Considering trying out the locums thing but I've never worked a locums job. For those of you who have, what questions do you wish you had asked prior to accepting a job?
Questions to ask before accepting a locums gig
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1. Non-compete, Non-compete, Non-compete! Get the terms for any restriction on your geographic area or hospital system before signing anything.
2. Make sure lodging, airfare, rental car, and malpractice are paid
3. Ask about patient/hr you will be seeing as well as if the site is single/double coverage.
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Will you have midlevel supervision responsibilities?
Maybe what specialist resources you’ll have access to. We have no specialists in town, but have access to on-call specialists to confer with over the phone for certain things.
Maybe what specialist resources you’ll have access to. We have no specialists in town, but have access to on-call specialists to confer with over the phone for certain things.
Have you had issues with noncompetes for locums gigs beyond restrictions on the actual hospital (IME they request you go through that company for one to two years from start date)? Curious. Thanks.
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Yes. Many won't let you work at the same hospital if the ED group fires the locums company. Some even have geographic restrictions.
Paperman
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I've worked between 5-10 different casual opportunities between residency and as attending.
First, you have to give us more than what you've provided. For instance, I've worked casual at:
-5,000 pt/yr. volume, 24 hour, middle of nowhere
-10,000 pt/yr volume , 24 hour, damn near close to nowhere
-10,000 pt/yr volume, 12 hour
-30,000 pt/yr volume, 9-10 hour, suburban, upscale
-50,0000 pt/yr volume, 9 hour, very urban
-80,000 pt/yr volume, 8 hour, very urban
-110 pt/yr volume, 8-9 hour, mixed urban-suburban
VASTLY different experiences across volume and locations. Scariest cases by far were at 5,000 volume and 10,000 volume facility. What kind of situation is this first and then it is very easy to tailor the questions. If you can't do that, well, maybe you're not ready for locums.
Example. Anaphylaxis to tPA in 400 lb patient with prior laryngeal reconstruction. Can't fit more than 2 fingers into mouth. Can't even visualize hard palate let alone soft palate Anesthesia and General Surgery back-up 1 hour away. Academic physicians (again, I trained at very academic university residency), no offense, but your pucker factor would have caused your own reflex anaphylaxis and would have created 2 airway patients. Oh, the support staff. ALWAYS think about the support staff. Your'e not in some cush affluent well-educated suburb my friend. Nurse at this tiny hospital: "I've never given propofol or ketamine before"......oh, wait, what about the equipment. Of course their equipment has to be up to date. 10-year old video laryngoscope, angle I'd never seen before. No bronchoscopy in house (apparently Anesthesia had their own they kept in car?!?!?!?!).
Are you ready for this?
Do you know/comfortable with:
-staffing (nurses, RT, radiology, consultants)
-docs at this facility (who are they? what are their credentials? can you talk to them?)
-equipment (bigger than you realize when in an unfamiliar place with unfamiliar support staff)
-specialty back-up (OK, you have ENT back-up, what does that mean though? 30 minute guarantee? Just a phone consult?)
-admitting process (who admitting to? push-back? hospitalists? FM? Pets? Psych?)
-transfer proces (accept transfers? What do you definitely keep? What don't you keep? Who do you cal with questions?)
-Oh, forgot to mention the obvious, travel, pay, liability, insurance, benefits, etc.
What I'm saying here is. I've had bread and butter locums getting good $$$ where I'm like, 80,000 patients, this place is a cakewalk...and I've been at sleeper hospitals where you're supposed to see 8 patients in 24 hours, but 2 might be sickest you've ever seen in your life. Oh, and there is no resident, attending, consultant or anything to bounce ideas off....and if you f*ck up, well, you're back-up is....you....
BTW, the 400 lb tPA anaphylaxis: Awake w/ ketamine blind-digital intubation.
I think I got like $180/hr at that place. They could keep it.
So, ya, locums is easy money.
First, you have to give us more than what you've provided. For instance, I've worked casual at:
-5,000 pt/yr. volume, 24 hour, middle of nowhere
-10,000 pt/yr volume , 24 hour, damn near close to nowhere
-10,000 pt/yr volume, 12 hour
-30,000 pt/yr volume, 9-10 hour, suburban, upscale
-50,0000 pt/yr volume, 9 hour, very urban
-80,000 pt/yr volume, 8 hour, very urban
-110 pt/yr volume, 8-9 hour, mixed urban-suburban
VASTLY different experiences across volume and locations. Scariest cases by far were at 5,000 volume and 10,000 volume facility. What kind of situation is this first and then it is very easy to tailor the questions. If you can't do that, well, maybe you're not ready for locums.
Example. Anaphylaxis to tPA in 400 lb patient with prior laryngeal reconstruction. Can't fit more than 2 fingers into mouth. Can't even visualize hard palate let alone soft palate Anesthesia and General Surgery back-up 1 hour away. Academic physicians (again, I trained at very academic university residency), no offense, but your pucker factor would have caused your own reflex anaphylaxis and would have created 2 airway patients. Oh, the support staff. ALWAYS think about the support staff. Your'e not in some cush affluent well-educated suburb my friend. Nurse at this tiny hospital: "I've never given propofol or ketamine before"......oh, wait, what about the equipment. Of course their equipment has to be up to date. 10-year old video laryngoscope, angle I'd never seen before. No bronchoscopy in house (apparently Anesthesia had their own they kept in car?!?!?!?!).
Are you ready for this?
Do you know/comfortable with:
-staffing (nurses, RT, radiology, consultants)
-docs at this facility (who are they? what are their credentials? can you talk to them?)
-equipment (bigger than you realize when in an unfamiliar place with unfamiliar support staff)
-specialty back-up (OK, you have ENT back-up, what does that mean though? 30 minute guarantee? Just a phone consult?)
-admitting process (who admitting to? push-back? hospitalists? FM? Pets? Psych?)
-transfer proces (accept transfers? What do you definitely keep? What don't you keep? Who do you cal with questions?)
-Oh, forgot to mention the obvious, travel, pay, liability, insurance, benefits, etc.
What I'm saying here is. I've had bread and butter locums getting good $$$ where I'm like, 80,000 patients, this place is a cakewalk...and I've been at sleeper hospitals where you're supposed to see 8 patients in 24 hours, but 2 might be sickest you've ever seen in your life. Oh, and there is no resident, attending, consultant or anything to bounce ideas off....and if you f*ck up, well, you're back-up is....you....
BTW, the 400 lb tPA anaphylaxis: Awake w/ ketamine blind-digital intubation.
I think I got like $180/hr at that place. They could keep it.
So, ya, locums is easy money.
Do you get an attorney to look at the contract?
No bougie?
I agree beware the 3k volume hospital in the middle of nowhere. They always try and offer $100 an hour (I kid you not- just got an email today). Once again, do telehealth instead or stay home on your couch. Locums market has really toughened up lately and places seem unwilling to negotiate. Midlevel encroachment.
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Wait.....you dont want to take that job, but then you call it "encroachment" when I take it that pay?
Lots of these small hospitals can barely afford to pay for a good PA to cover these EDs, let alone pay an EP $250-300/hr.
Should the hospitals just close?
Lots of these small hospitals can barely afford to pay for a good PA to cover these EDs, let alone pay an EP $250-300/hr.
Should the hospitals just close?
Paperman
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Bougies are the Procalcitonin of EM.
Paperman
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Thanks for the feedback.
One of the places I've been looking at is a critical care access hospital is remote northern California. 20k volume. 11 beds. "average" acuity. 24 hour MD coverage with 16 hour MLP. Rate is $320/hr which includes travel and malpractice. Epic EMR. I'm assuming little to no backup. I need to find out what the detail are regarding admissions and transfers. Any other specifics in the contract I should ask about?
One of the places I've been looking at is a critical care access hospital is remote northern California. 20k volume. 11 beds. "average" acuity. 24 hour MD coverage with 16 hour MLP. Rate is $320/hr which includes travel and malpractice. Epic EMR. I'm assuming little to no backup. I need to find out what the detail are regarding admissions and transfers. Any other specifics in the contract I should ask about?
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That is just under 1.4 pts/hr, EVERY hour. Either you're running your butt off for every one of the 24 hours (no sleep), or, you're getting a painful, continuous bolus of patients, for hours and hours at a stretch.
Sorry, should have clarified that it's 24hr MD coverage but the shifts are only 12 hours: 7a-7p, 7p-7a.
Paperman
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That's better.
12 hour shifts then right?
Seems busy, but depends on their flow
Ask about admission, transfers, gaps in coverage/specialites
Ask to speak to a couple partners/ED docs (seems silly, and CMG/recruiting service balked at this, but it is so worth it. Don't be embarrassed to ask)
Good luck and try to enjoy!
More importantly, if possible, use these experiences to gauge quality/advantages/disadvantages of your current job.
TPM
12 hour shifts then right?
Seems busy, but depends on their flow
Ask about admission, transfers, gaps in coverage/specialites
Ask to speak to a couple partners/ED docs (seems silly, and CMG/recruiting service balked at this, but it is so worth it. Don't be embarrassed to ask)
Good luck and try to enjoy!
More importantly, if possible, use these experiences to gauge quality/advantages/disadvantages of your current job.
TPM
Paperman
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Agree. Seek to understand flow prior to commital
Remember, they need you. NOT the other way around.
TPM
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Right above my post was mention of midlevel encroachment.
In some ways it is encroachment because if they didnt pay me $100/hr for that job they would have to cut the adminiscritters benefits to pay you your $200/hr. But there are lots of these hospitals where the administrators arent making much, and FP/hospitalists arent either. Paying you what you want would close the hospital
Closing rural hospitals is a terrible idea. If you ever try out rural life you would see that.
What I was saying was that it's hard to negotiate salaries for locums in general because they will just staff with a million midlevels and understaff with docs, so OP might have a hard time getting a good rate. I will add that any midlevel that thinks they can handle a rural ED solo better be 100% independent with no MD supervision and willing to own their own mistakes, and also is 100% Dunning-Kruger. One of the toughest jobs in medicine that would strike fear into many a seasoned doc. BTW, Boatswain, in those rural hospitals, the nurses are making just as much as in the bigger hospitals. Why are their salaries sacred cows? Shouldn't they discount their services?
I think single coverage for 24k is too slim, especially with twelves. If you have good nursing it might be OK, but I've worked in a similar situation and a swing shift MD made all the difference. A midlevel that isn't competent, or whose patients you have to see or whose charts you have to sign would make this intolerable. They are offering you a high rate because they have cut a a doc shift and given it to a midlevel. This may or may not be functional.
Any well-run ED will WANT you to talk to the director to see if it's a good fit. If not, red flag. The potential issues above are why you need to talk to the director.
I think single coverage for 24k is too slim, especially with twelves. If you have good nursing it might be OK, but I've worked in a similar situation and a swing shift MD made all the difference. A midlevel that isn't competent, or whose patients you have to see or whose charts you have to sign would make this intolerable. They are offering you a high rate because they have cut a a doc shift and given it to a midlevel. This may or may not be functional.
Any well-run ED will WANT you to talk to the director to see if it's a good fit. If not, red flag. The potential issues above are why you need to talk to the director.
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