Several thoughts:
1. Just because an LT company is talking to you, that doesn't mean they are going to find you a job.
2. It is very atypical to sign a contract with an LT company. Usually they find a practice opportunity, and you sign a contract about that job / position. If they are having you sign a contract just with them, why?
3. No matter what, make sure that anything you sign doesn't cost you money. You shouldn't have to pay for anything -- licensing, travel, etc. It also shouldn't prevent you from finding your own job, or working with a different LT company.
Here are my Tips / Traps for Locum positions that I share with my residents. In the spirit of fluu disclosure, I didn't write this -- one of my graduating residents who did a year of LT before fellowship did:
Locum Tenens: Dont Get Screwed
Before making even that first call to a locum tenens company, you need to be prepared. Hopefully this will help.
1. What is locum tenens?
As a locum tenens doctor, you will be an independent contractor. The locums company will hook you up with a job somewhere, but you are not an employee of the locums company nor the firm/hospital where you work. This is important to realize because (a) you will be in a higher tax bracket, (b) you get no benefits (e.g. you must buy your own health insurance), and (c) you get paid by the hour, so if you dont work (e.g. on a sick day), you dont get paid.
2. What happens when I call the company for the first time?
You will be connected with a recruiter. Make no mistake about it: this person is not your friend. You must approach your dealings with this person as if you are dealing with a car salesperson; a healthy dose of skepticism is a must. That being said, you want to be civil, because the recruiter is not going to want to sully the companys reputation by placing a rude doctor who has the potential to piss off the people in the practice in which (s)he is placed. The recruiter will ask you a bunch of questions about what you are looking for (hospitalist vs. outpatient vs. mixed), which geographic areas you are interested in, etc. Think about what you want BEFORE making the call. These recruiters love it if it seems like you dont know what you want. Why? They will TELL you what you want, talking up various jobs they couldnt get anyone else to take. They figure, since you are wishy-washy, it will be easier to push you into what they need to fill.
3. Government jobs vs. private practice.
The advantage to working for the govt (i.e. for a VA hospital or clinic) is that you only need ONE state medical licensein any stateand you can then work at any VA in the country. Also, it is likely that the VA will let you use their DEA #, which is a huge plus coming right out of residency, because your own DEA # can take a LONG time to come through. The disadvantage to working for the govt is that the salary is less and everything that the locums company provides for you (apt, rental car, etc) is going to be more no-frills. For example, most private-practice outpatient salaries are about $60/hr, whereas the VA outpatient work usually pays $45-50/hr. Private-practice jobs will give you a bigger, nicer car with power windows, while the VA jobs will give you a Chevy Cavalier with manual windows. Get the picture? All that being said, the job descriptions for the govt jobs seem to be more standard than the private-practice jobs. There seems to be higher potential to be abused in a private job, where they can basically set any schedule for you they want, as long as you agree to it and sign the contract. As you all know, outpatient clerks, nurses, etc. at the VA start to disappear around 4pm, which means that your hours will be more predictable. Also keep in mind that you will get holidays off when you work for the govt.
If you want to go private, make sure you find out from the recruiter how long it usually takes to get a license in the state you want to work. For example, CA can take up to 9 mos, whereas some other states have special locums/temp licenses that can come through in 1-2 mos. This brings me to the next point:
4. How many licenses should I get?
The recruiter may try to get you to sign up for a few licenses up front. This will be tempting, because they handle most of the paperwork. Also, they will try to stick a clause in the contract that says something to the effect of if you dont work in a state where we get you a license, then you must reimburse us for the cost of that license. Negotiate that point; they should pay for at least one or two licenses for you as a cost of doing business. Also, keep this in mind: a wise man once said, Be careful about signing up for licenses you may not use; they will haunt you for the rest of your life. As much as I hate to admit it, he is right. Even if you dont USE a license, once it is issued, you will have to include it on every form you ever fill out for the rest of your life. This will possibly delay your various applications for various things while your history in every state in which you are licensed is checked out.
5. When I am presented with an opportunity by a locums company, how long should I commit for?
This is a highly personal decision. Your chances of a practice wanting you are better if you commit up-front to a longer tour of duty. Obviously, the practice wants to train as few people as possible, so if you say you can work from Sept-Jan and another doctor says she can only work from Sept-Nov, you will probably get the job. But, make sure you know everything about the job before committing to longer than a month or two.
6. Talk to the supervising doctor at the practice/hospital at which youre thinking about working.
OK, so the recruiter calls you with a job opportunity that sounds pretty good. I strongly recommend asking for a contact person at the job. These recruiters know almost nothing about how a practice or hospital really works when it comes to call schedules and censuses, etc. You want to have a list of questions and get them all answered by someone who KNOWSi.e. someone who works there. Take notes while you talk to this personeverything they say will need to go into the contract you sign later. Beware, the recruiter may want to keep you away from a contact person, telling you something like, We try to get as complete a description of the job as we can, to make it easier for you. Nonsense. They just dont want you finding anything out that you may not like, which would kill the deal. Better to find out before you move across the country. In a normal job interview, you would probably never ask some of the things up-front that you MUST ask when you are dealing with a locum tenens situation. Do NOT be shy about nailing down the details of call, hours, number of patients you will be expected to see, etc. If you dont ask, the practice WILL take advantage of you. Think about ittheyre paying for your time, and they dont need you to be really happy if youre only going to be there a couple of months, so their goal is to milk as much work out of you as is possible in the specified time period. Remember, if you are talking to them on the phone, it is because the recruiter has already presented you to that practice, and the practice likes what they see on paper. They will hire you without ever speaking to youthats how locums works. So dont worry about talking to them about job specifics.
7. Dont just get it in writing, get it in writing EARLY.
The locums company will ask for a verbal commitment from you as soon as a practice indicates that they want you. Once you give your commitment, you are already in a weaker position to bargain. The locums company canand willwait until the very last minute to present you with a contract. Then, at that last minute, they will put things in there that shouldnt be and eliminate other things that should be. Yes, the famed bait and switch. They figure youve been counting on this job and will sign just about anything. DO NOT BECOME A VICTIM OF THIS! Early on, you need to type up those notes you took about the job details and e-mail them over to the recruiter. Ask the recruiter to add a little sentence in there about how the details as you have described them look about right. If they try to change things when you actually get the contract, you will at least be able to show them what they previously agreed to, which may make it a little easier to get it into the contract as it should be. Also, make sure you get some sort of e-mail or preliminary contract early on that includes all the details of payment, termination clauses, etc. For example, perhaps you are negotiating for a govt outpatient job that will be paying $50/hr. Make sure you know IN ADVANCE whether this job pays overtime, and at what rate. If overtime hours (anything over 40 hrs per week, usually) are billed at the standard rate instead of 60, 70, or even time and a half, you want to know that up-front, so that maybe you can find a different job that pays overtime hours at a higher rate. Make sure you ASK about the holiday policy. What is standard for private practice contracts may not apply to some govt contracts. For example, holiday pay is often 1 ½ times the usual salary. If you dont work on a holiday, but you have to work the day before or the day after a holiday, then you may be entitled to receive ½ the usual pay on the holiday (i.e. you get half pay for NOT going to work). Also, think about the termination clause. Usually, a practice has to give 30 days notice; beware the locums company that tries to put in a clause that says you can be terminated at any time without notice or compensation. Many of these notice clauses are in the generic contract, but may be conspicuously absent or radically changed when you receive your assignment-specific contract. You should also insist on a clause of your own: If the reality of the practice fails to conform to the practice description that is in the contract, then the Physician [thats you] may terminate the contract with 10 days notice.
8. Contracts, malpractice, and payment.
READ every line of the contract. Yes, most of it is a generic contract, but just about every line is negotiable. ASK about whether the locum tenens companys malpractice insurance has a tail. That is, you want to make sure that no matter what happens when, if you ever get sued, youll be coveredno exceptions. KNOW how and when you will get paid. If the practice takes its sweet time paying the locums company every two weeks, does the locums company guarantee your salary to be on time, since the check will likely come directly from the locums company? Worse yet, if the practice defaults, will the locums company pay you out of its pocket and deal with the practice lateron the companys time, not yours?
9. Dont sign it if it isnt right.
If the locums company tries to screw you at the last minute (or at any time, for that matter), dont sign the contract. So what if its the day before you are scheduled to fly out to the practice? Insist that the locums company present you with a contract that you find acceptable. Do not get on a plane until that contract is signed and countersigned. Once you get to the practice location, you have no bargaining leverage whatsoever. Remember, the locums companys reputation depends on you being at the job as originally promised to the practice. The company will not let the deal fall through. You CAN hold the deal hostage if they are being unfair to you. They know you want the job, but if they think youre willing to kill the deal on a certain point, they will cave to some extent.
10. Why so much space devoted to getting screwed by the locums company?
It has to do with how the company gets paid. There are different financial situations for govt and private practice, but lets take the govt jobs as an example. Govt jobs are often a bid. This means that several locums companies vie for the privilege of providing their physicians to that govt facility. Obviously, the company with the best combination of a low bid and doctors that the facility is interested in will win the bid. So, lets say that Locums Company X successfully wins the bid at a price of $90/hr. Company X will now receive $90/hr from the govt for every hour the physician works. So out of that $90/hr, Company X will pay the physician his/her hourly wage, buy the physicians round-trip airfare (if applicable), rent the physician a car, pay for a furnished apt and utilities, etc. You can see that, for every dollar Company X does NOT spend on the physician, that is a dollar that goes into Company Xs pocket. Get ready to be nickel and dimed, people. Make sure you ask about EVERYTHING up-front. If you must have a certain amenity (like a dishwasher or W/D) in your apt, make sure the recruiter knows that up-front and that it will be a deal-breaker if they try to screw you.
11. With all this talk about getting screwed, why do locum tenens at all?
Well, you can live in parts of the country youve never seen before. You can make a lot of money and not have any expenses other than food, entertainment and, ironically, personal medical insurance (malpractice is covered by the locums company). You can kill time while looking for a more permanent job or waiting to start a fellowship. If you are waiting for one year to start your fellowship, locums will be ideal, because most practices dont want to hire someone as a perm if that doctor will only be around for one year. Also, keep in mind that many practices hire locums docs with the intent of making them into perms, so you can try out a practice for a couple of months risk-free and then decide whether to join or not.
