Locums after graduation advice

[apr27]

Hey guys,

I'm considering doing locums after I graduate as I haven't found the right job for myself. Few questions if you don't mind:

1) How long does it take it typically set up? I graduate in July and I was hoping to seamlessly transition in August
2) If any, what are the hidden costs. fees, etcs??
3) Should be looking into certain types of insurances now? Disability etc....
4) Any other things I should be aware of when trying to set this up to make the transition as smooth as possible?

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[psychbender]

I wouldn't advise going straight into locums from residency, as your greatest period of growth in going to be in that first year after graduation, and it is really better if you have a stable, supportive environment.

That being said, are you trying to do locums just for a few months, while you continue to look for a more permanent job, or are you envisioning doing locums long-term?

If you're using an agency, they should provide malpractice and most of the logistical support (hotel, airfare, rental car). You should be able to pay for these yourself, and submit for reimbursement, so you can get the bonus miles, travel points, whatever on your own card, but I know I didn't realize that when I briefly did locums between jobs years ago. You'll need to get health insurance yourself, or through a spouse, and look into opening your own retirement account (self- funded 401k vs SEP-IRA vs other options discussed on this forum ad nauseum). Any fees (state licenses, DEA licenses, credentialing fees) should be covered by the locums agency. If they won't, then either go through another agency, or deduct those as business expenses from your total 1099 income, come tax time.

It is entirely feasible to get the ball doing now, and show up in August for an assignment. Credentialing documents don't usually take that long. Now, some places, if they can afford to be choosy, may turn your packet down, as you'll be fresh from residency, but I don't doubt that you'll find some work to get started.

 

[osumd]

I strongly recommend against going straight to locums as a fresh grad. You will bounce through unfamiliar environments, different practice styles, locums CRNAs, different equipment/monitors/machines, unclear of who/how to call for help, no relationship with surgeons/proceduralists, with no one really invested in helping you succeed, all while trying to navigate the typical fresh grad learning curve of being on your own.

 

[apr27]

I wouldn't advise going straight into locums from residency, as your greatest period of growth in going to be in that first year after graduation, and it is really better if you have a stable, supportive environment.

That being said, are you trying to do locums just for a few months, while you continue to look for a more permanent job, or are you envisioning doing locums long-term?

If you're using an agency, they should provide malpractice and most of the logistical support (hotel, airfare, rental car). You should be able to pay for these yourself, and submit for reimbursement, so you can get the bonus miles, travel points, whatever on your own card, but I know I didn't realize that when I briefly did locums between jobs years ago. You'll need to get health insurance yourself, or through a spouse, and look into opening your own retirement account (self- funded 401k vs SEP-IRA vs other options discussed on this forum ad nauseum). Any fees (state licenses, DEA licenses, credentialing fees) should be covered by the locums agency. If they won't, then either go through another agency, or deduct those as business expenses from your total 1099 income, come tax time.

It is entirely feasible to get the ball doing now, and show up in August for an assignment. Credentialing documents don't usually take that long. Now, some places, if they can afford to be choosy, may turn your packet down, as you'll be fresh from residency, but I don't doubt that you'll find some work to get started.

Thanks for your reply.

I'm a pain fellow looking for a better pain opportunity. I just wanted to do anesthesiology locums to make money and use the scheduling flexibility to find an opportunity I like. Honestly, my plan would be to stay at the institution I'm at currently.

 

[apr27]

I strongly recommend against going straight to locums as a fresh grad. You will bounce through unfamiliar environments, different practice styles, locums CRNAs, different equipment/monitors/machines, unclear of who/how to call for help, no relationship with surgeons/proceduralists, with no one really invested in helping you succeed, all while trying to navigate the typical fresh grad learning curve of being on your own.

Thanks. I understand that concern. You can see above that it's more of temporary move if that changes your perspective.

 

[anaesthetic]

I strongly recommend against going straight to locums as a fresh grad. You will bounce through unfamiliar environments, different practice styles, locums CRNAs, different equipment/monitors/machines, unclear of who/how to call for help, no relationship with surgeons/proceduralists, with no one really invested in helping you succeed, all while trying to navigate the typical fresh grad learning curve of being on your own.

Second this. I graduated within the last five years, and that first year or so in a stable, supportive environment at 1-2 hospitals was essential for my growth as an anesthesiologist. I developed my own style, got comfortable with many different/difficult scenarios on my own as well as on care team, and developed great relationships with my partners, surgeons, CRNAs, and OR staff.

Could you do locums straight out? Probably. It is bad for you? Maybe, maybe not. That being said, having a stable environment just smoothens out a lot of the unanticipated issues that your partners can help you navigate through, both clinical and nonclinical.

I think doing locums temporarily in search of a more stable/permanent job is fine as well. Pays very well currently, and a lot of my colleagues have left for those pastures recently.

 

[Dr. Rude]

Have to agree with above posters. Any chance You can sign a part time gig at your current institution post residency and do some locums part time while working for them for awhile till you figure things out and keep looking?

 

[apr27]

Have to agree with above posters. Any chance You can sign a part time gig at your current institution post residency and do some locums part time while working for them for awhile till you figure things out and keep looking?

Perhaps. I just want to make money, pay off some credit card debt, and find a good chronic pain job. There isnt a part time pain option for me here or anywhere near by for pain, so I was thinking Anesthesiology was my best option.

 

[apr27]

Second this. I graduated within the last five years, and that first year or so in a stable, supportive environment at 1-2 hospitals was essential for my growth as an anesthesiologist. I developed my own style, got comfortable with many different/difficult scenarios on my own as well as on care team, and developed great relationships with my partners, surgeons, CRNAs, and OR staff.

Could you do locums straight out? Probably. It is bad for you? Maybe, maybe not. That being said, having a stable environment just smoothens out a lot of the unanticipated issues that your partners can help you navigate through, both clinical and nonclinical.

I think doing locums temporarily in search of a more stable/permanent job is fine as well. Pays very well currently, and a lot of my colleagues have left for those pastures recently.

I agree. I think the potential responsibility and expectations are greater, but it would likely be at an academic institution where I wouldnt have do any "big" cases. Like I said, I just want to make money, pay off some credit card debt, and find a good chronic pain job. There isnt a part time pain option for me here or anywhere near by for pain, so I was thinking Anesthesiology was my best option.

 

[Modoc]

I believe that having a stable first year job is important for your growth as an independent anesthesiologist. Doing your own cases vs supervising 4 rooms are two different practice models that have their own challenges, the later being harder. I moonlight countless shifts during my cardiac fellowship where I supervised 3-4 rooms, and its a challenge. You uncover weaknesses in your perioperative management skills and operating room management (esp when your "anesthesiologist in charge/ board runner etc" that take time to figure/iron out. Being in a supportive environment is critical. also, academic sites are where "big" cases end up. I remember I was supervising a 7 level complex spine, a lung decortication and lobectomy, and a pneumonectomy in 3 different rooms at the same time during my first moonlighting shift; not all CRNA/AA are created equal, they vary in skill set and experience significantly. So you need to have your skills perfected or at least tested in your first job to be a effective Locum, I believe it would decrease your risk of liability/malpractice. just my 2 cents

 

[teacher2md]

I believe that having a stable first year job is important for your growth as an independent anesthesiologist. Doing your own cases vs supervising 4 rooms are two different practice models that have their own challenges, the later being harder. I moonlight countless shifts during my fellowship where I supervised 3-4 rooms, and its a challenge. You uncover weaknesses in your perioperative management skills and operating room management (esp when your "anesthesiologist in charge/ board runner etc" that take time to figure/iron out. Being in a supportive environment is critical. also, academic sites are where "big" cases end up. I remember I was supervising a 7 level complex spine, a lung decortication and lobectomy, and a pneumonectomy in 3 different rooms at the same time during my first moonlighting shift; not all CRNA/AA are created equal, they vary in skill set and experience significantly. So you need to have your skills perfected or at least tested in your first job to be a effective Locum, I believe it would decrease your risk of liability/malpractice. just my 2 cents

In that kind of 3:1 supervision, are you actually managing the case after it’s started? Are the CRNAs receptive to that? Or do you basically wait for them to ask for your help?

 

[Modoc]

In that kind of 3:1 supervision, are you actually managing the case after it’s started? Are the CRNAs receptive to that? Or do you basically wait for them to ask for your help?

The plan is always developed by myself, I also perform all invasive procedures with the exception of intubation (that's just my style of work). In between case starts I am constantly revolving from room to room to check on the patient and how the intra op management is going. I get called if anything odd or wrong is occurring. I don't leave much decision making to the mid level in the room unless I am unavailable. I usually stand around for 15 min or so after induction to help position and monitor vitals. But sometimes I have other rooms to start, so I have to leave.

there's two types of anesthesiologist, the ones that are completely hands off and wait for a call, or the ones that are very hands on, I am the latter. I believe the patient get much better care if the MD is just doing the case, but unfortunately that's not the case at my institute, so I try to actively manage as much as I can. some may think that it annoying, some may think its an overkill, but at the end of the day I am liable and I am the most experienced (maybe not by time but def by case diversity and in resuscitative capability) to manage or perform any procedure, thus I insure the patient gets the highest standard of care I can provide.

The midlevels are generally very receptive to it, if they do anything I am not comfortable with or just testing the waters with me- it has happened- I make it very clear that its not okay, and educate them on my practice style and the importance of my presence.

Usually when I start a case with someone new they always have a need to mention they do / have done hearts to provide me with reassurance of their skill set ? I'm not sure (this happens without me mentioning anything about heart or my training) - that's my first red flag, I clearly state my plan and what my expectations are, and let them know I will be actively engaged in the room.

 

[Lecithin5]

Will sort of go against the grain: if locums works best for you as a short term option, go for it until you find the right fit. Sure, ideally you find a permanent, solid job from the get-go. But I did something similar (fellowship, then locums for a year) until I found the right job (doc-only practice; level 1 center; doing all types of cases…)- I’d like to think that I’m doing just fine. Like riding a bike…

Sep ira, sep ira, sep ira. Take advantage of the opportunity to stash away money as a 1099. Hopefully the locums company will set you up with malpractice, with tail. You’ll need to get health insurance. Good luck.

 

[Lecithin5]

The plan is always developed by myself, I also perform all invasive procedures with the exception of intubation (that's just my style of work). In between case starts I am constantly revolving from room to room to check on the patient and how the intra op management is going. I get called if anything odd or wrong is occurring. I don't leave much decision making to the mid level in the room unless I am unavailable. I usually stand around for 15 min or so after induction to help position and monitor vitals. But sometimes I have other rooms to start, so I have to leave.

there's two types of anesthesiologist, the ones that are completely hands off and wait for a call, or the ones that are very hands on, I am the latter. I believe the patient get much better care if the MD is just doing the case, but unfortunately that's not the case at my institute, so I try to actively manage as much as I can. some may think that it annoying, some may think its an overkill, but at the end of the day I am liable and I am the most experienced (maybe not by time but def by case diversity and in resuscitative capability) to manage or perform any procedure, thus I insure the patient gets the highest standard of care I can provide.

The midlevels are generally very receptive to it, if they do anything I am not comfortable with or just testing the waters with me- it has happened- I make it very clear that its not okay, and educate them on my practice style and the importance of my presence.

Usually when I start a case with someone new they always have a need to mention they do / have done hearts to provide me with reassurance of their skill set ? I'm not sure (this happens without me mentioning anything about heart or my training) - that's my first red flag, I clearly state my plan and what my expectations are, and let them know I will be actively engaged in the room.

That’s great that your environment allows for this type of management and that your midlevels are receptive. I have to imagine that in many places midlevels aren’t as receptive, or are passive aggressive, or even flat out become vindictive in how they practice just to spite the doc…

 

[abolt18]

Will sort of go against the grain: if locums works best for you as a short term option, go for it until you find the right fit. Sure, ideally you find a permanent, solid job from the get-go. But I did something similar (fellowship, then locums for a year) until I found the right job (doc-only practice; level 1 center; doing all types of cases…)- I’d like to think that I’m doing just fine. Like riding a bike…

Sep ira, sep ira, sep ira. Take advantage of the opportunity to stash away money as a 1099. Hopefully the locums company will set you up with malpractice, with tail. You’ll need to get health insurance. Good luck.

Why would you do a SEP IRA and make yourself unable to do a Backdoor Roth IRA? Do a Solo 401k instead.

Solo 401(k) Vs SEP IRA: Which Is Better? | Bankrate

These plans are easy for a small business owner – even a self-employed freelancer – to start quickly while generating serious tax breaks and preparing for the future.

www.bankrate.com

 

[Lecithin5]

Why would you do a SEP IRA and make yourself unable to do a Backdoor Roth IRA? Do a Solo 401k instead.

Solo 401(k) Vs SEP IRA: Which Is Better? | Bankrate

These plans are easy for a small business owner – even a self-employed freelancer – to start quickly while generating serious tax breaks and preparing for the future.

www.bankrate.com

You’re correct- I think I did sep- I wasn’t (and still am not) super savvy with this sort of stuff. Good link above.

 

[BLADEMDA]

You’re correct- I think I did sep- I wasn’t (and still am not) super savvy with this sort of stuff. Good link above.

Sep is for people with side gigs who already contribute to retirement plans at their main gig. If you don’t have another gig and rely on 1099 work for the majority of your income then a 401k plan with employer contributions is superior to a SEP.

 

[abolt18]

Sep is for people with side gigs who already contribute to retirement plans at their main gig. If you don’t have another gig and rely on 1099 work for the majority of your income then a 401k plan with employer contributions is superior to a SEP.

I disagree about SEP being the go-to for side-gigs. Solo 401k i think is still better for side-gig 1099 income so one can still do the Backdoor Roth.

Two For The Money: Can I Contribute To Two Retirement Plans If I Work Two Jobs? - Windgate Wealth Management

It’s a simple question. Can you contribute to two retirement plans if you work two jobs? And let’s face it. It’s a good question to ask. Perhaps you make a nice salary at a corporate day job and are running a small side business that is starting to generate profits. Take the time to understand …

windgatewealth.com

Solo (Individual) 401(k)s – What You Need to Know | White Coat Investor

Are you interested in starting a solo 401(k)? Here are all the details you need to know about these retirement accounts for individuals.

www.whitecoatinvestor.com

 

[epidural man]

Since you will likely end up in Pain, I love the idea of you doing locums and I would keep doing it after you start full time pain.

Once you let your anesthesia skill go - it’s gone forever - and that would be a real shame.

Because someday, you may want to go back to it.

I have not not been quiet on my belief that chronic pain is dying a slow death - so please understand, that is my bias.