locum tenens straight out of residency

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greenpistachio

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Has anyone here done locum tenens right out of residency?

I'm a PGY2 in family medicine and I'm thinking about doing locum for a while after residency. My reasons are 1) I don't want to settle yet in a particular area of the country, would rather see different places, different practices. I don't have kids or a spouse so I'm free to go wherever. 2) want to have some time off between locum jobs to travel. I would want to work in a family medicine primary care clinic or urgent care, not a hospitalist.

I have read the posts by CabinBuilder on the FM forum, which are very helpful. But really I want to know what you guys think about how feasible it is to do a lot of traveling and not working in the first 1-2 years out of residency.

Is it realistic for a new residency grad to do locums for a few months at a time, take a few months off, then do another locum job for another few months?

Do locum agencies look favorably or unfavorably on young residency grads?

How much time gap between clinical work can I have before it looks bad to employers?
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Would you really want locums right out of residency? Most docs view the three years out of residency as an extension of training. That's why the pay for a doc with three years experience is so much higher than a new grad. Most of us want to be around more senior physicians, or at least colleagues, that we can turn to for advice, in a practice that you know has things under control, and for the first year ideally with a slow and steady increase in the rate you see patients.

Locums is mostly about dropping you into a hospital so dysfunctional that it couldn't retain its own staff and letting you deal with whatever walks through the door. Not necessarily a bad thing down the line, depending on compensation, but not how I'd want to start my first day out of residency.
 
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I have a friend who did it for a couple of years as he was dating a traveling nurse at the time. He said it was stressful as hell but he made fat bank. But 2 years was enough.
 
I know someone who did locums (he wanted a job in a "popular/desirable" area, no jobs were currently available) out of residency while he waited for his "dream job" to open up. I don't know the details but it worked out for him.
 
You can do locums after residency and it's no big deal explaining it to employers.
 
You'd need to carry your own insurance. And fund your own benefits. And as was pointed out in another thread, if something goes bad a facility will be very quick to throw an outsider under the bus before their own house staff so you'll always have a target on your head.

Finally jumping from facility to facility might not be so quick and easy and may involve a ton of paperwork to the extent credentialing and privileges are involved.

Finally if money gets tight the locums guy is the first to go - they have nothing invested in you.

So yes you can make good money and have good flexibility but there are also many very good reasons most don't structure our careers this way.
 
Law2Doc said:
You'd need to carry your own insurance. And fund your own benefits. And as was pointed out in another thread, if something goes bad a facility will be very quick to throw an outsider under the bus before their own house staff so you'll always have a target on your head.

Finally jumping from facility to facility might not be so quick and easy and may involve a ton of paperwork to the extent credentialing and privileges are involved.

Finally if money gets tight the locums guy is the first to go - they have nothing invested in you.

So yes you can make good money and have good flexibility but there are also many very good reasons most don't structure our careers this way.
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To be fair, if you contract with a locums company, they take care of most/all of this for you. Pretty much everything but a license will be covered by the company including med mal insurance and credentialing.

And the beauty of locums is that there's always another job out there if the one you have goes away. Most of the time you have a contract for a particular period of time that may or may not be renewed and will have penalties for both sides if the contract isn't fulfilled.

There are lots of reasons not to do locums but the issue you bring up are at the bottom of the list.
 
gutonc said:
To be fair, if you contract with a locums company, they take care of most/all of this for you. Pretty much everything but a license will be covered by the company including med mal insurance and credentialing.

And the beauty of locums is that there's always another job out there if the one you have goes away. Most of the time you have a contract for a particular period of time that may or may not be renewed and will have penalties for both sides if the contract isn't fulfilled.

There are lots of reasons not to do locums but the issue you bring up are at the bottom of the list.
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First, the locums companies may cover some things but the level of insurance they get you might not be reasonable for your risk level. You are the odd man out on any lawsuit -- good luck with that. Second, it's easy to say there will always be another job, but that's pretty market dependent. Third penalties for cutting a contract short only exist if there's no cause. Doctors all make errors so there's always some cause they can point to.
 
Law2Doc said:
First, the locums companies may cover some things but the level of insurance they get you might not be reasonable for your risk level. You are the odd man out on any lawsuit -- good luck with that. Second, it's easy to say there will always be another job, but that's pretty market dependent. Third penalties for cutting a contract short only exist if there's no cause. Doctors all make errors so there's always some cause they can point to.
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maybe so, but the med mal risk for family medicine isn't very high. OP isn't a neurosurgeon.
 
and yes, doing locums straight out of residency is a stupid thing to do.
 
Law2Doc said:
Second, it's easy to say there will always be another job, but that's pretty market dependent.
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The whole point of locums is that the entire country is your market. There's always another job.
 
Law2Doc said:
You need to be licensed and credentialed and get privileges everywhere you go. It's a pain to do regionally but absurd to try and do nationally. So no I'd say this is more spin than fact.
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Again...pretty much every locums company will do everything but the licensing for you (and some will help with that). It's not as big of a deal as you seem to want it to be.
 
gutonc said:
Again...pretty much every locums company will do everything but the licensing for you (and some will help with that). It's not as big of a deal as you seem to want it to be.
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Having done credentialing at a couple of places now, which nobody can really do for you, sorry, yeah it's a pretty big, time consuming deal. And can take months to get approved at most places. Not something you want to do repeatedly and not something that happens at the drop of a hat. But whatever.
 
Law2Doc said:
Having done credentialing at a couple of places now, which nobody can really do for you, sorry, yeah it's a pretty big, time consuming deal. And can take months to get approved at most places. Not something you want to do repeatedly and not something that happens at the drop of a hat. But whatever.
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I'm credentialed at 7 different hospitals. All I've ever had to do is sign the forms. And I don't do locums.

Places that need a doc will grease the wheels.

And there are plenty of people who don't need hospital credentials to practice. I could do my job just fine without any hospital credentials (but then my partners would be pissed at me that I couldn't take weekend call).
 
gutonc said:
I'm credentialed at 7 different hospitals. All I've ever had to do is sign the forms. And I don't do locums.

Places that need a doc will grease the wheels....
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Not been my experience at all (or that of the people I have trained with, all of whom have also bitched about their own credentialing nightmares). Which I would argue means there are quite a few places where locums simply can't work as seamlessly. Which is again why you kind of are at the mercy of the availability of certain jobs in certain markets -- the handful with both demand and the inclination to grease the wheels and not be sticklers for lengthy credentialing processes.

And you can't carry dozens of state licenses affordably and each new one you get can take half a year to get it. So you aren't likely going to be doing this nationally.

I'm seeing this being a much riskier career path than you guys are making out. Not that it can't be done (obviously some have done it), but rather that it comes part and parcel with a host of issues and risks I personally wouldn't even wish on my enemies.
 
Law2Doc said:
First, the locums companies may cover some things but the level of insurance they get you might not be reasonable for your risk level. You are the odd man out on any lawsuit -- good luck with that. Second, it's easy to say there will always be another job, but that's pretty market dependent. Third penalties for cutting a contract short only exist if there's no cause. Doctors all make errors so there's always some cause they can point to.
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you haven't worked locums have you?

the med mal is usually more than adequate 1/3 mil or 3/6 mil in the states that require higher coverage, i have yet to have a locums job not include med mal with tail...

if you pigeon hole yourself to a big city...yeah, locums will not be that plentiful, but you end up just working the whole time so might as well go to the place that pays the most for the work you do...and there are plenty of those places (every 3 months or so, my phone is ringing off the hook with locums companies cold calling with positions...

and as far as leaving? its standard in the contracts that you just have to give 30 days notice to leave...of course if you do this consistently, your recruiter is not going to be so keen on finding you work...
 
Law2Doc said:
Having done credentialing at a couple of places now, which nobody can really do for you, sorry, yeah it's a pretty big, time consuming deal. And can take months to get approved at most places. Not something you want to do repeatedly and not something that happens at the drop of a hat. But whatever.
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the locums companies have people do this for you...they send you the packets filled out, you go over it and send it back...the most i've had to do is take things to be notarized, but otherwise they take care of 90% of it.
 
Law2Doc said:
And you can't carry dozens of state licenses affordably and each new one you get can take half a year to get it. So you aren't likely going to be doing this nationally.
.
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they pay for them too...the only ful license i have paid for was my license for fellowship (and if i had gotten my act together sooner, my locums company would have paid for it )
they paid for my renewals as well...
 
Law2Doc said:
Not been my experience at all (or that of the people I have trained with, all of whom have also bitched about their own credentialing nightmares). Which I would argue means there are quite a few places where locums simply can't work as seamlessly. Which is again why you kind of are at the mercy of the availability of certain jobs in certain markets -- the handful with both demand and the inclination to grease the wheels and not be sticklers for lengthy credentialing processes.

And you can't carry dozens of state licenses affordably and each new one you get can take half a year to get it. So you aren't likely going to be doing this nationally.

I'm seeing this being a much riskier career path than you guys are making out. Not that it can't be done (obviously some have done it), but rather that it comes part and parcel with a host of issues and risks I personally wouldn't even wish on my enemies.
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The people I know who did locums had the company fill out all of the credentialing paperwork except the signature on the end, the company filled out all the licensing paperwork (except the stuff you had to do like give them a copy of your original diploma and such) including associated paperwork such as requesting USMLE transcripts and such, the company paid all the fees for the above, AND paid for (or arranged) expedited processing of everything. One guy I know took a 1 week/month locum gig in Montana where on top of all that the company pays for a monthly flight and a place to stay while he's there.

Credentialing is a nightmare in places that will function just fine with or without you. If they really need staff and are paying top dollar for a locum physician, they will credential you in days. As in a few days. Less than a week. Especially when they're dealing with a company that has already vetted you and has a packet of information on you prepared to give out at any given time.
 
rokshana said:
...
and as far as leaving? its standard in the contracts that you just have to give 30 days notice to leave...of course if you do this consistently, your recruiter is not going to be so keen on finding you work...
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I don't think I actually ever said there was an issue with leaving. I said they could dump you in an instant if the jobs dried up and that lengthy credentialing and licensing could make it difficult to jump from job to job as seamlessly as some people on here are describing. A lot of you guys letting other people prepare forms and just signing on the dotted line might not be doing the kind of multistate contract review and due diligence that is wise for a high liability employment situation, but whatever.

As for what med malpractice level is adequate, it really depends on what you are doing and how complete the coverage is, but I'm betting your coverage isn't as adequate as you think it is -- a million dollar per incident policy only sounds good until you get sued for 5-- and this too is something that really ought to be painstakingly reviewed and discussed each time you choose a gig, which I suspect you guys aren't doing.

Sorry but as a professional if you are just willy-nilly signing things (which amount to contractual obligations) and letting a locus company "handle it and I'll show up", and let them tell you what level of insurance is adequate for each state etc, the lawyer in me cringes and I suspect you might be setting yourself up for potential horribles you aren't even aware. Most will skate by fine for years without falling off this tight wire, but someone somewhere will be left holding the bag.
 
Raryn said:
The people I know who did locums had the company fill out all of the credentialing paperwork except the signature on the end, the company filled out all the licensing paperwork (except the stuff you had to do like give them a copy of your original diploma and such) including associated paperwork such as requesting USMLE transcripts and such, the company paid all the fees for the above, AND paid for (or arranged) expedited processing of everything. One guy I know took a 1 week/month locum gig in Montana where on top of all that the company pays for a monthly flight and a place to stay while he's there.

Credentialing is a nightmare in places that will function just fine with or without you. If they really need staff and are paying top dollar for a locum physician, they will credential you in days. As in a few days. Less than a week. Especially when they're dealing with a company that has already vetted you and has a packet of information on you prepared to give out at any given time.
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We are talking about professionals doing high liability work with essentially no due diligence by either party. Sounds legit ... 🙂

Most of the time there will be no issues. But when there are who do you think the paperwork has set up to be the big loser if you are just signing pre prepared forms?
 
Law2Doc said:
Not been my experience at all (or that of the people I have trained with, all of whom have also bitched about their own credentialing nightmares). Which I would argue means there are quite a few places where locums simply can't work as seamlessly. Which is again why you kind of are at the mercy of the availability of certain jobs in certain markets -- the handful with both demand and the inclination to grease the wheels and not be sticklers for lengthy credentialing processes.

And you can't carry dozens of state licenses affordably and each new one you get can take half a year to get it. So you aren't likely going to be doing this nationally.

I'm seeing this being a much riskier career path than you guys are making out. Not that it can't be done (obviously some have done it), but rather that it comes part and parcel with a host of issues and risks I personally wouldn't even wish on my enemies.
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I have 5 active state licenses. Most are 2 years in duration so if the expiration dates are staggered then it's a non-issues.
There are tons of locum jobs out there but you have to be flexible. I did the long term ones that were 3-9 months.
I did it for 5 years because I never lasted in a permanent job longer than 3 months (due to various reasons) so locums paid the bills.
 
I did locum tenens right out of residency. I have worked in 4 different states now. The locums agency always paid for the state license. They helped with privileging, but there were usually a fair number of forms for me to fill out too, but no major headaches. The privileging application for the permanent job I'm taking is orders of magnitude more onerous than any I had to fill out for a locums gig (which is consistent with what Raryn said above, about how credentialing is a nightmare in places that will function just fine with or without you.)

The one caveat I would give to the OP is that many privileging applications ask for your work history, and require you to "explain" any gap longer than one month. I have no idea how they evaluate your explanation, or whether an explanation of "I was sailing around the world" would affect your approval. If you're going to another locums place that's desperate for a doc, I doubt they'd care.

Also, while the agency will pay for licensure, if you do this for more than a couple of years, maintaining multiple state licenses could get cumbersome. Not because of the expense, but because each state has its own CME requirements, and keeping track of which ones you've satisfied, which ones you need to satisfy in time for renewal, etc., could get time-consuming. And another thing privileging applications often ask is if you've ever lost a license, had one denied, or... let one expire. I have no idea why they care if you've let one expire. If you reason for doing so was "I stopped doing locums in that state," I doubt they'd deny you privileges, but they do check all this stuff, so the longer your application gets, the longer it will take to get approved.

I would just ignore Law2Doc. He's been posting the same crap since before I even started a post-bac pre-med program, and now here we are. Many, many, happy and healthy SDN posters have gotten on with our lives and our careers while he continues his futile attempts to rain on people's parade for no reason.

Slack3r said:
You're forgetting that Law2Doc's experiences are generalizable to everyone.
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I think you mean lack of experiences. He's clearly never done locums and yet he can't wait to tell everyone what a terrible idea it is and how many problems it will cause.

Anyone who has any questions about doing locums, feel free to PM me.
 
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