures they do which is "procedure only", not post-op care.

And BTW, surgeons are responsible for all post-op care, regardless of how long it takes. The 90 days you are referring to is the "global period" in which all care is bundled into the reimbursement for the procedure. Its a MAJOR flaw in the billing and reimbursement system as none of that post-op care is reimbursed...regardless of how many times the patient comes back.

 

[JackADeli]

Do you feel that the negativeness of locums is heavier for surgeons...

Yes. Some additional perspectives can be found: http://www.facs.org/fellows_info/bulletin/2008/tolls0508.pdf

...overall- locums surgeons are frowned upon by our main profesional group- the american college of surgeons who condemn "itinerant surgery" ...

Yes, to my knowledge being an "itinerant surgeon" is not accepatble by the professional standards of the college..

...The College strongly believes that surgical care involves treatment of the patient throughout the course of the disease or condition that necessitated the operation. This belief is the premise behind the College's ban on itinerant surgery....

IMHO/IMPO, you may call it by another name, but Locums for a general surgeon is really the equivalent of moonlighting... just paid more then when you did it in residency.

 

[ESU_MD]

Yes. Some additional perspectives can be found: http://www.facs.org/fellows_info/bulletin/2008/tolls0508.pdfYes, to my knowledge being an "itinerant surgeon" is not accepatble by the professional standards of the college..IMHO/IMPO, you may call it by another name, but Locums for a general surgeon is really the equivalent of moonlighting... just paid more then when you did it in residency.

thanks for finding that reference! I knew I heard that term "itinerant surgeon" , but I couldnt think of where I heard it.