Upcoming Locum Assignment - The Hard Numbers

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Volatile said:
I locums at a small level 3 community hospital. Call is homecall at a beeper rate. When I get called in rate is $220/hr, they tack on an additional hour of pay for travel time (I live 10mins away though ) . I sit my own cases, no cardiac, OB, or peds <9yo. I’ve never had any complex trauma, they go to the level 1/2’s. I have never been called in at night. If I did cardiac or complex peds I would push for a higher rate for those cases but I’m not interested. I have full time benefits at my main w2 gig but if I was strictly working 1099 I would have pushed for higher rates.
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Sometimes cardiac can negotiate a higher hourly rate. I too sit my own cases exclusively as I am unwilling to go to places where they ask me to supervise 3:1 or 4:1 some incompetent CRNAs. It was far more important to me to get 10 hours guaranteed at a smaller $$$ amount ($215 vs say $240) with a bump to $275 when over 10 hours as opposed to having variable days where I may be there anytime between 8 and 12 hours. I prefer the regularity of it so I can then use the gym and explore the local scenery.

Not every locum trip is exclusively business. Most places have some entertainment and nature to explore and enjoy.
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Zekchar said:
If Biden wins, the markets are going to tank. Thus I want "dry powder" to either have more to invest or to have more options for a down payment in case I need to switch jobs. The market is grossly overvalued and eventually the Fed will stop printing money. Then the full brunt of COVID will be felt. Unfortunately I believe it will be drastic.
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and when that happens... i'm sure the republicans will try to blame it on the democrats
 
When you arrive at a new locums gig, how long does it take you to feel somewhat comfortable with the general layout of things?

I would think it would take me at least a few days to get to know where things are, the nuances of the culture at that hospital (Dr. XXX doesn't ever want any regional blocks, Dr. YYY takes three times as long as you would expect, etc.), the EMR, the buttons on their epidural pumps, which CRNA's can be trusted and which ones can't, etc.

Do you show up a day early to at least get a feel for the layout of the OR/PACU/locker room?

I would worry that I would just start to feel comfortable as my gig was coming to an end...
 
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Dinkyconductor said:
When you arrive at a new locums gig, how long does it take you to feel somewhat comfortable with the general layout of things?

I would think it would take me at least a few days to get to know where things are, the nuances of the culture at that hospital (Dr. XXX doesn't ever want any regional blocks, Dr. YYY takes three times as long as you would expect, etc.), the EMR, the buttons on their epidural pumps, which CRNA's can be trusted and which ones can't, etc.

Do you show up a day early to at least get a feel for the layout of the OR/PACU/locker room?

I would worry that I would just start to feel comfortable as my gig was coming to an end...
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Last one i did, i was 90 minutes in the door when emerg rang with a cspine # needing a tube. That was a nice introduction
 
Dinkyconductor said:
When you arrive at a new locums gig, how long does it take you to feel somewhat comfortable with the general layout of things?

I would think it would take me at least a few days to get to know where things are, the nuances of the culture at that hospital (Dr. XXX doesn't ever want any regional blocks, Dr. YYY takes three times as long as you would expect, etc.), the EMR, the buttons on their epidural pumps, which CRNA's can be trusted and which ones can't, etc.

Do you show up a day early to at least get a feel for the layout of the OR/PACU/locker room?

I would worry that I would just start to feel comfortable as my gig was coming to an end...
Click to expand...
It’s not bad. The local people help you. It’s in their best interest to help you.
Just be amicable and not a jerk and you get used to it.
 
Dinkyconductor said:
When you arrive at a new locums gig, how long does it take you to feel somewhat comfortable with the general layout of things?

I would think it would take me at least a few days to get to know where things are, the nuances of the culture at that hospital (Dr. XXX doesn't ever want any regional blocks, Dr. YYY takes three times as long as you would expect, etc.), the EMR, the buttons on their epidural pumps, which CRNA's can be trusted and which ones can't, etc.

Do you show up a day early to at least get a feel for the layout of the OR/PACU/locker room?

I would worry that I would just start to feel comfortable as my gig was coming to an end...
Click to expand...

I personally felt fairly comfortable by the end of day 2. Day 1 always entails HR stuff, getting passwords, and figuring out locker room codes. Usually 1 doc is assigned to show you around and observe one case, then you're on your own. The beauty of anesthesia is that once you're good at it, the work stays the same no matter where you go.

At baseline I tend to be very self sufficient and minimize how much I rely on anesthesia techs and others for help or support. Thus, by the 3rd case I'd be fetching my own spinal kits and 100ml vials of propofol and thus not annoying the techs.

As for which CRNAs to trust, the answer is none of them. I only do locums at places where Its physician only practice and thus I minimize my disappointment. Never show up especially early or offer free labor. You are a hired hand and the site is invested in your clinical output only. They will help facilitate your orientation and put you in a position to do what you do best ... provide anesthesia. Stay out of the local drama, account for every minute worked, be nice and friendly to everyone, and you'll have a great time.

When that paycheck hits at the end of 2 weeks, it's extra sweet.
 
Zekchar said:
I personally felt fairly comfortable by the end of day 2. Day 1 always entails HR stuff, getting passwords, and figuring out locker room codes. Usually 1 doc is assigned to show you around and observe one case, then you're on your own. The beauty of anesthesia is that once you're good at it, the work stays the same no matter where you go.

At baseline I tend to be very self sufficient and minimize how much I rely on anesthesia techs and others for help or support. Thus, by the 3rd case I'd be fetching my own spinal kits and 100ml vials of propofol and thus not annoying the techs.

As for which CRNAs to trust, the answer is none of them. I only do locums at places where Its physician only practice and thus I minimize my disappointment. Never show up especially early or offer free labor. You are a hired hand and the site is invested in your clinical output only. They will help facilitate your orientation and put you in a position to do what you do best ... provide anesthesia. Stay out of the local drama, account for every minute worked, be nice and friendly to everyone, and you'll have a great time.

When that paycheck hits at the end of 2 weeks, it's extra sweet.
Click to expand...
Never had anyone assigned to observe me for any case. Almost always been emailed all my passcodes. Often I literally show up and am given a room in most places after I am shown the ORs. Start with a late room. Yeah supervising CRNAs as a locums sucks in most places. I quit one place as I found something better and the other place I do it is a small surgicenter and the CRNAs are good and call for help when needed. Never been given a locker. Usually just leave my stuff in some anesthesia office and wallet and phone with me.

Every place is different. I go with the culture. If the nurses and techs are helpful and know that’s their job to assist me and get me stuff, I go with the flow. Just today I asked for some nasal trumpets and the RN showed me the anesthesia cart. I said, OK, thanks. Now I know.
 
Interesting...I would have thought that supervising CRNA's would be -better- than doing your own cases in an unfamiliar environment, since they could answer most of those questions about the culture/where things are etc.

"Yeah supervising CRNAs as a locums sucks in most places."

Any reason that supervising CRNA's in locums is worse than supervising them in a non-locums setting? I've never supervised a CRNA but it does seem that everyone on this forum categorically hates it. Do they just dump all the worst ones on you, knowing you won't be there in a month to complain about it?
 
Dinkyconductor said:
Interesting...I would have thought that supervising CRNA's would be -better- than doing your own cases in an unfamiliar environment, since they could answer most of those questions about the culture/where things are etc.

"Yeah supervising CRNAs as a locums sucks in most places."

Any reason that supervising CRNA's in locums is worse than supervising them in a non-locums setting? I've never supervised a CRNA but it does seem that everyone on this forum categorically hates it. Do they just dump all the worst ones on you, knowing you won't be there in a month to complain about it?
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You don’t know the CRNAs. You don’t know who’s good who’s incompetent. You May get some bad attitudes but that’s a cultural thing not necessarily because you are a locums. They may not call for induction.
You may get one who doesn’t call when patients decompensate. Walked into a room with a CRNA who was limping a patient along who’d obviously aspirated through the LMA and I just happened to be making rounds and noted the patients color was off through the door. He declined the RNs offer to call me for help and this went on for over 15 minutes with poor sats and him telling surgeon that’s he was ok up there. Patient spent the night in the Unit. Thankfully younger and did fine.
Because they don’t need us.
You just don’t know what you are getting into.
I have had a bad couple of days, but it was all me. I don’t like to be responsible for others.
 
When I hear of stories like this I always think, but isn’t that obvious? I guess some people never get it.

chocomorsel said:
You don’t know the CRNAs. You don’t know who’s good who’s incompetent. You May get some bad attitudes but that’s a cultural thing not necessarily because you are a locums. They may not call for induction.
You may get one who doesn’t call when patients decompensate. Walked into a room with a CRNA who was limping a patient along who’d obviously aspirated through the LMA and I just happened to be making rounds and noted the patients color was off through the door. He declined the RNs offer to call me for help and this went on for over 15 minutes with poor sats and him telling surgeon that’s he was ok up there. Patient spent the night in the Unit. Thankfully younger and did fine.
Because they don’t need us.
You just don’t know what you are getting into.
I have had a bad couple of days, but it was all me. I don’t like to be responsible for others.
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secretasianman said:
When I hear of stories like this I always think, but isn’t that obvious? I guess some people never get it.
Click to expand...

That aspiration case was probably a combination of CRNA denial ("it cant possibly be..." "it doesn't happen to me...") and arrogance ("asking for help makes me look weak"). Unfortunate situation. I've had a few of these myself, in cases even more obvious than that... patient for endoscopy who vomited and with a pool of vomit on pillow next to him... desat to 80s, CRNA doesn't know why and didn't page me... GI nurse in room pages me because she was concerned. Intubated, fiberoptic scoped to retrieve aspirate, sent to ICU. Patient fortunately turned out ok and extubated next day.
 
Sounds like the gi nurse was a better crna than the crna.
siucng said:
That aspiration case was probably a combination of CRNA denial ("it cant possibly be..." "it doesn't happen to me...") and arrogance ("asking for help makes me look weak"). Unfortunate situation. I've had a few of these myself, in cases even more obvious than that... patient for endoscopy who vomited and with a pool of vomit on pillow next to him... desat to 80s, CRNA doesn't know why and didn't page me... GI nurse in room pages me because she was concerned. Intubated, fiberoptic scoped to retrieve aspirate, sent to ICU. Patient fortunately turned out ok and extubated next day.
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coffeebythewater said:
That aspiration case was probably a combination of CRNA denial ("it cant possibly be..." "it doesn't happen to me...") and arrogance ("asking for help makes me look weak"). Unfortunate situation. I've had a few of these myself, in cases even more obvious than that... patient for endoscopy who vomited and with a pool of vomit on pillow next to him... desat to 80s, CRNA doesn't know why and didn't page me... GI nurse in room pages me because she was concerned. Intubated, fiberoptic scoped to retrieve aspirate, sent to ICU. Patient fortunately turned out ok and extubated next day.
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Good management. I had this happen in the past month. I walked in, wasn’t called. Intubated, bronched, suctioned. I extubated pt as there was no particulate matter, just a bunch of mag citrate. Pt stayed overnight on telemetry.
 
D P356 said:
Good management. I had this happen in the past month. I walked in, wasn’t called. Intubated, bronched, suctioned. I extubated pt as there was no particulate matter, just a bunch of mag citrate. Pt stayed overnight on telemetry.
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It's a numbers game in GI lab.
Do enough cases and you will have a patient aspirate.
I've had a handful of cases over the years, some completely unexpected (appropriate NPO, no gerd, no HH, no other risk factors)

If patient is fully awake we just monitor sats on supplemental O2, work of breathing, and have them cough a bunch
If patient isn't fully awake or isn't satting well we intubate, bronch and send to unit. Sometimes I try to extubate, sometimes I don't.
Either case they need to go somewhere w continuous pulse oximetry and possibly ICU.
 
The locums industry has fallen of a cliff. Blame Covid, economy whatever, there are 10 Locum applicants for one job opening. Driving the negotiation to rates at the lower end/per hour. Unless case volume picks up hospitals don’t seem to be in a hurry to get locums. Plenty of standard full time jobs with Somnia, vituity, NAPA Etc. No problem for young anesthesiologists.
 
Really? Why are the locums companies calling me then? Random people I have no relationship with. The Rona has put a strain and imbalance in the whole system. If you were close to retiring, would you have any interest in busting ass to work more, and put yourself at more risk? I think not.

inquisitiveanes said:
The locums industry has fallen of a cliff. Blame Covid, economy whatever, there are 10 Locum applicants for one job opening. Driving the negotiation to rates at the lower end/per hour. Unless case volume picks up hospitals don’t seem to be in a hurry to get locums. Plenty of standard full time jobs with Somnia, vituity, NAPA Etc. No problem for young anesthesiologists.
Click to expand...
 
inquisitiveanes said:
The locums industry has fallen of a cliff. Blame Covid, economy whatever, there are 10 Locum applicants for one job opening. Driving the negotiation to rates at the lower end/per hour. Unless case volume picks up hospitals don’t seem to be in a hurry to get locums. Plenty of standard full time jobs with Somnia, vituity, NAPA Etc. No problem for young anesthesiologists.
Click to expand...

I get emails and calls every day asking for locums help...
 
inquisitiveanes said:
The locums industry has fallen of a cliff. Blame Covid, economy whatever, there are 10 Locum applicants for one job opening. Driving the negotiation to rates at the lower end/per hour. Unless case volume picks up hospitals don’t seem to be in a hurry to get locums. Plenty of standard full time jobs with Somnia, vituity, NAPA Etc. No problem for young anesthesiologists.
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Yeah no, there are people getting 250-300/h. No need to accept bottom of the barrel jobs while getting jacked by a bunch of suits. Many partners are escaping covid and retiring into a booming stock market. Operations are still happening and groups are offering reasonable (1-2 year) tracks.
 
secretasianman said:
Really? Why are the locums companies calling me then? Random people I have no relationship with. The Rona has put a strain and imbalance in the whole system. If you were close to retiring, would you have any interest in busting ass to work more, and put yourself at more risk? I think not.
Click to expand...

Yes you are correct, if I am close to retirement, I would not be interested in Full time new employment and putting myself at Covid risk. However one cannot sit idly at home without doing any work either. With the locums and part time gigs drying out, and no ability to travel, newly formed anesthesia venture (Vulture) companies are waiting for us to sign the dotted lines for full time fun.
Sorry, the American dream becomes a nightmare when things don’t work out. Capitalism as a Ponzi scheme has to expand and find newer markets to get greater returns.

Jack London: The Iron Heel: Chapter IX. The Mathematics Of A Dream - Free Online Library

Free Online Library: London, Jack - The Iron Heel by Jack London Chapter IX. The Mathematics Of A Dream - best known authors and titles are available on the Free Online Library
london.thefreelibrary.com
 
If you are speculating then it is not helpful to be posting misleading statements that are hurtful to the profession on the whole. If I wanted to quit now and go full locums, I can probably pull it off based on what I know. Just saying. I also know a friend in SoCal who does full time locums who immediately got work the week they opened back up, and continues to work. How would that happen with a 10:1 ratio of supply to demand?

inquisitiveanes said:
Yes you are correct, if I am close to retirement, I would not be interested in Full time new employment and putting myself at Covid risk. However one cannot sit idly at home without doing any work either. With the locums and part time gigs drying out, and no ability to travel, newly formed anesthesia venture (Vulture) companies are waiting for us to sign the dotted lines for full time fun.
Sorry, the American dream becomes a nightmare when things don’t work out. Capitalism as a Ponzi scheme has to expand and find newer markets to get greater returns.

Jack London: The Iron Heel: Chapter IX. The Mathematics Of A Dream - Free Online Library

Free Online Library: London, Jack - The Iron Heel by Jack London Chapter IX. The Mathematics Of A Dream - best known authors and titles are available on the Free Online Library
london.thefreelibrary.com
Click to expand...
 
GassYous said:
Yeah no, there are plenty of people getting 250-300. No need to accept bottom of the barrel jobs while getting jacked by a bunch of suits. Many partners are escaping covid and retiring into a booming stock market. Operations are still happening and groups are offering reasonable (1-2 year) partnership tracks.
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Escaping Covid and planning realistically is good. However where is the booming market? Just getting some indices to go up everyday is not a reality. Why is jc penny’s bankrupt and laying off employees? Why do you think I as an anesthesiologist is immune to all that lay offs? The last gig I worked in July 2020, hospital had 1-2 cases per day. 2 endos, Medicare pays 85 bucks for that. Locums paid 1800 per day +accommodation +malpractice. The locums company turned around and charged 3300 per 8 hr shift. Vulture company takes over anesthesia services at this hospital and fires locums Company.
 
secretasianman said:
If you are speculating then it is not helpful to be posting misleading statements that are hurtful to the profession on the whole. If I wanted to quit now and go full locums, I can probably pull it off based on what I know. Just saying. I also know a friend in SoCal who does full time locums who immediately got work the week they opened back up, and continues to work. How would that happen with a 10:1 ratio of supply to demand?
Click to expand...

Right now this is what it is. I am not a recruiter. Just stating the down side of locums opportunity. For that position in Valencia, there were 10 competing bids. People keep talking about SoCal? My anesthesia colleagues drive up all the way from beautiful Palm Springs to Central Valley California to do locums. Can you please send some of those Locum recruiter calls my way.
 
inquisitiveanes said:
Right now this is what it is. I am not a recruiter. Just stating the down side of locums opportunity. For that position in Valencia, there were 10 competing bids. People keep talking about SoCal? My anesthesia colleagues drive up all the way from beautiful Palm Springs to Central Valley California to do locums. Can you please send some of those Locum recruiter calls my way.
Click to expand...

In my neck of the woods, NE, plenty of recruiters calling for the same jobs.
 
inquisitiveanes said:
Right now this is what it is. I am not a recruiter. Just stating the down side of locums opportunity. For that position in Valencia, there were 10 competing bids. People keep talking about SoCal? My anesthesia colleagues drive up all the way from beautiful Palm Springs to Central Valley California to do locums. Can you please send some of those Locum recruiter calls my way.
Click to expand...
This morning's email ... I have no affiliation with this specific recruiter

"I am working with multiple hospitals in California in need of Anesthesiologist. With multiple facility locations needing help, so hopefully you will find one that fits your needs. If you are interested and available to help with coverage or know anyone that would have interest, please call, text, or email an updated copy of your CV. See details about these opportunities below.

Opportunity #1

  • Flexible schedule
  • 8,12, and 24 hour shifts available
  • Caseload: 10-12 patients per day
  • Procedures: Nerve Blocks, No OB, General, GI, ENT, GYN, ortho, vascular, thoracic, urology, plastics, ophthalmology
  • Board Certified Anesthesiologist
  • CA License
  • Cardiac is NOT required
  • Paid Travel and Lodging
  • Interim will cover malpractice (tail)
Job #205995

Opportunity #2

  • 7:00am - 3:00pm & 7:00am – 5:00pm
  • Excellent Support Staff
  • General Anesthesia Cases
  • No Cardiac
  • Must be Board Certified
  • Paid Travel and Lodging
  • Interim will Cover Malpractice (Tail)
Job #205954
Opportunity #3

  • Monday – Friday
  • 8,10 & 12 hour shifts available
  • Must be willing to take weeknight overnight OR PM call
  • Weekends available if locum desires
  • Low Volume: Less than 10 patients per day
  • Bread and butter Anesthesia- No Cardiac or Neuro
  • Board Certified Anesthesia- Required
  • 30 Day credentialing process
  • Interim physicians will cover malpractice (tail)
Job # 205990

Opportunity #4

  • Monday – Friday
  • Shifts: 12 Hours plus Call Coverage
  • Bread and Butter Anesthesia
  • Average 4-5 cases per day
  • Must be willing to cover Trauma and OB
  • No Hearts
  • Cerner EMR
  • Credentialing: 30-60 Days
  • License: CA
  • Must be Board Certified or truly eligible (5 years post residency)
  • Paid Travel and Lodging
  • Interim will cover your malpractice (tail)
Job # 206006

Looking forward to speaking with you soon!

Nick Rike
RECRUITING DIRECTOR
Direct: (314) 336-4380
Mobile: (314) 814-1882
www.interimphysicians.com
 
inquisitiveanes said:
Right now this is what it is. I am not a recruiter. Just stating the down side of locums opportunity. For that position in Valencia, there were 10 competing bids. People keep talking about SoCal? My anesthesia colleagues drive up all the way from beautiful Palm Springs to Central Valley California to do locums. Can you please send some of those Locum recruiter calls my way.
Click to expand...

Here's another from yesterday. Also I have no affiliation.

"
Hope you had a good weekend! We are still looking for locums help in Northern California. Any chance you might be able to help out or may know someone?

Anesthesiology locums needed in northern California
Need is ongoing (30-60 day credential)
Shift times are 7a-3p in the main OR
Large variety of cases (lots of ortho and general).
Also have gyn, ENT, vascular, head and back, urology.
No hearts
No nights, no call
Average 4-10 cases per day
Must be board certified
Located in Redding, CA
This job pays $185/hr plus travel and lodging

Please send current cv if interested!




Dawn Everson
Senior Staffing Consultant

Office 801-784-6052 | Fax 801-784-2247 | Text 801-784-6052
Mailing Address
PO Box 1865 | Sandy, UT 84091
Physical Address
10150 Centennial Pkwy, 120 | Sandy, UT 84070
 
inquisitiveanes said:
Right now this is what it is. I am not a recruiter. Just stating the down side of locums opportunity. For that position in Valencia, there were 10 competing bids. People keep talking about SoCal? My anesthesia colleagues drive up all the way from beautiful Palm Springs to Central Valley California to do locums. Can you please send some of those Locum recruiter calls my way.
Click to expand...
Well maybe if you want to hold on to a saturated market like Southern California you will be fighting with ten other people for a job. I have no problem getting work now. But I also go to “undesirable“ places that are desirable to me.
Plenty of work out there. I get emails all the time from different companies.
 
chocomorsel said:
Well maybe if you want to hold on to a saturated market like Southern California you will be fighting with ten other people for a job. I have no problem getting work now. But I also go to “undesirable“ places that are desirable to me.
Plenty of work out there. I get emails all the time from different companies.
Click to expand...

That dude probably wants a locum gig 10 feet from Malibu beach. This way he can improve his base ban in between turnovers. Must have fine dining for after hour shenanigans and a wine bar within distance of his 4 Seasons stay. Gen cases only with 8 hours guaranteed with no call. $300/hr or he wont even reply to your email. Oh and make sure the steak in cafeteria is aged the right amount during his 1 hour lunch break.
 
Zekchar said:
Here's another from yesterday. Also I have no affiliation.

"
Hope you had a good weekend! We are still looking for locums help in Northern California. Any chance you might be able to help out or may know someone?

Anesthesiology locums needed in northern California
Need is ongoing (30-60 day credential)
Shift times are 7a-3p in the main OR
Large variety of cases (lots of ortho and general).
Also have gyn, ENT, vascular, head and back, urology.
No hearts
No nights, no call
Average 4-10 cases per day
Must be board certified
Located in Redding, CA
This job pays $185/hr plus travel and lodging

Please send current cv if interested!



Dawn Everson
Senior Staffing Consultant

Office 801-784-6052 | Fax 801-784-2247 | Text 801-784-6052
Mailing Address
PO Box 1865 | Sandy, UT 84091
Physical Address
10150 Centennial Pkwy, 120 | Sandy, UT 84070
Click to expand...
The pay seems quite low
 
Lashler9054 said:
The pay seems quite low
Click to expand...

It is. That's also their anchoring. You anchor at $275 and chances are you will settle at $215-230. Thats business strategy negotiations 101. They hope theres a needy and desperate enough sucker who will accept the $185. Your job is to get a fair market rate. The only way you'll know the fair market rate is by emailing multiple recruiters back and negotiating. Then you see what most will settle on and let that be your walk away number.
 
Aren't those rates crap? You're basically working like a hospitalist, 2 weeks on, presumably 2 weeks off and take home is around 300k pre tax... Unless of course you want to work those other 2 weeks for another 120 hours or even part time, which you can also do as a hospitalist.
 
Another thing I've been concerned about...have locum anesthesiologists found that they're placed in a room more or less at random, or does a practice tend to put the locum person in the most unpleasant room (roughest cases/difficult surgeons/sickest patients)?

I can envision a practice doing this, again knowing that the locum person won't stick around to complain/retaliate.

On the other hand, if a practice develops a reputation for abusing its locum providers, it might make it tough for them to hire them again next time they're needed.
 
Dinkyconductor said:
Another thing I've been concerned about...have locum anesthesiologists found that they're placed in a room more or less at random, or does a practice tend to put the locum person in the most unpleasant room (roughest cases/difficult surgeons/sickest patients)?

I can envision a practice doing this, again knowing that the locum person won't stick around to complain/retaliate.

On the other hand, if a practice develops a reputation for abusing its locum providers, it might make it tough for them to hire them again next time they're needed.
Click to expand...

I thought it was fairly distributed. They're invested in you succeeding so once they put you in some easier situations and all is well, they let you spread your wings a bit more. If you perform poorly, everything is grossly disrupted so they set you up to fail. Especially when the permanent people then have to pick up the slack.
 
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