The LOCUMS how to guide

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cabinbuilder

cabinbuilder

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I have been recently contacted about how to get started with locums by quite a few on the boards. Here is some general information that pertains to what I do in rural family practice/small ER/urgent care/rural hospital, etc.

Locums is a great way to see the country and get ahead. The highest paying jobs are RURAL where there is a doctor shortage. You will need to have a license in the states you wish to practice unless you work at an IHS site or government military base. IHS or military pay is quite low at 60-65/hr. Generally I get $80/hr+ more for ER coverage and being on call. Fast track ER and urgent care is generally $90-115/hr+, depends on the site. When I work a site I like to have it in my contract that I will get a 50 hr week minimum so I maximize my time and not just sit in a hotel room. I also get an 8 hour/day guarantee. I have been in a situation where I was sent home at the half day due to lack of rooms - I still get paid for the 8. I'm not there to sight see.

As far as what you can do in residency- be up on your procedures: joint injections, casting, suturing, taking off lesions, taking off nails, taking out fish hooks, be comfortable with general ER stuff, know your belly pain, what to do with an MI, if you can learn stress tests. Don't know if you learned prenatal/OB (I didn't) but that would be a plus. Know how to be a hospitalist. If you can learn how to manage vents in ICU that would be a plus( I don't do vents) but I don't work where they have ICU generally.

Not every agency covers the entire country. You will need to google i.e. (physician jobs oregon) and see which companies come up. I currently am signed with Delta, comphealth, martinfletcher, and onyxmd. Be careful when dealing with multiple companies since once you are presented to a site, you are contract bound to take that job should you be accepted. I generally don't deal with more than 2 companies at a time. You will need to be board certified and not have any malpractice issues. If you work for more than one company be sure you get a copy of all malpractice facesheets for future employement (you have to submit to each employer/site). Have all your documents scanned on your computer: driver's license, SSN, medical degree, Intern Certificate, Residency Certificate, Board Certificate, state license, DEA, DPA, Nevada Pharm, BLS, ACLS, etc. You will need to submit these every time you change sites/companies.

Assignments can vary in length. Most places request a 2 month minimum because it takes so long to credential you in order to work there 1-2 months typically for all paperwork on their end to be complete. I have worked 3 weeks up to 9 months at a given site. It depends on their need and their budget. Some places just want vacation coverage. For me I only take the longer assignments because I can make more and then I'm off when my kids are off.

Locums pays for your travel, housing, rental car, and malpractice plus your wages. Don't settle for less than that. You do not need to worry about tail coverage. There should never be any money out of pocket for you as the provider except food/gas depending on the site. They do not take taxes out of your check so it's up to you to hold money back each paycheck or pay at the end of the year like I do. Get a good accountant. If you have a problem at a site or it's not what was presented to you, call your locums company right away and get the problem fixed. I have left a site after 5 days because it wasn't what was told to me. Remember that you are the relief help and there should not be any hassles toward you.

I hope that helps. Feel free to ask questions.
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I just wanted to say that I love your attitude and outlook about work and how you should be treated. Hope to have that level of assertiveness once I'm working! Thanks for sharing the information. 🙂
 
Well, a lot of it has been trial and error. You go through all this training and no one ever tells you that you do not need to beg for a job anymore. Employers expect that you as the physician will counter offer,etc. Doctors are in high demand, currently FP is the hot commodity, you can basically get what you ask for in terms of permanent positions. Locums pay has little wiggle room but you have to remember that the site that hires you is paying more than you see since your agency get's paid too for all the travel, arrangements, credentialling, etc. they do for you.
 
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What do you mean when you say "you do not need to worry about tail coverage"?

The physician doesn't need it? Or the physician ought not pay for it out of pocket?
 
sazerac said:
What do you mean when you say "you do not need to worry about tail coverage"?

The physician doesn't need it? Or the physician ought not pay for it out of pocket?
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Locums company doesn't ever take you off the books so even if you stop doing locums you are continuously covered by their malpractice. So when you quit locums you don't have to buy your own tail coverage.
 
How far away from your home do you usually work? How do you keep from going stir crazy with bordom (or knowing there are things going on in your home town that you'd like to be doing) when you are committed to being gone for 2 months? When I traveled for consulting it would drive me nuts to not be able to do anything at home M-Thus nights. Sure, a lot of times there wasn't anything going on, but when there was and I had to miss it..ugh.
 
notinkansas said:
How far away from your home do you usually work? How do you keep from going stir crazy with bordom (or knowing there are things going on in your home town that you'd like to be doing) when you are committed to being gone for 2 months? When I traveled for consulting it would drive me nuts to not be able to do anything at home M-Thus nights. Sure, a lot of times there wasn't anything going on, but when there was and I had to miss it..ugh.
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I work 100 miles - 2500 miles away from home. It differs from consulting as I don't usually get done at 5pm. I try to get a schedule where I work 12 hour shifts for as many days I can get so I am maximizing my time making money and not sitting in a hotel room. I spend lot of time after hours working on the next job ahead, getting the paperwork in order, schedules, etc. That takes a lot of time too. Many places I work I can get home on the weekends. As far as where I live, I'm only there because my kids love the high school there. I don't think about what is going on where I live -I guess I'm really a homebody since I grew up in the middle of nowhere and I'm self entertained. I do a lot of craft projects while I am away, catch up on my reading, I do all my bills online. I am also one who has been known to get on a plane if I have a 4 day break and go visit someone in a neighboring state. Usually there is a staff member who I click with and we go do things, movies, shopping, etc. My next job is 5 months - not too worried about it. An when that time is done, I can be home for as long as I want until the next job starts.
 
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Do you ever fear not having a job? I mean, what if you can't secure another job placement by the end of your upcoming 5-month commitment?

Also, I have asked you this question in the past, but I want to ask again. Can your SO accompany you to different job sites? I realize that your husband may need to stay with the kids now, but later once they are off to college, do you think it is feasible that he travels with you?

Lastly, what type of medical training would best prepare one to work rural locum jobs? FM/OB, IM/Ped, FM/ER, FM/Psych? Also, do such opportunities exist for general surgeons?

Thank you
 
Ibn Alnafis MD said:
Do you ever fear not having a job? I mean, what if you can't secure another job placement by the end of your upcoming 5-month commitment? NO fear, I have been doing this long enough to know there are more jobs than doctors to cover. I seriously get 3-5 jobs on my email daily and at least 4 calls a week from recruiters I'm not signed with. I have 2 main ladies who work daily to secure jobs for me. I always have 2-3 in play at all times. I have been doing this for 4 years and have never had an issue getting a job. The only time it gets hairy is when I quit a perm job last minute (like I did in October) and had a 4 week gap that was unexpected before starting the next job (my own fault tho).

Also, I have asked you this question in the past, but I want to ask again. Can your SO accompany you to different job sites? I realize that your husband may need to stay with the kids now, but later once they are off to college, do you think it is feasible that he travels with you? I don't see why not? You would most likely have to buy their plane ticket. Where I am housed it' a private room so it's not like I'm being policed as to who is with me. I expect when my kids are out of the house my husband will come with me. Might be boring for him though since I work ALL the time when out there. It will be up to him.

Lastly, what type of medical training would best prepare one to work rural locum jobs? FM/OB, IM/Ped, FM/ER, FM/Psych? Also, do such opportunities exist for general surgeons? For what I do, FP is totally the best route for rural training. Many times I am the ONLY provider for a given clinic or area. I carry many hats at one time: ER, hospitalist, ortho, FP, Peds, general clinic, radiology. There have been times when I was covering ER and didn't have a rad report until the next day but needed to make a decision about treatement (everyone needs to learn to read their own films. I have caught many many mistakes) When I did training I did not do OB care just general gyn issues you would see in the ER. I made sure I could read my own films including MRI's so I can explain to patients what is happening with them, doing general clinic ortho (joint injections, bursa injections, cast, splint). You have to be able to cut lesions off, suture whatever comes through the door. I do lots of podiatry/nail care, there is lots of psych in rural medicine (not my favorite).

Also, do such opportunities exist for general surgeons. I have been in places where there was a general surgeon who came through as a traveler, not much work as a "long term locum" as you would need to be where there is an OR available or at least do screening and diagnostic scopes. In places where a surgeon has a monthly 2-3 days scheduled a site, generally the FP's would try to co-ordinate with their patients who cannot travel to be seen on those days for extensive lesions or initial consultations for a problem. You have to understand that a lot of places where I work it's just me in some trailer or make-shift clinic with a secretary and if I'm lucky a nurse.
Thank you
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This is great information cabinbuilder!

I'd prefer to do shorter locums.I've read that some of the LT companies vary in terms of quality. Which particular companies have you had the best luck with?
 
MedicineMan99 said:
This is great information cabinbuilder!

I'd prefer to do shorter locums.I've read that some of the LT companies vary in terms of quality. Which particular companies have you had the best luck with?
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There are always short assignments, for me it's not worth it to do 2 days here, 5 days there since I have to travel far. But if you live close to a large area like Dallas, Forth Worth, Austin, Houston, etc. there are always short term assignments where local docs are preferred.

I have had the best luck with Deltalocums, and Comphealth. They have worked well for me. In the past I have used MartinFletcher and OnyxMD and I still get alerts from locumtenens.com but have never been on assignment with them.
 
I'm in the process of signing with Delta. As you've mentioned before, it's important to save enough money since we are independent contractors and will have to pay taxes at the end of the year. Did you have trouble with that?

Also, how about benefits? Since they don't provide them, did you buy your own health insurance?
 
MedicineMan99 said:
I'm in the process of signing with Delta. As you've mentioned before, it's important to save enough money since we are independent contractors and will have to pay taxes at the end of the year. Did you have trouble with that?

Also, how about benefits? Since they don't provide them, did you buy your own health insurance?
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I actually don't save throughout the year. I work extra hours Jan-Apr to save for taxes. Thats what I'm doing now. Works for us. Yes, I buy my own health insurance (catastrophic) through State Farm since I have all my other policies with them. It's a lot cheaper than Obamacare. Obamacare would have tripled my payments
 
MedicineMan99 said:
I'm in the process of signing with Delta. As you've mentioned before, it's important to save enough money since we are independent contractors and will have to pay taxes at the end of the year. Did you have trouble with that?

Also, how about benefits? Since they don't provide them, did you buy your own health insurance?
Click to expand...

You do realize that you have to pay estimated taxes each quarter, right?
 
cabinbuilder said:
I actually don't save throughout the year. I work extra hours Jan-Apr to save for taxes. Thats what I'm doing now. Works for us. Yes, I buy my own health insurance (catastrophic) through State Farm since I have all my other policies with them. It's a lot cheaper than Obamacare. Obamacare would have tripled my payments
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Will your catastrophic plan still work out well financially once the maximum Obamacare penalties are in full swing in a few years? My long-term goal has always been to be a career locums physician that doesn't work a full calendar year, but this has left health insurance as a serious concern post-Obamacare.
 
Mad Jack said:
Will your catastrophic plan still work out well financially once the maximum Obamacare penalties are in full swing in a few years? My long-term goal has always been to be a career locums physician that doesn't work a full calendar year, but this has left health insurance as a serious concern post-Obamacare.
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I joined one of the religious exempt "Cost share" groups, it complies with ACA and costs $370 for my whole family.....we'd be paying triple that otherwise
 
ThoracicGuy said:
I worked as a 1099 independent contractor and I had to pay quarterly federal and state taxes. What reasoning does your accountant give for not having to pay estimated taxes?
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I am also a small business partner and get several 1099s each year. I also choose not to pay quarterly taxes. It would probably be less stressful to pay quarterly taxes but you don't have to if you don't want to. I just pay a huge tax bill every April.
 
Mad Jack said:
Will your catastrophic plan still work out well financially once the maximum Obamacare penalties are in full swing in a few years? My long-term goal has always been to be a career locums physician that doesn't work a full calendar year, but this has left health insurance as a serious concern post-Obamacare.
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Mad,

Are you considering something like FM and doing locums long-term so you can travel?
 
Silent Cool said:
Mad,

Are you considering something like FM and doing locums long-term so you can travel?
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I want to do a mix of volunteering and traveling overseas for three or four months a year, then work my butt off 60+ hours a week stateside for the remainder of the year. Locums are pretty much the only way to make that happen that I can see. FM is one of the three or four fields I'm tossing around right now, but who knows how I'll feel when it finally comes time for the match.
 
MedicineMan99 said:
I am also a small business partner and get several 1099s each year. I also choose not to pay quarterly taxes. It would probably be less stressful to pay quarterly taxes but you don't have to if you don't want to. I just pay a huge tax bill every April.
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MM99,

How is it that you are able to pay in a lump sum instead of quarterly? I thought that all 1099 had to pay estimated quarterly taxes.

thanx
 
Mad Jack said:
I want to do a mix of volunteering and traveling overseas for three or four months a year, then work my butt off 60+ hours a week stateside for the remainder of the year. Locums are pretty much the only way to make that happen that I can see. FM is one of the three or four fields I'm tossing around right now, but who knows how I'll feel when it finally comes time for the match.
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What are the other three? I'm wondering what fields would allow one to have such work flexibilities.
 
Ibn Alnafis MD said:
What are the other three? I'm wondering what fields would allow one to have such work flexibilities.
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IM, EM, and and psych are the three most sought after locum specialties after FM. FM offers more opportunities than the other three internationally though, hence my leaning more toward FM.
 
What is the call schedule for you at a typical locums assignment, and what has the range been? Heard of a doc that didn't sleep more than 2 hours at a time and couldn't be farther than a mile from the clinic at any time on his assignment...

I think getting a few calls at 3 AM per week is do-able, but if I'm getting a few calls per night, that's a different story...
 
SuckySurgeon7 said:
What is the call schedule for you at a typical locums assignment, and what has the range been? Heard of a doc that didn't sleep more than 2 hours at a time and couldn't be farther than a mile from the clinic at any time on his assignment...

I think getting a few calls at 3 AM per week is do-able, but if I'm getting a few calls per night, that's a different story...
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Depends on the assignment and you know before hand if you have to take call. Most jobs I'm on don't have call. There have been a few. The range is phone call from home overnight for the practice/nursing home - that generally is $50. If I am doing inpatient and I have to come in for ER admit -$100/hr call back time. When I was on a job in Nevada by myself it was 24/7 call for 2 weeks straight but I got paid around the clock - even when asleep and I got about 5 hours a sleep night on that one. I was on call 26 days in a row t ($300 extra per day on top of the regular $1000/day) in Southeast Alaska one time but usually slept all night because the Island was pretty good about waiting until clinic was open for basic stuff. Soo..... it all depends on the job, you can pick jobs that don't have call. But if you do, then yes, you have to be within 20 minutes of the hospital when you are on call. I used to take as much call as I could since that's where the money adds up. I don't anymore since I'm too tired.
 
This seems to be very U.S. oriented. Does anybody know if the same possibilities (working abroad on temporary assignments with decent pay) exist for European doctors? If I'm not mistaken it is quite hard to get a license in the U.S. as a foreigner (my uncle had to re-do his GYN residency).
Thanks
 
So how do you put locums experience on your CV? Do you list all the positions you've held or do you just generalize? My fear is that if someone doesn't understand locums, they won't understand many different gigs that last only a few months- they'll just think I get fired a lot.
 
MedicineMan99 said:
So how do you put locums experience on your CV? Do you list all the positions you've held or do you just generalize? My fear is that if someone doesn't understand locums, they won't understand many different gigs that last only a few months- they'll just think I get fired a lot.
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I put every location on my CV and I designate whether the position was locums or perm. Here is an excerpt:


10/4/13-10/25/13 UMC-Urgent Care - Permanent

1800 W. Charleston Ave

Las Vegas, NV 89102

Contact: Dr. John Onyema 702-383-1914



Urgent Care clinic – multiple sites. Resigned during orientation as job was not as anticipated. Was informed after the fact that I would not be able to do manipulation and procedures were not encouraged. I was to write prescriptions only or send patients to the ER for any issue that needed local anesthetic. The medical care was unacceptable to me and I left on good terms, eligible for re-hire in the future.


08/19/13-10/04/13 Tillamook Regional Medical Center –Comp Health

Urgent Care-Locums

1100 Third Street

Tillamook, OR 97141

Contact: Gina Seufert 503-815-2465

General urgent care/walk-in clinic. Relief for the ER-similar to fast track with full lab, CT, xray, and US available. Bronchitis, Sinus issues, Seasonal allergies, Fracture care, Nail Care, Lesion removal, Ear infections, Rashes, Fish hook removal, Sports injuries, OMT, I&D. Referral as needed to specialists or the ER for higher level of care. Generally saw more patients than the ER on a typical day. Simples cases to very ill patients who did not want to wait in the ER. Did ambulance transfers and direct admits when needed. Specialist consults available.



05/14/13-06/19/13 Golden Health Family Medical Center-CompHealth

1993 Errecart Blvd

Elko, NV 89801

Contact: Brenda Truitt 775-748-4880 fax 775-777-8494


Urgent care Cases/Walk-Ins in Family Practice Clinic. On-site x-ray. Bronchitis, Sinus issues, Seasonal allergies, Fracture care, Nail Care, Lesion removal, Ear infections, Rashes, Fish hook removal, Sports injuries. Took care of many sick patients who did not want to go to ER. Arranged outpatient antibiotics, home care, direct admits when needed.




07/09/12-3/15/13 Alaska Island Community Services- DeltaLocums

320 Bennett Street

Wrangell, AK 99929

Contact: Carly Allen 907-874-2373 fax 907-874-4719


Coverage of Inpatient service, ER (24hr call), Long term care patients, and Family Practice Clinic (Chronic medical mgmt and urgent care overflow). CT/US/xray available. Medevac to nearest ICU/Trauma center. Family Practitioners only on the Island. No dentist, no specialists. Only access by boat or plane. Many times I was the only physician on the entire Island. Longest call stretch for ER/hospital was 24 days in a row. Averaged one medevac a week.
 
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I just want to thank you again for sharing so much with us. From where I am starting now, it is hard to imagine how anyone could manage to be so omnicompetent as you would need to be to handle everything that comes your way. But you certainly model the role for which I'm aiming. I'm grateful for the example you set.
 
Promethean said:
I just want to thank you again for sharing so much with us. From where I am starting now, it is hard to imagine how anyone could manage to be so omnicompetent as you would need to be to handle everything that comes your way. But you certainly model the role for which I'm aiming. I'm grateful for the example you set.
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Well, don't think I know how to deal with everything. No one can know that. I have lots of help via phone when I'm out there by myself but I generally do have another provider there to consult with. Glad it was helpful.
 
Updating the locums thread: So I got a call from a doc who needed help and had a poor experience with trying to do locums. I thought I would update this thread on some of the things that I told them to do when trying to get on the locums bandwagon. Remember that the locums company is there to find the jobs for you and ASSIST you with the paperwork but it is ultimately up to you as the provider to make sure all the paperwork is in order in a timely fashion.

1. Once I am presented to a job - I give them one week to secure said job before moving on. I sometimes get presented to 2 jobs at the same time through my 2 different companies and I am very clear that whichever job secures me first gets that contract
2. You should always get a confirmation of the job (on locums letterhead) within one week of being accepted. It should outline the dates expected to work, rate of pay (straight and holiday, OT, etc, call (if any). Should stated that travel/housing/rental car are provided. If there is anything on there that you do not agree with be sure to SAY SOMETHING and get that changed during the preliminary negotiations. Do not take a verbal acceptance as meaning you have that job.
3. You should be contacted by the credentialing office by both the locums company and/or the job site within 1-2 weeks of your job confirmation. Credentialling can take from 2 -12 weeks depending on the site. You don't want to be the reason you start date gets delayed for not doing the paperwork quickly.
4. If you are accepting a job in a state you don't have a license in, IT IS UP TO YOU to get the licensing paperwork started and sent in. The locums folks will help with questions but that is your ultimate responsibility. The locums company will send you a FedEx label anytime something needs to be expedited. You just need to ask for that.
5. I have a 24-48 hour turnaround on any paperwork requests, etc. Be sure to have your CME, patient logs, licenses, diplomas, driver's license, peer references, proof of malpractice cover sheets (every job/company I have worked for I request a copy as you will always need to send these to every new perm/locum job). I make sure that I am not the weakest link.
6. You do not need to have a lawyer go over a locums contract
7. You do not need to research the site you are going to. Some of this you have to take on faith and know that if you get to the job and it's not what was pitched to you or you feel in danger: YOU WALK OUT.
 
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Cabin, can you please offer some more details about what you include in your patient logs and how you keep them organized/searchable? How does this wind up playing out with potential locums positions? Do they ask how many abscesses you've drained, or how many people with ESRD and DM you've cared for? Thanks!
 
VenturaResident said:
Cabin, can you please offer some more details about what you include in your patient logs and how you keep them organized/searchable? How does this wind up playing out with potential locums positions? Do they ask how many abscesses you've drained, or how many people with ESRD and DM you've cared for? Thanks!
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I put the info in a spread sheet designating site, date, diagnosis, procedure. I also have separate for IP,ER, Urgent care, clinic if I work more than one site on the job.

12/16/2013 G.O-C. 6 yr. M URI, B/L cerumen impaction, fever, cough Ear Lavage
12/16/2013 O.C-R. 34 yr. F UTI, HA, URI
12/16/2013 S.H. 33 yr. M Back pain, radiculopathy
12/16/2013 M.B. 17 yr. F Back pain, Somatic dysfxn C,T,L spine OMT HVLA C,T,L spine
12/16/2013 E.Y-R. 29 yr. F RUQ pain ?Gallstones
12/17/2013 D.L-L. 5 yr. M Facial eczema
12/17/2013 G.V. 2 yr. M Oral thrush, B/L otitis, keratitis pilaris, eczema to cheeks
12/17/2013 A.C. 23 yr. F Rt Elbow pain/sprain, severe eczema to hands Brace
12/17/2013 J.V-P. 41 yr. M Contact dermatitis eyelids
12/17/2013 J-X.G-D. 6 yr. M Night time enuresis, premature, n/o penis infections
12/17/2013 Y.A-H. 17 mo. F B/L otitis media, URI 400mg/5u 1 1/4
12/17/2013 J.A. 37 yr. F Irritable Bowel, costochondritis
12/17/2013 E.V. 27 yr. F Food Poisoning, vomiting, diarrhea BRATTY
12/17/2013 J.R-C. 39 yr. M Rt. Knee medial tendonitis at insertion of sartorius 2cc 0.5% marcaine, 1cc kenalog Rt. Knee
12/17/2013 A.P. 2 yr. M Otitis Media, diarrhea, seasonal allergies
12/18/2013 T.B-P. 3 yr. F Otitis media, conjunctivitis, cerumen impaction Ear Lavage
12/18/2013 M.M. 48 yr. M DKA - sent to ER
12/18/2013 S.B-P. 7 yr. F B/L Otitis Media, B/L Conjunctivitis
12/18/2013 E.O-J. 34 yr. F Back Pain, Somatic dysfxn C,T,L spine HVLA OMT C,T,L spine
12/18/2013 B.W. 49 yr. M Rt Hip Bursitis, Rt Sacral Trigger point 3cc. 0.5% Marcaine injected into right hip bursa
12/18/2013 S.H. 33 yr. M Back Pain f/u MRI MRI
 
I have a spiral notebook that I keep my logs in during the job. The information then gets put into a spreadsheet later. Helps me keep track of what charts I have done and signed too since I hate EMR and haven't figured out a better way to keep track. Also give me quick reference for patients with pending labs, etc so I don't have to search the EMR.
 
Seriously wondering how many back pain patients you get per day/wk?
 
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