Veteran locum physician Dr. Trevor Cabrera offers his pointers and perspectives to newly graduated residents about locum tenens.
Most providers working locum tenens have traditionally done so as an adjunct to some sort of other stable “permanent” job, as a bridge between jobs, or as they are slowly edging their way into semi-retirement after toiling away at a tenured position for an entire career.
Regardless of the reason — for family, freedom, or to altruistically care for indigent populations in underserved parts of the country or the world — a majority have generally served some time established in their field as an attending physician prior to working locum tenens. For many reasons, including life stability, experience among peers, and establishment of a practice mentality, this makes sense. However, healthcare has evolved. The growing desire of young physicians is to seek a deviation from the historic norm, and with a changing workforce, more and more new physicians immediately after residency training find themselves considering locum tenens work. As one of those new graduates in the last few years, with very few before me to look to for questions, guidance, and warnings, I want to give my perspective on the things I wish I would have done or known as a brand-new graduate — affectionally termed a ResiGrad.
Maintain relationships with mentors
Recently, a senior resident contacted me for advice on starting out his career working locum tenens, with specific questions of where to find a mentor and what to do if he had questions and there’s no one nearby. Well, frankly, if you chose this path, there will be many unknowns. Working locum tenens pushes physicians to use their critical thinking skills and become creative practicing medicine.
I remember during the first several months as a new attending, there were many late nights that I would call back to speak to my mentors from training. I will never forget the difficult cases I would occasionally run by them as I decided what the next best step would be on my own. Further, it is absolutely critical that physicians collect multiple references from training to serve as attestations for each new job as the connections are generally only valid for 24 months. This last point cannot be emphasized enough, especially as you move from one facility to another.
What do locums do about benefits?
Prior to graduating residency, I was sure to expand my individual disability insurance, at the least to allow a rider for further expansion down the line. Negotiating other benefits such as health and dental insurance as a locum tenens can be difficult, and is something that should be considered carefully prior to starting. While I purchased my insurance through the Healthcare Marketplace, holding a part-time W-2 job in addition to working locums is sometimes useful to allow some sort of personal coverage in case of emergency.
Plan out certifications, licenses, and renewals
Paying attention to deadlines and renewal guidelines for medical licenses and DEA certificates obtained throughout the end of training can be useful. I would recommend waiting as long as you can to seek reimbursement for the above in potential job opportunities. You can also consider self-purchase of a license or even obtaining your licenses through the IMLC if you plan on exclusively working locums. It also becomes significantly harder to find renewal programs for CPR certificates after training. As many programs are built into academic institutions to renew basic life-savings skills, I wish I had taken advantage of their discounts and ease at the end of my training.
Taxes are tedious
Consider establishing a tax home in a state without income taxes. Post office boxes are great for business mail. Follow the law, and when it gets complicated, finding a good accountant might be worthwhile. If you are a daring entrepreneurs, establish an LLC, read the books, and figure out ways to legally traverse the system as an independent contractor; but, humbly remember you are a healthcare provider, most likely not a tax expert, yet.
LEARN MORE: 7 tax benefits of being a locum tenens doctor
From day one, keep track of your malpractice certificates of liability insurance, keep spreadsheets with expiration dates, CME needs, and health records. I personally also have supplemental Word documents with a list of my hospital affiliations, privileges, contacts, and of course, my residences for the last decade.
Working locum tenens directly out of residency can be exciting and intimidating, but I will forever stand by the professional and personal worth I have found in it. While the list goes on and on of things that you can learn or need to know, hopefully this starts off the ResiGrad on the right path to success as a locum tenens.