As a physician considering a locum tenens position, one of your biggest questions will undoubtedly concern patient continuity of care. How will your relationship with patients be different if you’re only there for a few weeks, or even days? Will you be able to engage in meaningful ways with your patients? Will your work still be as rewarding?
In the end, there’s really no right or wrong answer. What serves as a good fit for one doctor may not work well for another. Still, physicians who have worked locum tenens often have surprising things to say when it comes to continuity of care.
More time with patients and more professional satisfaction
Dr. David Jessup, an interventional cardiologist, had mixed feelings about locum tenens physicians for a long time. He didn’t quite understand how they fit in. For one thing, they didn’t have to attend all the same meetings that he and the other doctors did.
But after trying locums for himself, Dr. Jessup discovered that what he’d previously thought of as oddities were actually perks. “If I’d wanted to be a businessman,” he says, “I’d have gotten my MBA. Locums allows me the opportunity to be a doctor. I don’t worry about my RVUs. It really provides me a lot of professional satisfaction to be able to tell patients that I get paid regardless of what I do to you.”
It’s a subtle shift of perspective, but one that makes the time Dr. Jessup spends with his patients more enjoyable. He may not participate in all of the decision-making, but he feels that he has more bandwidth to spend time with his patients and answer their questions.
“I’ve received more thank you cards and had more patients attempt to bribe me to stay now that I’m a locums,” he says. “I’ve received gift baskets and going away cards. I will agree that I don’t have the tenure follow up with some patients that I had previously. But I will disagree that my relationships aren’t as in depth.”
Is continuity of care in crisis?
Dr. Faisal Shamshad, another interventional cardiologist, came to locums like many physicians — that is, almost by accident. He wanted to change hospitals, but a no-compete clause in his previous position prevented him from accepting another job in his current location for 18 months. Locums seemed like a good way to bridge the gap.
Fast forward several years, and Dr. Shamshad is still working locums — but only because he prefers it. “I often say that when you do locums for over a year, it becomes very hard to go back into a setting and work for the proverbial man.”
Still, Dr. Shamshad cares deeply about continuity of care, which he says is a problem for all doctors, not just locum docs. “I’m in the hospital as the interventionalist — every day there’s a different general cardiologist rounding on the patients,” he says. “And the next day, it’s a different guy. The third day, there will be a different one. These patients are sort of lost!”
Paradoxical as it might sound, Dr. Shamshad finds that a locum tenens physician often has a unique opportunity to be different — to serve patients in ways the other doctors can’t. His experience has been similar Dr. Jessup’s.
“Since I’m not under pressure for generating tons of RVUs, I can afford the time to talk about things,” he says. “Even if it’s not my patient but I’m coming in to do a procedure — I can sit down with them, go through their chart, and tell them, ‘This is why you’re here. This is why your doctor ordered this stuff.’”
For Dr. Shamshad, continuity of care in today’s healthcare systems is very nearly in crisis. He isn’t sure what the solution is but being a locums doesn’t mean he’s on the outside.
Being truly engaged with your patients
Dr. Umesh Bhandari, a psychiatrist, turned to locum tenens early in his career for two reasons: one, because he wasn’t sure what region of the United States he wanted to call home; and two, because he wanted to avoid the organizational politics and bureaucracies that come with a full-time position. What Dr. Bhandari didn’t expect was how much being able to take time off between assignments would help him care for his patients more effectively.
As a psychiatrist, Dr. Bhandari’s cases are often intense: a patient recovering from a drug overdose, another who has attempted suicide. For a full-time physician, the stress can be overwhelming. “When I look at the notes of the doctors I’m relieving, I can tell when they’ve hit a wall,” says Dr. Bhandari, “because their notes are not as detailed.”
For Dr. Bhandari, being a locum means coming to these situations with new eyes and a mental freshness that allows him to be more present and engaged with his patients. His ideal assignment is seven days on, seven days off. He may not be able to monitor the long-term progress of his patients, but in the short-term he feels more invested.
“If you’re there, be engaged, be in the moment, work with your patients,” he says. “They’re looking to you for guidance, for information, for someone to talk to about med management. True success can only be achieved if you’re there and engaged on the unit — day in and day out.” Easier said than done, of course. But working locums protects Dr. Bhandari from burning out.
Not so different than being a full-time employed physician
For Dr. Shyrlena Bogard, an OB/GYN, locum tenens is a good fit because it gives her time to pursue her other interests on the side. Meanwhile she has a completely different take on continuity of care than someone new to locums might expect. That’s because, despite being a locum tenens physician, Dr. Bogard has worked at the same location for the last three years.
“I know the nurses really well,” she says. “Some of the patients I’ve delivered more than one of their babies. The patients recognize me in town.”
While Dr. Bogard’s experience may seem to contradict many people’s understanding of what it means to be a locum, it isn’t necessarily unusual. After all, a locums tenens physician gets to choose what contracts to accept, which means choosing your location.
Add to that the fact that Dr. Bogard is already in a field of medicine where patients aren’t surprised when a new doctor walks into the room. “Obstetrics is a 24-hour job,” she explains. “Gone are the days when a practitioner is on call 24/7. Most patients have the understanding that the physician who’s on call for the hospital is the physician who’s going to do their delivery.”
What would locums mean for you?
When you become a locum tenens physician, you get to choose when and where you work. Being able to control your own schedule is one of the great advantages. Of course, there are downsides too, and working locum tenens may not be right for everyone. But if concerns about patient continuity of care is keeping you from accepting a locums assignment, you may want to reconsider. Many physicians say working locums can actually improve your interactions with patients, giving you the time and energy to be the best possible physician you can be.
