Gawking at modern art on Canyon Road in Santa Fe, New Mexico’s capital. Trekking through snow-capped mountains across Southern Vermont. Sipping a Sezarac at the Hotel Monteleone in the French Quarter of New Orleans after a string of shifts are complete, with a Second Line (brass band) pumping out beats.
Locums began as a small flicker in my career; however, as I breathed more life into it, the opportunities and incredible diversity of experiences it offered were simply unlimited. When I fanned the flicker to flames, I realized just how much this model offered to enrich both my career and my life. That flame engulfed my career.
Picking your assignments
With that said — with endless possibilities on your horizon — how does one go about carving out a career? Is locums full-time or part-time for you? Is it better to go for a higher paying position? Is your heart in it for better pay, liberation from administrative hassles, to simply see the country? Or are you looking to sharpen your skill set in a different locality?
All fair questions, and all things to ruminate over. I dove into my locums career without really contemplating any of these. My initial focus was freedom with my schedule and my practice, and practicing under my own standards. But as the years went on, I realized there was more to this model than I anticipated.
A richness of diversity
While I mentioned in previous posts that I have locums arrangements with several hospitals, through the years I have carefully chosen my practice to maintain a richness in diversity of experiences. I have learned generally to understand and question why an institution needs me, and why they are paying more than others. Often it was simply because the needs became urgent and staffing is sparse. Unfortunately, however, it can also mean the environment is challenging to work in, or the administration may be more difficult to collaborate with.
Once this “elephant in the room” question is out of the way, I step back and ask myself simply what this assignment will offer me. Location in a desirable city? Complex pathologies? Ongoing needs and avoiding the headaches of constantly recredentialing? Or perhaps the pay itself justifies the experience, so that I can take other lower paying assignments in more favorable locations.
Deepening my clinical experience
I enjoy selecting places that will have variations in disease presentations and acuity. There are many varieties of patients emergentologists take care of, and with that comes complex pathologies and a multitude of procedures. When I work in border towns, I manage a heavy load of trauma independently. At our county hospital in Houston, we care for large underserved populations with minimal access to care. In my critical access localities, my specialty back-up is minimal and the flow extremely fast-paced.
Each state also has various nuances that alter what I must manage and further broadens my skill set. The opioid epidemic has devastated rural communities in the South, causing me to fine-tune my skills managing Narcan drips and incising abscesses from IV drug use in challenging anatomical locations. The massive migration of immigrants from the south brings drug packers and stuffers as well as cartel violence. And rural Missouri is replete with agricultural-related incidents such as toxic exposures and trauma related to industrial equipment. This variety makes me feel in full command of the spectrum of skills I must know and manage as an ER physician, so that just when I may feel comfortable in one setting, I am thrust into a new one and my focus must change.
Living as a local
Beyond this, the richness of “living” in a city temporarily and also working there unearths an entirely new form of traveling. It has allowed me to make some of the greatest friends all over the country. I often stay over in the states I work in to spend time with my friends. My time in New Mexico is just one example: Albuquerque has a thriving craft brewery scene, while Santa Fe has unlimited options for hiking and mountain biking.
There are of course downsides to this model. One is the constant traveling to so many locations. Personally I find that part enjoyable if it allows me to have the schedule I want. Going to an unknown ER can also be a bit daunting, but I relieve that stress by speaking to other physicians that work there to understand the environment.
Certain EMRs are very difficult to work with to optimize patient care. When an institution does not invest in a high quality EMR, I have found that to be a potential warning sign that there may be other issues that will make the assignment challenging. Some of these underlying issues often include having to do with admission orders, hospitalists that give pushback, and poor staffing of the ED, which can push an ER provider beyond their means. Finally, it’s a good idea to try to vet out the duration of need, simply because engaging in the credentialing process and getting comfortable with staff, then having the work dry up, is very frustrating.
Never look back
Locums is such a unique way to be a physician, to serve parts of the country that are in need, and to experience cities in a unique way. This richness in diversity can be tailored specifically for you based on what you hope to gain from the model. It also allows you to work independently and by your own ethical standards, which can often be challenging in this current healthcare climate. Ultimately, my career has been imbued with such a richness of friends and experiences — as well as autonomy — that I do not think I could ever turn back.