Pro and cons of doing locum

[Smallmelon]

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Locum seems to pay well, protected from over-booking and calls.

Travel won’t be too much a problem, as there are multiple medical systems near where I live. They all go up and down, hence locum is always in need.

The only downside is no retirement benefit or medical insurance. What are the other potential pitfalls? Does it matter which locum company to work with? It seems a reasonable transition in between jobs if I feel burnout in current job but not ready to commit to the next one yet.

Happy to hear some thoughts.

 

[osprey099]

Locum seems to pay well, protected from over-booking and calls.

Travel won’t be too much a problem, as there are multiple medical systems near where I live. They all go up and down, hence locum is always in need.

The only downside is no retirement benefit or medical insurance. What are the other potential pitfalls? Does it matter which locum company to work with? It seems a reasonable transition in between jobs if I feel burnout in current job but not ready to commit to the next one yet.

Happy to hear some thoughts.

Probably wouldn't recommend it as your first job or if you're early career. Might make you a little less desirable if you decide to try to settle down into a more permanent role elsewhere. From family standpoint, it would be very hard if you have spouse/young kids at home.

But I definitely think it's an attractive option if closer to retirement or if kids are out of the house and/or spouse doesn't work and can travel with you to the locums locations. I can see myself (when I'm in 50s after I retire from private practice) pick up locums in places like Alaska, Hawaii etc and treat them as mini-extended vacations with my wife.

 

[gutonc]

Locum seems to pay well, protected from over-booking and calls.

Travel won’t be too much a problem, as there are multiple medical systems near where I live. They all go up and down, hence locum is always in need.

The only downside is no retirement benefit or medical insurance. What are the other potential pitfalls? Does it matter which locum company to work with? It seems a reasonable transition in between jobs if I feel burnout in current job but not ready to commit to the next one yet.

Happy to hear some thoughts.

I have so many feels about this question. I will start with some caveats.
1. I have never done locums. Like @osprey099 I have considered it as a retirement transition job however I'm already the age that they mentioned and am nowhere near retirement.
2. I have hired a number of locums docs and fired more. I have been named in (and quickly dismissed from) a wrongful termination lawsuit from a locums doc. I have spent the last year in my new position doing a lot of what the admin nerds call "service recovery" with patients and referring docs based on prior locums at this site.

Honestly, nobody but admin likes locums. For the rest of us, they are considered a necessary evil in a world where there is a physician maldistribution problem and it takes a year or more to recruit and onboard a permanent oncologist.

I have never worked with a locums doc that I was interested in hiring for a FT position. I have worked with a couple that I didn't want to punch in the face every day.

Having said all that, locums come into a difficult spot in most settings and TBH, the best you can hope for in that setting is "I didn't hate them". It's hard to pick up a new patient panel and try to figure everything out on the fly, especially when you disagree with prior management. Patients struggle with not having an oncologist that they can trust and engage with. It's also hard to work with a staff that isn't used to you and has probably circled the wagons to protect themselves from "you".

Knowing what I know now, I can only imagine doing very short term locums work (like 4 weeks or less for vacation coverage). There are a ton of rural solo docs out there (I'm one of them now) who need to take time off and need somebody to cover for them. I would 100% support this use of locums. Longer term locums (3-12 months) assignments, at least in oncology, are generally a s***show.

I am getting killed right now with my workload, but I am adamantly opposed to hiring a locums doc to support me for more than 2 weeks at a time.

 

[dozitgetchahi]

I have so many feels about this question. I will start with some caveats.
1. I have never done locums. Like @osprey099 I have considered it as a retirement transition job however I'm already the age that they mentioned and am nowhere near retirement.
2. I have hired a number of locums docs and fired more. I have been named in (and quickly dismissed from) a wrongful termination lawsuit from a locums doc. I have spent the last year in my new position doing a lot of what the admin nerds call "service recovery" with patients and referring docs based on prior locums at this site.

Honestly, nobody but admin likes locums. For the rest of us, they are considered a necessary evil in a world where there is a physician maldistribution problem and it takes a year or more to recruit and onboard a permanent oncologist.

I have never worked with a locums doc that I was interested in hiring for a FT position. I have worked with a couple that I didn't want to punch in the face every day.

Having said all that, locums come into a difficult spot in most settings and TBH, the best you can hope for in that setting is "I didn't hate them". It's hard to pick up a new patient panel and try to figure everything out on the fly, especially when you disagree with prior management. Patients struggle with not having an oncologist that they can trust and engage with. It's also hard to work with a staff that isn't used to you and has probably circled the wagons to protect themselves from "you".

Knowing what I know now, I can only imagine doing very short term locums work (like 4 weeks or less for vacation coverage). There are a ton of rural solo docs out there (I'm one of them now) who need to take time off and need somebody to cover for them. I would 100% support this use of locums. Longer term locums (3-12 months) assignments, at least in oncology, are generally a s***show.

I am getting killed right now with my workload, but I am adamantly opposed to hiring a locums doc to support me for more than 2 weeks at a time.

Agree with all of this.

Locums is ok for hospitalists, ER, anesthesia etc - the shift work “interchangeable cog” specialties where it’s much more “plug and play”.

For outpatient longitudinal care specialties, it is indeed a ****show. I am a rheumatologist and I have watched the hospital system across town fire their incumbent rheumatologist, and then go through a succession of locums that all bailed after 6 months. For whatever reason, the doctors that do locums in these specialties…let’s just say they’re not members of the “A team”, or even the “B team”. Almost every patient I inherited from these people needed lots of “detangling” as I call it…lots changing treatment plans and new workups to figure out wtf was actually wrong with them, because their last diagnosis was clearly not correct.

 

[hehe5347]

have spent the last year in my new position doing a lot of what the admin nerds call "service recovery" with patients and referring docs based on prior locums at this site.

Out of curiosity, what were the biggest issues with the locums? Were they actually diagnosing patients incorrectly? Giving the wrong treatment?
I myself have considered locums but was heavily discouraged for the reasons listed above and am happy I never ended up doing them.
We had a locum for a few months and she was amazing, BUT she was a former academic doc who got burned out from academics (and I can maybe see why, she really went the extra mile with each patient), the caveat is that we’re seeing 11-14 patients per day so not a crazy schedule and she said she actually saw more per day at her prior job, so who knows.

 

[sloh]

When there’s no skin in the game, that will be reflected in poor care. That’s why locums often leaves much to be desired. Incentives are everything.

 

[gutonc]

Out of curiosity, what were the biggest issues with the locums? Were they actually diagnosing patients incorrectly?

Yes. Seen it.

Giving the wrong treatment?

Yes. Seen that too (carboplatin AUC 7 + Paclitaxel 250mg/m2 for metastatic melanoma (first line)? Gem/Abraxane for met colon (first line)?

I myself have considered locums but was heavily discouraged for the reasons listed above and am happy I never ended up doing them.
We had a locum for a few months and she was amazing, BUT she was a former academic doc who got burned out from academics (and I can maybe see why, she really went the extra mile with each patient), the caveat is that we’re seeing 11-14 patients per day so not a crazy schedule and she said she actually saw more per day at her prior job, so who knows.

I've never seen a locums seeing more than 10 patients a day, usually more like 5 or 6, while everyone else is seeing 18-22.

I'm sure there are some good ones out there, and like I said, I think it can be a really tough gig to take on. But so far, I have yet to meet a really good locums doc.

 

[osprey099]

Yes. Seen that too (carboplatin AUC 7 + Paclitaxel 250mg/m2 for metastatic melanoma (first line)? Gem/Abraxane for met colon (first line)?

How do those regimens even get past insurance auth or pharmacy review??

And are these oncs from the Stone Age ordering these regimens??

 

[gutonc]

How do those regimens even get past insurance auth or pharmacy review??

I honestly have no idea. If I hadn't seen it myself, there's no way I would have believed it.

And are these oncs from the Stone Age ordering these regimens??

Some are. This particular one just seemed to make things up.

 

[HemeOncHopeful19]

Yes. Seen that too (carboplatin AUC 7 + Paclitaxel 250mg/m2 for metastatic melanoma (first line)? Gem/Abraxane for met colon (first line)?

 

[bobsmith]

When there’s no skin in the game, that will be reflected in poor care. That’s why locums often leaves much to be desired. Incentives are everything.

Yeah, as someone who recently inherited a group of patients who previously saw a rotating group of locums providers, I think there is a lot of, "OK yeah this doesn't really add up, but I'm only here for a little bit so I'm not going to change anything"

 

[gutonc]

Yeah, as someone who recently inherited a group of patients who previously saw a rotating group of locums providers, I think there is a lot of, "OK yeah this doesn't really add up, but I'm only here for a little bit so I'm not going to change anything"

Which, to be fair to the locums, may be the right approach depending on the situation. If it's a very short term (vacation/holiday/FMLA) situation of a month or less, you can probably just get away with this in 95% of the cases. The other 5% I'd probably just turf until the regular doc came back.

It's those longer term, 6-12 month situations, where you really see some crazy s***.

 

[MD46]

Had a locum doc give rituxan maintenance for DLBCL.

 

[gutonc]

Had a locum doc give rituxan maintenance for DLBCL.

I've seen that from non-locums docs. Unfortunately, a lot of people don't read pas the headline on journal articles.

At least it was "right disease/right drug" even if wrong indication.

 

[onconc]

Adding my 2c
As others have already said, the only locums I know are either single or are close to retirement. No one with young kids is a Locum.

We had locums for a bit since there was a gap before the new FTE physician joined. She (the locum) was decently capable. Our only grouse was that she was being paid higher than us (FTE physician) on a hourly basis because of their sweet contract.

 

[ShuperNewbie]

Reviving this thread since I'm at the point now where I'm thinking of getting a new phone number because of all the locums recruiter texts and calls.

Has anyone worked locums in heme/onc here before? It honestly seems impossible in oncology, since patients are complicated and really depend on good continuity (I mean, it takes over 4 months just to get through R-CHOP). Has anyone out there actually tried it? And if so how was it?

 

[whoknows2012]

Reviving this thread since I'm at the point now where I'm thinking of getting a new phone number because of all the locums recruiter texts and calls.

Has anyone worked locums in heme/onc here before? It honestly seems impossible in oncology, since patients are complicated and really depend on good continuity (I mean, it takes over 4 months just to get through R-CHOP). Has anyone out there actually tried it? And if so how was it?

I almost took a gig out in vail for Feb during presidents week. Would’ve taken the family to ski as they were providing housing. The didn’t want to pay more than $17,500 per week but would negotiate 🤣

 

[osprey099]

I almost took a gig out in vail for Feb during presidents week. Would’ve taken the family to ski as they were providing housing. The didn’t want to pay more than $17,500 per week but would negotiate 🤣

I'd do $17500 for the week if the hospital set my family up at the Vail Four Seasons 😀

 

[gutonc]

Reviving this thread since I'm at the point now where I'm thinking of getting a new phone number because of all the locums recruiter texts and calls.

Has anyone worked locums in heme/onc here before? It honestly seems impossible in oncology, since patients are complicated and really depend on good continuity (I mean, it takes over 4 months just to get through R-CHOP). Has anyone out there actually tried it? And if so how was it?

I have not done it, but have worked with a number of locums over the years. They have ranged from acceptable to atrocious. IME it tends to attract people who can't hold down a job otherwise, but there are people who do it for flexibility reasons, others because of life transitions and still others as a runway to retirement. I can imagine myself doing it for a few years while traveling around the country.

You are correct that it would be hard to do it well, especially if there is crappy documentation or if you're going to one of those places where it's one locums after another in a place vainly trying to keep the doors open and the infusion dollars flowing and nobody but admin is invested. I think that one of these 1-2 week vacation coverage gigs, or an FMLA coverage position would be reasonable though. There are lots of oncology offices out there that don't have enough work to support 2 physicians but need to stay open when the doc on site takes a vacation.

 

[MifflinDunder]

Do they tell you beforehand who/what you’ll be covering? For example, the malignant heme or the GI oncologist is out, the schedule typically looks like this etc.

 

[gutonc]

Do they tell you beforehand who/what you’ll be covering? For example, the malignant heme or the GI oncologist is out, the schedule typically looks like this etc.

When I have hired locums, the job description is pretty explicit.

It's also much more common to be covering a generalist than it is a sub-specialist.

 

[RainerMaria]

Do you always hire through an agency or have you fielded “cold calls” as well? Who covers the malpractice insurance?

 

[gutonc]

Do you always hire through an agency or have you fielded “cold calls” as well? Who covers the malpractice insurance?

Agency. Primarily because I have worked in large institutions (academic and multi-state community hospital group) and they have contracts with staffing agencies for this stuff. Doesn't mean a cold call might not work, but since the agency does all the work (references, licensing, malpractice, privileging paperwork) it is easier for the institution to use them and just write a check. For a PP or small hospital based practice, it would likely be more economical to use an independent person.