Locums

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Noyac

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So I am back for a moment to see if I can revive my interest in this site. But that's another story.

Here's some advice for new grads and anyone that wants to be respected in their field. DON'T DO LOCUMS. I have never seen a locums come into my hospital that could compare to the quality of my group. Now without boasting too much, we have a group that is some of the best of the best. Everyone was a chief resident in their residency with the exception of a few. Everyone here was the top performer of their group prior to coming here. Everyone has a great personality. And last but not least everyone is extremely athletic with some pretty impressive accomplishments. So to come to my group as a locums is like walking on to the LSU football team midseason and trying to perform without being noticed. It ain't gonna happen. Why in the world would you want to do this to yourself? So lets say you go to a weak practice. You are still the outsider in a foreign land. The nurse won't trust you because they have seen so many awful locums to date. The surgeons won't trust you for the same reason.

We have essentially zero complications (not an exaggeration). The only anesthesia complications are with locums and we watch them like a hawk. They get the easiest cases, knee scopes, total joints, hysterectomies, etc.

But I do owe a debt of gratitude to locums. My next contract with the hosp will demand more money if I continue to have to work with these "TOOLS". Plus after having locums, the hosp. thinks we are the only ones that can perform a safe anesthetic.

Grads, do yourselves a huge favor. Sign with a real group. Learn everything you can from them and if it doesn't work out move on. Don't stigmatize yourself. Locums SUCK!

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Bah, we've heard it all before. What a guy like Mike Wallace would want to know is what are you payin' the locum agency for these dregs of society? Give us REAL, HONEST numbers and hours. Also, what is wrong with your group or practice that requires you to hire these locum dudes. We'll be watching for any forehead and upper lip sweat, believe me. Regards, ------Zippy
 
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So I am back for a moment to see if I can revive my interest in this site. But that's another story.

Here's some advice for new grads and anyone that wants to be respected in their field. DON'T DO LOCUMS. I have never seen a locums come into my hospital that could compare to the quality of my group. Now without boasting too much, we have a group that is some of the best of the best. Everyone was a chief resident in their residency with the exception of a few. Everyone here was the top performer of their group prior to coming here. Everyone has a great personality. And last but not least everyone is extremely athletic with some pretty impressive accomplishments. So to come to my group as a locums is like walking on to the LSU football team midseason and trying to perform without being noticed. It ain't gonna happen. Why in the world would you want to do this to yourself? So lets say you go to a weak practice. You are still the outsider in a foreign land. The nurse won't trust you because they have seen so many awful locums to date. The surgeons won't trust you for the same reason.

We have essentially zero complications (not an exaggeration). The only anesthesia complications are with locums and we watch them like a hawk. They get the easiest cases, knee scopes, total joints, hysterectomies, etc.

But I do owe a debt of gratitude to locums. My next contract with the hosp will demand more money if I continue to have to work with these "TOOLS". Plus after having locums, the hosp. thinks we are the only ones that can perform a safe anesthetic.

Grads, do yourselves a huge favor. Sign with a real group. Learn everything you can from them and if it doesn't work out move on. Don't stigmatize yourself. Locums SUCK!

If your practice is so great why do you need locums?

Locums is fine. There is no reason why new grads cant do some locums to see what practice is a right fit. rent an apartment and get on the locums trail. talk to different people in diff parts of the country and go for it. Dont listen to this ridiculous prejudicial statement.
 
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Why in the world would you want to do this to yourself?

A lot of people start out in France doing locums so they can have a look around to find the practice that fits them. Try before you buy: there are a lot of $hitty places out there
 
Do what you want. I'm just giving the PP view of locums as I see it.

OK Zip, as many of you know I am a hosp employee. The administrators agree that we need more physicians but want to wait and see how everything works out with the economy etc. In the meantime they are supplying locums to help cover the cases about 1-2 weeks a month (one person). We pay them around $160/hr plus mal prac, travel, and boarding. We pay additional for call and overtime. It ends up being around 10-12K/week.

So if you disagree with what I said then tell me what you disagree with and we can discuss it. Nowhere in the statement did I say the money wasn't good. I am talking about the clinical aspect which is more important.
 
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If your practice is so great why do you need locums?

Locums is fine. There is no reason why new grads cant do some locums to see what practice is a right fit. rent an apartment and get on the locums trail. talk to different people in diff parts of the country and go for it. Dont listen to this ridiculous prejudicial statement.

So give us your experiences.

The funny thing is that these guys leave thinking they did a good job. :scared:

Surgeons don't want to work with any more locums and nurses don't trust anything they do. If a good one comes around, they are stigmatized b/c they are still in the category of locums.
 
If a good one comes around, they are stigmatized b/c they are still in the category of locums.


You prolly think that all black people steal. all asian men cant do porn. hispanics are all wetbacks who must clean after you. What you are doing is generalizing. I met tremendous locums.. really strong. I met full timers who are really strong. I met some horrid permanent anesthesiologists. I mean horrid. I met some good ones too.. Ive been to alot of places and I cant generalize my man. For all the residents out there, i encourage them to do locums.. IF you dont you may end up in a practice like noyacs where they generalize everything. also can you give specific instances why you thinkall Locums are " substandard physicians"?
 
So what if you aren't interested in ascending up to a partnership status and are living in a city temporarily and are not interested in anything long term. That to me is a better gig than being tied down in a contract. And really, just cuz someone is a locums, does not automotatically mean they are incompetent. People have their own reasons for not wanting to be tied down. Yes, there's stigma associated with it, I'm sure, just like there's a stigma in most temporary jobs, but I'm sure if you feel like you did a good job and did your best, screw what others think. People are always going to critisize regardless of your job title. Can't go around trying to impress everyone everytime.
 
You prolly think that all black people steal. all asian men cant do porn. hispanics are all wetbacks who must clean after you. What you are doing is generalizing. I met tremendous locums.. really strong. I met full timers who are really strong. I met some horrid permanent anesthesiologists. I mean horrid. I met some good ones too.. Ive been to alot of places and I cant generalize my man. For all the residents out there, i encourage them to do locums.. IF you dont you may end up in a practice like noyacs where they generalize everything. also can you give specific instances why you thinkall Locums are " substandard physicians"?

Alright, so you want to put words in my mouth. You are calling me a racist, right? Did you read my post on Jet's NFL buddy? You can call me what you want, I don't care. The fact is the locums we get are stigmatized by everyone at my facility due to the past locums. And all I ask the people of this forum is, why do that to yourself?

As far as the permanent folks that suck. Well we don't have any. We had 2 mediocre ones in the past and they are gone. But they were better than every locums we have had with the exception of 2. We have used some folks that have permanent jobs that want to make more money by working their vacations. They are strong physicians. They are not a problem at all.

So I didn't cal all locums substandard. I merely asked why stigmatize yourself. Why associate yourself with a practice style that is lacking.

So maceo, what's your interest in locums? Are you one? Do you employ them? Are you a locums pimp?
 
Let me throw my mindset on your situation... Dude, you're a hospital employee! In the eyes of the hospital, you're a liability rather than an asset. You ain't makin' any money for the hospital. It's great that you have 1-2 locum dudes floatin' around. Why be concerned about it, you ain't payin' them, the hospital is. It's great that the locum dudes have a higher complication rate than the perm. guys, great that you're polysyllabic and the locum dude is monosyllabic on a good day---gives you job security. Play off of the "good" vs. "evil" themes; Shakespeare did it and they say he was a genius. Throw the riskier cases to the "sharks." If you're on call and finish before the locum, don't take over his case; let him finish. The locum dude won't mind because he wants to maximize his income. Why "...watch them like a hawk?" ---you're not responsible for them. And trust me dude, despite what the surgeons tell you, they don't give a rat's arse who does their case, they just want it done in a timely fashion. In summary, what we have here is a guy who has his backyard in order but isn't satisfied; he wants to get his neighbor's backyard in order. That's what's wrong with society... ------Regards, ----Zip
 
So I am back for a moment to see if I can revive my interest in this site. But that's another story.

Here's some advice for new grads and anyone that wants to be respected in their field. DON'T DO LOCUMS. I have never seen a locums come into my hospital that could compare to the quality of my group. Now without boasting too much, we have a group that is some of the best of the best. Everyone was a chief resident in their residency with the exception of a few. Everyone here was the top performer of their group prior to coming here. Everyone has a great personality. And last but not least everyone is extremely athletic with some pretty impressive accomplishments. So to come to my group as a locums is like walking on to the LSU football team midseason and trying to perform without being noticed. It ain't gonna happen. Why in the world would you want to do this to yourself? So lets say you go to a weak practice. You are still the outsider in a foreign land. The nurse won't trust you because they have seen so many awful locums to date. The surgeons won't trust you for the same reason.

We have essentially zero complications (not an exaggeration). The only anesthesia complications are with locums and we watch them like a hawk. They get the easiest cases, knee scopes, total joints, hysterectomies, etc.

But I do owe a debt of gratitude to locums. My next contract with the hosp will demand more money if I continue to have to work with these "TOOLS". Plus after having locums, the hosp. thinks we are the only ones that can perform a safe anesthetic.

Grads, do yourselves a huge favor. Sign with a real group. Learn everything you can from them and if it doesn't work out move on. Don't stigmatize yourself. Locums SUCK!


can you elaborate on the types of complications you get with locums?

I am not sure what being a chief resident has to do with a group being an elite one. Unless they were chosen because of their skills and talent during residency (and we know that is not always the case), it means jack.

What is the most complex case your group is doing, since you talk about giving them the easy stuff.
 
Noyac, just had one of them "Zip moments"... Do your X-mas shoppin' early for the head honcho CEO bean counter. Run on down to Ace Hardware and getcha one of them old timey galvanized milk pails. In big black letters with a sharpie write "LOCUM TENEM TEAR BUCKET" Wrap it all up and put ya a nice pink bow on it and give it to the CEO. If he asks,"what's this for?" Tell him it's to catch all those tears when he writes those big checks to the locum agency. Rub it in hard and deep, lettum feel the burn... Regards, ----Zip
 
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Let me throw my mindset on your situation... Dude, you're a hospital employee! In the eyes of the hospital, you're a liability rather than an asset. You ain't makin' any money for the hospital. It's great that you have 1-2 locum dudes floatin' around. Why be concerned about it, you ain't payin' them, the hospital is. It's great that the locum dudes have a higher complication rate than the perm. guys, great that you're polysyllabic and the locum dude is monosyllabic on a good day---gives you job security. Play off of the "good" vs. "evil" themes; Shakespeare did it and they say he was a genius. Throw the riskier cases to the "sharks." If you're on call and finish before the locum, don't take over his case; let him finish. The locum dude won't mind because he wants to maximize his income. Why "...watch them like a hawk?" ---you're not responsible for them. And trust me dude, despite what the surgeons tell you, they don't give a rat's arse who does their case, they just want it done in a timely fashion. In summary, what we have here is a guy who has his backyard in order but isn't satisfied; he wants to get his neighbor's backyard in order. That's what's wrong with society... ------Regards, ----Zip


Zip, your responding to me like I am asking for advice on how to utilize these guys. That is not the case. I am warning people who may be considering the locums route and who may not be fully informed.

Believe me, I know how to use these guys. I also know how to use the administrators who are having to listen to the complaints. The bucket is a good idea though.

AS far as the surgeons go, mine do care who is doing their cases. One won't work with them at all. Another cancels his cases if he gets a locums and feels the cases are above a locums level.

What I have described is a situation a typical locums doc will find him or herself in. Once again I'll ask, Why do this to yourself? Why put yourself in this situation?

Zippy, not everyone has the same "I don't care" attitude as you.

In this situation, my neighbors backyard is my backyard. I am the director and these tools are under my authority and therefore, all anesthesia issues are my issues.
 
can you elaborate on the types of complications you get with locums?

Well the last one needed help inserting an LMA.

One guy brought a pt to the PACU unresponsive (not the problem) breathing through a nasal trumpet which was traumatically inserted. When the pt was responsive the nurse pulled the nasal airway and the bleeding started again. It was so profuse that it completely obstructed the right lung with clot. My partner had to rescue the pt with an intubation and a bronch to clear clots. When the arrived in PACu there was blood on the side of her face from the trumpet insertion.

Pts in pacu in severe pain is not uncommon for locums that have come to us.

I have many more scenarios but you get the idea.
 
Well, if you're the anesthesia director, are you getting paid more than the other permanent docs? If you are gettin' more money, is the extra money worth the HAs? I could make a case of you bein' an enabler. You're supporting "prima donnaism" among certain surgeons. That surgeon that demands no locums on his cases needs to get "throttled." You still gonna get paid the same if the case is canceled or not. Regards, ---Zippy
 
One guy brought a pt to the PACU unresponsive (not the problem) breathing through a nasal trumpet which was traumatically inserted.

reminds me of someone :smuggrin:
so what would your advice be someone fresh out of residency? i think that for new grads it's a way to learn what PP's about without having to be tied up with a group: what do you do if the group you chose sucks? doesn't it also reflect poorly if you make a quick change?
 
So I am back for a moment to see if I can revive my interest in this site. But that's another story.

So, tell us the "other story". Why did your interest in this site wane? Is it because of the political banter? Because we are now under the watchful eye of Planktonmd and his authority as admin? Because of something you read here that offended you? Because you are bored with the repetition of the themes here?

Pray, do tell.

-copro
 
So, tell us the "other story". Why did your interest in this site wane? Is it because of the political banter? Because we are now under the watchful eye of Planktonmd and his authority as admin? Because of something you read here that offended you? Because you are bored with the repetition of the themes here?

Pray, do tell.

-copro

Nothing offended me.

The boredom (unless Jet is posting and Mil for that matter) is a problem here for me but not the whole story. I won't give any details.
 
reminds me of someone :smuggrin:
so what would your advice be someone fresh out of residency? i think that for new grads it's a way to learn what PP's about without having to be tied up with a group: what do you do if the group you chose sucks? doesn't it also reflect poorly if you make a quick change?

My advice is to go to a very busy practice where you can do everything. I have said this many times b/4. Learn as much as you can and work your ass off for a few years. If you make partner and you like the group then great. If you don't like the group then move on. The knowledge you gain from one of these practices is invaluable. You won't get this knowledge doing locums. As you can tell o this site, anesthesia is much more than putting people to sleep and waking them up well. Its dealing with surgeons, hospitalist, administrators, insurance companies, billing companies if you use one, negotiating contracts, dealing with partners (this can be very difficult), learning to advertise, sitting on hosp boards and committees, ang the list goes on. These things are not part of the locums gig. If you want just do anesthesia and never be a part of something bigger then I can't help you. Even the bad jobs can teach you something.
 
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I am not sure what being a chief resident has to do with a group being an elite one. Unless they were chosen because of their skills and talent during residency (and we know that is not always the case), it means jack.

Your right, "chief" means very little except it does mean that you are not the biggest tool of the class. So far, all of the chiefs I've met were pretty competent. Its a start. I didn't want to go too far into it but was giving an idea of our group. If chief means nothing to you then fine, I won't argue.
 
Well, if you're the anesthesia director, are you getting paid more than the other permanent docs? If you are gettin' more money, is the extra money worth the HAs? I could make a case of you bein' an enabler. You're supporting "prima donnaism" among certain surgeons. That surgeon that demands no locums on his cases needs to get "throttled." You still gonna get paid the same if the case is canceled or not. Regards, ---Zippy

So many ways to respond to you Zip.
But the bottom line is I have more than a work relationship with my surgeons. I bike, ski, camp, play hockey (yes Jet this coonass is playing hockey) and travel with them. It is a close nit group here. These same surgeons have gone to bat for me, even the prima donna that refuse locums. He makes about 5 times more money for the hospital than any other surgeon alone. And I know you are aware that money talks. But to be fair he is a big supporter of my group. And his refusal to work with locums started long b/4 I arrived. They went through quite a few locums and this place got fed up with the locums b/c none of them could perform a good anesthetic on a routine basis.
 
Hey Noy

It's interesting that you give the Locums, the "easy" cases. I can see that you feel comfortable with them doing those cases. However, in PP isnt that what most of the docs want to do? If you are getting paid the same or more (which is usually the case with locums right), then isn't it catering to the Locums by giving them the 'easy' cases?

Also, if locums are getting paid for performance, then wouldnt doing "4 Phaco/cataract" surgeries in the time it takes to do 1-2 appys be more financially appealing to them. Moreover, 'easier' ?

In contrast, I had heard that the locums get the cases that no one wants to do. Essentially, getting 'dumped' on.

Just wondering..
 
Zip, your responding to me like I am asking for advice on how to utilize these guys. That is not the case. I am warning people who may be considering the locums route and who may not be fully informed.

Believe me, I know how to use these guys. I also know how to use the administrators who are having to listen to the complaints. The bucket is a good idea though.

AS far as the surgeons go, mine do care who is doing their cases. One won't work with them at all. Another cancels his cases if he gets a locums and feels the cases are above a locums level.

What I have described is a situation a typical locums doc will find him or herself in. Once again I'll ask, Why do this to yourself? Why put yourself in this situation?

Zippy, not everyone has the same "I don't care" attitude as you.

In this situation, my neighbors backyard is my backyard. I am the director and these tools are under my authority and therefore, all anesthesia issues are my issues.


Im not a locum .... I was one for almost a year when i got out.. I was at like 5 practices.. and i did all the asa 4 patients with stridor.. vascular..etc you get the picture.. it helped me narrow what i wanted down. I wasnt tied down to any of them. I made some good money.. took off when i wanted. I did not care what anyone thought of me.. all my patients did well. It was a great option for me. and i agree with zip surgeons couldnt care less who does their cases.. ANd what possible case can be over the head of a locum.. Maybe a lung.. who cares dont put them in the lung room.
 
I read this post with interest. As for myself I am a recent graduate. I am finishing up my first locums assignment. As for my reasons to doing locums... no ties to anyone or anywhere and love to travel. The 2 biggest reasons... I was just not taking a permanent job. period. I have read and seen how most grads (50%) within the first 2 years out quit their first permanent job... whether they were lied about hours and just saw the number of zero's in the contract when they signed. second, I want complete control of my schedule. If I want to take a vacation, I take it . I dont have to ask anyone for time off, I just dont get paid. I have more tax breaks as an independent contractor. where I am at right now, the locums get treated quite well. I am sure this is not the case everywhere. At 3pm sharp I am relieved, otherwise the OT starts kicking in.... There is a recent grad where I am at who is a permanent employee. They work him like a dog, covering 2 rooms, remote sites, and quite a bit of late call and overnites.I make much more than him.
I do all my own cases. Being a locum makes one more diverse. They have the top of the line machines here so I have learned how to use these. There is no "locum" stigma here. Maybe I will encounter it at othe rplaces. I am not looking to be buddies with any surgeons. The bottom line is that I am happy.
There is something to be said about a 3 page contract than a 30 page on for a permanent position. I encourage new grads to do it. I wont do it forever, but you only live once. I get to check out different areas of the country, meet some new people, and call the shots with my schedule. I plan to do some mission trips in the future. Pretty hard to do that a drop of the hat being in a group... Do I worry about being able to secure a permanent job in the future? hell no. Ive already made some contacts with some of the other locums I have met who do this during vacation weeks from their permanent jobs, and not full-time like myself. go for it!
 
I read this post with interest. As for myself I am a recent graduate. I am finishing up my first locums assignment. As for my reasons to doing locums... no ties to anyone or anywhere and love to travel. The 2 biggest reasons... I was just not taking a permanent job. period. I have read and seen how most grads (50%) within the first 2 years out quit their first permanent job... whether they were lied about hours and just saw the number of zero's in the contract when they signed. second, I want complete control of my schedule. If I want to take a vacation, I take it . I dont have to ask anyone for time off, I just dont get paid. I have more tax breaks as an independent contractor. where I am at right now, the locums get treated quite well. I am sure this is not the case everywhere. At 3pm sharp I am relieved, otherwise the OT starts kicking in.... There is a recent grad where I am at who is a permanent employee. They work him like a dog, covering 2 rooms, remote sites, and quite a bit of late call and overnites.I make much more than him.
I do all my own cases. Being a locum makes one more diverse. They have the top of the line machines here so I have learned how to use these. There is no "locum" stigma here. Maybe I will encounter it at othe rplaces. I am not looking to be buddies with any surgeons. The bottom line is that I am happy.
There is something to be said about a 3 page contract than a 30 page on for a permanent position. I encourage new grads to do it. I wont do it forever, but you only live once. I get to check out different areas of the country, meet some new people, and call the shots with my schedule. I plan to do some mission trips in the future. Pretty hard to do that a drop of the hat being in a group... Do I worry about being able to secure a permanent job in the future? hell no. Ive already made some contacts with some of the other locums I have met who do this during vacation weeks from their permanent jobs, and not full-time like myself. go for it!

how are the tax benefits better for an independent contractor??
 
You're supporting "prima donnaism" among certain surgeons. That surgeon that demands no locums on his cases needs to get "throttled." You still gonna get paid the same if the case is canceled or not. Regards, ---Zippy

I concur. I bet you (and the other permanents) set up the atmosphere by making remarks like "watch out Dr Knee, he is a locums". I'm sure that even the cleaning team in your place has the same regard for locums. Dude a lot of it is in your mind. You scrutinize every single complication from a locums and blame the them for being sub par, while the perms complications are blamed on a difficult case.

I bet there is a lot of self selection. The ones who are constantly fired from jobs end up doing locums. I grant there's got to be a lot of bad ones. But, I don't make generalizations and I don't discourage people from being one.
 
I never did locums but I truly believe it takes a better doctor to be able to go from a practice to another and be immediately functional.
Imagine that every couple of weeks is the first day on the job for you!
No one knows you, everyone is watching you, you have no idea what the local culture is and you have no idea where stuff is.
If you can do this successfully you are definitely a strong physician.
 
I have an interest in doing some locums in the future. My question is this. Do you generally have to carry your own malpractice or does the job site pay it. #2 how feasible would it be just to do a weekend here or there as some extra cash from your main job. thanks in advance
 
Okay, thanks for your previous answer. (I still wish you'd tell us why you're not posting as much... I will therefore believe it has to do with some 'personality conflict' on this forum... and I guess it's my privilege to do that until you attempt to convince us otherwise... or confirm that supposition.)

You are still the outsider in a foreign land. The nurse won't trust you because they have seen so many awful locums to date. The surgeons won't trust you for the same reason.

I'm ready to answer this now.

I call this the "interloper effect". Most of us, as residents, are quite well aware that this exists. When we rotate "off service", we are the interlopers on whatever service we got to, be it "pain" or "pre-admin clinic" or the "ICU" or wherever. There is a certain standard way of doing things that people have gotten used to on those units, and each month there are new personalities and skill levels that show up and turn-over the apple cart, so to speak.

As residents, we are met with disdain, lack of trust... the "unknown" factor... when rotating on a new service. Again, this happens monthly. It takes a few weeks for people to start to develop an impression of your capabilities, right or wrong, and God forbid you make even a small error during that time or you're going to be labeled a ******* until you finish on that service.

This is human nature. This is what you're describing. The interloper is like the new serf in the fiefdom. No one is quite sure what he/she will do, why he/she's there, and what their intentions are. The members of the kingdom have met plenty of other interloper serfs before, and they're going to heap upon them the lack of trust and overall disdain they developed with the other serfs throughout their experience, mostly because they don't follow the standard operating procedure of the place (because no one has likely told them). After all, it's their kingdom. It's their territory. They have to protect it from a would-be Trojan horse that may disrupt the normal order of things. This is understandable.

I just point this out because I want you to recognize it for what it is... prejudice. Now, I'm not inherently saying that it is wrong, and I can site examples of my own on terrible locums characters being thrown into cases they can't handle/shouldn't be doing. I guess the difference is that I feel I gave them a chance when they showed up. Sure, after a while, you learn whether or not they are, as Mill puts it, an "assassin". And, sure, you get a little pissed at having to relieving them at 3:00 PM everyday and "fix" the stupid things (in your own opinion) they did during a case. But, bottom line, there are some great locums out there. And, many get offered permanent positions.

So, in other words, don't hate the playa, hate the game. If there was enough incentive (and work) for a highly qualified individual to come and work with you permanently, this would be a non-issue. Until then, locums are going to be a reality in your environment. You're disdaining and ostracizing a person that is there because of the necessity of the hospital's situation. You are classifying them, de novo and a priori, when they walk in the door as a "problem" before they even say "hi" to their first patient. What I think you should be doing instead is embracing and helping them, telling them how things are done at your place, who to watch out for, and making sure that they get the work done efficiently and effectively.

You should recognize that the financial situation of your hospital is the reason they are there, not because of some inherent personality defect that person has. There is a lot to learn when walking into a new system, and that first week can be dizzying. I pains me when I see the snap judgments being made about people in that timeframe, first impressions that often become albatrosses hung around their necks, when you really haven't given them a full, honest chance. You do this because it's easy, it's intellectually lazy, and you know that they'll be gone in a short time. This is why they are an easy target for your opprobrium.

Just my $0.02.

-copro
 
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I have an interest in doing some locums in the future. My question is this. Do you generally have to carry your own malpractice or does the job site pay it. #2 how feasible would it be just to do a weekend here or there as some extra cash from your main job. thanks in advance

locums companies im familiar with (not gas locums, but locums nontheless) the staffing company provides the malpractice.
 
give me a break...

OK, would you call placing a 2 1/2 LMA in the same adult 3 times and then moving towards intubation b/c the LMA didn't work right and then blaming the LMA a solid anesthetic plan?
How about a tetracaine spinal for a 30 min knee scope on a ASA1 pt. That guy got admitted for 24hr obs.
Pt asleep for TKA bleeding through the tourniquet (275mmHg) b/c BP is 220/135 and the assh*le locums is on the phone.

DO I need to go on? I can do this all night.

What is important is that I have been working with locums for over 4 yrs now and more than half of them are sub par. My views are not based on one incident. Not even a few incidents. THis is coming from a long time of working with these guy/gals. We have sent a handful home after 1-3 days.

So how any of you guys have started your own practice in anesthesia?
 
OK, would you call placing a 2 1/2 LMA in the same adult 3 times and then moving towards intubation b/c the LMA didn't work right and then blaming the LMA a solid anesthetic plan?
How about a tetracaine spinal for a 30 min knee scope on a ASA1 pt. That guy got admitted for 24hr obs.
Pt asleep for TKA bleeding through the tourniquet (275mmHg) b/c BP is 220/135 and the assh*le locums is on the phone.

DO I need to go on? I can do this all night.

What is important is that I have been working with locums for over 4 yrs now and more than half of them are sub par. My views are not based on one incident. Not even a few incidents. THis is coming from a long time of working with these guy/gals. We have sent a handful home after 1-3 days.

So how any of you guys have started your own practice in anesthesia?

We are more prone to generalize the bad than the good. We assume that the bad is more potent and contagious. ~ Eric Hoffer

Noy perhaps all the locums you have worked are subpar? It is entirely possible that you are getting some bummy characters. On top of that, you probably give them one strike before they even come in b/c of your past experiences. Something to think about...

Maybe this board doesn't have veterans like you who have started their own practice BUT being measly residents/ junior attendings and the bottom feeding scum that we are, we have some experience with locums and, like others have echoed before, I find it hard to generalize all locums as subpar and all full-timers are awesome.
 
OK, would you call placing a 2 1/2 LMA in the same adult 3 times and then moving towards intubation b/c the LMA didn't work right and then blaming the LMA a solid anesthetic plan?
How about a tetracaine spinal for a 30 min knee scope on a ASA1 pt. That guy got admitted for 24hr obs.
Pt asleep for TKA bleeding through the tourniquet (275mmHg) b/c BP is 220/135 and the assh*le locums is on the phone.

DO I need to go on? I can do this all night.

What is important is that I have been working with locums for over 4 yrs now and more than half of them are sub par. My views are not based on one incident. Not even a few incidents. THis is coming from a long time of working with these guy/gals. We have sent a handful home after 1-3 days.

So how any of you guys have started your own practice in anesthesia?
you seem to be an elitist..... why would you have tetracaine around anyway.. its your fault for buying the stuff.. Ive never used tetracaine in my life.. and i do a LOT of spinals.. If the case is long enough to merit tetracaine.. they are going to sleep bitch.. anyway, chill out noyac life is short.. help the young or old and ill informed. gently make your point to them and offer your assistance and guidance if you are that good. One of the problems in anesthesia and medicine in general is the Im better than him attitude. dont take it too hard.. go home and go to the local college bar.. find a young 20 year old girl to spend time with buy her a beer and listen to her .. (do that often) I bet she is not as uptight as you then come back on this board and reread your posts.. and tell me what you think. or better yet go to your local strip parlor. and just talk to the girls there.. you need it..
 
you seem to be an elitist..... why would you have tetracaine around anyway.. its your fault for buying the stuff.. Ive never used tetracaine in my life.. and i do a LOT of spinals.. If the case is long enough to merit tetracaine.. they are going to sleep bitch.. anyway, chill out noyac life is short.. help the young or old and ill informed. gently make your point to them and offer your assistance and guidance if you are that good. One of the problems in anesthesia and medicine in general is the Im better than him attitude. dont take it too hard.. go home and go to the local college bar.. find a young 20 year old girl to spend time with buy her a beer and listen to her .. (do that often) I bet she is not as uptight as you then come back on this board and reread your posts.. and tell me what you think. or better yet go to your local strip parlor. and just talk to the girls there.. you need it..

That doesnt make sense, Slim. Why would you select a general anesthetic based solely on the duration of the case?

Oh, and uhhhhh, BTW,

Noy needs no strippers.

Dudes married to athletic/intellectual/wifey hottie who's in a different league than the "strippers" you suggest he "needs".
 
you seem to be an elitist..... why would you have tetracaine around anyway.. its your fault for buying the stuff.. Ive never used tetracaine in my life.. and i do a LOT of spinals.. If the case is long enough to merit tetracaine.. they are going to sleep bitch.. anyway, chill out noyac life is short.. help the young or old and ill informed. gently make your point to them and offer your assistance and guidance if you are that good. One of the problems in anesthesia and medicine in general is the Im better than him attitude. dont take it too hard.. go home and go to the local college bar.. find a young 20 year old girl to spend time with buy her a beer and listen to her .. (do that often) I bet she is not as uptight as you then come back on this board and reread your posts.. and tell me what you think. or better yet go to your local strip parlor. and just talk to the girls there.. you need it..

Tetracaine, I didn't have any idea we had it. He got it from pharmacy. I am old enough however to have used it.

Sounds like I have offended you. Were you one of these locums I'm talking about?
You arguments are weak, calling me an elitist. Your jumping on Zip's bandwagon. You have not attempted to address the concerns I raised, feeling defensive maybe?
Listen I am telling the story as it is. If this story is wrong then where are the people who are using these locums? Why aren't they speaking up here in support of you? The only person on this site that also uses locums is MIl. Ask him for his opinion.
Plus, I never considered myself better than most until locums started coming around. Now I'm starting to wonder. But when did I ever say that "I" was better than anyone. I did say that "we" have to do the more difficult cases. When you are done trying to put words in my mouth and you want to talk about the issues here then let me know. Otherwise, you can keep calling me names all you want but I will continue to tell the truth here.
 
That doesnt make sense, Slim. Why would you select a general anesthetic based solely on the duration of the case?

Oh, and uhhhhh, BTW,

Noy needs no strippers.

Dudes married to athletic/intellectual/wifey hottie who's in a different league than the "strippers" you suggest he could benefit from.

Thanks Jet
I didn't think I needed to justify his comment with a response, plus he thinks I'm an elitist.
But coming from you this comment has more merit especially since you've seen my wife.
:thumbup:
 
Thanks Jet
I didn't think I needed to justify his comment with a response, plus he thinks I'm an elitist.
But coming from you this comment has more merit especially since you've seen my wife.
:thumbup:

Just pointing out reality, my friend.

An ignorant post like that deserves an immediate reality response.
 
OK, would you call placing a 2 1/2 LMA in the same adult 3 times and then moving towards intubation b/c the LMA didn't work right and then blaming the LMA a solid anesthetic plan?
How about a tetracaine spinal for a 30 min knee scope on a ASA1 pt. That guy got admitted for 24hr obs.
Pt asleep for TKA bleeding through the tourniquet (275mmHg) b/c BP is 220/135 and the assh*le locums is on the phone.

DO I need to go on? I can do this all night.

Please do! Besides being really freakin' amusing, it gives me confidence that I won't EVER be one of these guys you're talking about.

There's talk among the anesthesia residents at my current hospital about a locums guy who talks on his cell phone while rolling patients into the OR. The ASA ought to have a buncha 250+ enforcers built like like Jet to come and yank these guys right out of the OR and pull their licenses.. They're bad PR for the whole specialty.

Copro might be surprised at my opinion, but I think his post was right on. Your attitude is basically unfair prejudice.

But as someone who used to ride the 1 train up and down the west side to 168th street at odd hours of the night, I hear yah.
 
Bandwagon or no bandwagon, I'm already startin' to like the mindset of this Maceo guy. Well it's like this: since ya been about 18 or so ya been on the forked road where all the sheep go. You've taken all the tests, put up with the mindless BS, late nights and have said your "yes sirs" and "no ma'ms." Lo and behold another forked road appears after residency. The academic guys, the partnership wannabes, the traditional route guys who want to build a practice from the ground up follow the sheep down one road, the road they've been on their whole life and even their forefathers, and the locum road warriors take the other. Ya only live once---getcha some of dat EXCITEMENT! Regards, ----Zip
 
Bandwagon or no bandwagon, I'm already startin' to like the mindset of this Maceo guy. Well it's like this: since ya been about 18 or so ya been on the forked road where all the sheep go. You've taken all the tests, put up with the mindless BS, late nights and have said your "yes sirs" and "no ma'ms." Lo and behold another forked road appears after residency. The academic guys, the partnership wannabes, the traditional route guys who want to build a practice from the ground up follow the sheep down one road, the road they've been on their whole life and even their forefathers, and the locum road warriors take the other. Ya only live once---getcha some of dat EXCITEMENT! Regards, ----Zip
 
General comment to no one in particular

This thread seems to have degenerated into a discussion of whether all (or most) locums anesthesiologists suck. I don't think that was Noy's initial point nor is it, really, a useful question.

What I took from his post was that enough locums guys suck, that IF YOU WORK AS A LOCUMS people will assume you suck and you will have to prove that assumption wrong. We can debate whether that's right or wrong - but it doesn't really matter. Sounds to me like it's probably true.

So the issue is then - when faced with the choice to work locums or not, you should consider strongly that it you may well be presumed incompetent and that should factor into your career choices.
 
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I agree with Noyac on this. I think his orginal post was not really on the competency of Locums but on this as a new graduate career choice. I think that you learn more the first few years out of residency than you actually do in residency. Some of the most important things to learn and learn early in private practice is how to interact with surgeons, staff, and administrators. I just don't see how a locums position would give you the opportunity for this. There is alot more to anesthesiology than coming to work and going home. My advice to a new graduate is to take a job with a well established, honest group. Learn from the older partners the things it takes to run a well, established, successful group. Also, they are a great resource for continuing your practice of anesthesiology. Regardless of whether or not you pass your boards or where you trained, the combined experience and knowledge of a good group of anesthesiologists will be helpful when you run into something that you haven't seen.

pd4
 
Tetracaine, I didn't have any idea we had it. He got it from pharmacy. I am old enough however to have used it.

Although I haven't done any recently, tetracaine spinals used to be our norm and I've done hundreds with it. With a little epi and you can get 4-5 hours or more. Perfect for the slow vascular surgeon who can't do a fem-pop in under 4 hours.
 
I agree with Noyac on this. I think his orginal post was not really on the competency of Locums but on this as a new graduate career choice. I think that you learn more the first few years out of residency than you actually do in residency. Some of the most important things to learn and learn early in private practice is how to interact with surgeons, staff, and administrators. I just don't see how a locums position would give you the opportunity for this. There is alot more to anesthesiology than coming to work and going home. My advice to a new graduate is to take a job with a well established, honest group. Learn from the older partners the things it takes to run a well, established, successful group. Also, they are a great resource for continuing your practice of anesthesiology. Regardless of whether or not you pass your boards or where you trained, the combined experience and knowledge of a good group of anesthesiologists will be helpful when you run into something that you haven't seen.

pd4

Isn't this what Zippy calls "following the sheep down the fork in the road"?

I am not someone most people would call a conformist. In other words following the sheep. And while you seem to understand, pd4, many here seem to be either in denial or unable to see the real picture as some of us see it.

Pilot Doc, you are right. My intent was to warn residents who may be thinking about locums. It was to enlighten them as to how some locums perform and that they will likely be lumped into that category.

I think some got offended when I described my group as I see it. But to be honest, I can only describe what I see and very poor locums is what I see.

Another thing to consider as a locums is that you are given much less leeway as a locums than a permanent person would be given. You are easily released as a locums. I just released our latest locums and we are working short handed right now. The guy was dangerous and inappropriate with staff. Whats funny is that he had no idea about any of this:eek:. Extremely poor judgement which leads to impressions he unfortunately has placed on every other locums that enters our facility.

All of you that doubt me in this have every right and I won't deny that of you. Go ahead and see for yourself. Follow Zippy's advice and see where it gets you. You won't be bad off but would you be in a better position had you gone to a good group whether you stay with them or not? I say YES. After two years of locums work when compared to two years in a good practice it is my opinion that the locums person will be way behind in experience in everything from anesthesia, to contracts, to politics, to everyday workings of an OR and a strong group. Even a poor group can teach you more, even if it is how not to handle issues.
 
Although I haven't done any recently, tetracaine spinals used to be our norm and I've done hundreds with it. With a little epi and you can get 4-5 hours or more. Perfect for the slow vascular surgeon who can't do a fem-pop in under 4 hours.

Agree completely:thumbup:
 
I agree with Noyac on this. I think his orginal post was not really on the competency of Locums but on this as a new graduate career choice. I think that you learn more the first few years out of residency than you actually do in residency. Some of the most important things to learn and learn early in private practice is how to interact with surgeons, staff, and administrators. I just don't see how a locums position would give you the opportunity for this. There is alot more to anesthesiology than coming to work and going home. My advice to a new graduate is to take a job with a well established, honest group. Learn from the older partners the things it takes to run a well, established, successful group. Also, they are a great resource for continuing your practice of anesthesiology. Regardless of whether or not you pass your boards or where you trained, the combined experience and knowledge of a good group of anesthesiologists will be helpful when you run into something that you haven't seen.

pd4

I think that's probably good advice. I've learned a lot more since July, good and bad, than I thought I would. And it is nice to have senior partners to back me up when I need it whether it's fighting with a surgeon over a case or helping out on a difficult airway.

And plain tetracaine comes in our spinal kits along with heavy lido and bupiv. Just sayin'.
 
That doesnt make sense, Slim. Why would you select a general anesthetic based solely on the duration of the case?

Oh, and uhhhhh, BTW,

Noy needs no strippers.

Dudes married to athletic/intellectual/wifey hottie who's in a different league than the "strippers" you suggest he "needs".


because if im not sure patients appreciate looking at the ceiling for six hours and im not gonna sedate someone for six hours.... so any spinal case longer than 2cc of marcaine goes to sleep in my hands. mmmk

noyac needs to come down for his type a to type b or c.. fine some docs suck some dont. help the ones who suck and move on.. Why do you have to point out the inadequacies of others?

I did locums for 8 months right out of residency. It aint an easy gig for the aforementioned reasons. doing cases with surgeons you have no idea whether they have a license or not
 
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