Veteran locum, Ripal H. Patel, MD, MPH, shares his insights into what it takes to be successful as a locum tenens physician.
When I first heard of what locum tenens was, I thought it was insanity. Why in the world would you make your life harder, fly into new localities, decipher how to work new medical records, and try to embed yourself into hospital or ER environments with which you were not familiar? Insanity!
And yet, as I explored all that the model offered, I realized I was only trying to dissuade myself from trying something new and exciting. We often do that, don’t we? We are terrified of change, so we will comfort ourselves with falsehoods to avoid pushing ourselves to new limits. And yet, once we do look back, we sigh, realizing how asinine it was to feel such trepidation.
It’s easier than you think
After I thrust myself into my first contract, I came to see that each falsehood was indeed just that. The EMRs were not that difficult to learn. It’s like a language — you know what you need to know, and simply avoid all the unnecessary components built into these systems that are not instrumental in patient care. The traveling was enjoyable, the ERs were all the same structurally, and most hospitals operate on fairly similar models of flow, admissions, and transfer.
How then does one remain successful in this model of practice? I get asked this often, and like all things in life, the answers are rather simple.
1. Be nice
Seriously. It’s really just that simple. Be nice to your staff, be nice to your colleagues, and try your best to be nice to consultants. Sometimes the latter can be difficult, especially — as I have found in rural localities — where standards of practice might be different from your own. But simply put, pick your battles. When you remain committed to this mindset, staff will generally go out of their way to help you, assist you in navigating the system, and make your shifts run smoothly.
2. Be ready
Not complicated, but as you’ll likely be working in more challenging environments, keep up to date on your procedures, evidence-based medicine, and new innovations in care. If you’re working in a town with a high number of cancer patients or cirrhotics, be comfortable with your thoracentesis or paracentesis skills. If there is a high-volume of pediatrics, brush-up on pediatric emergencies. Often (I have learned) being ready also means having to bringing your own equipment — such as airway videoscopes or ring tourniquets for lacerations — in case your facility lacks these supplies. For suggestions on what items to bring with you on assignment, check out my suitcase manifesto.
3. Don’t take it personally
I can’t emphasize this point enough. As doctors, we often harbor a bit of an inner-diva complex. I stand guilty as charged. This really manifests itself in scheduling future assignments when we are not asked to come back. As I have mentioned in many of my prior posts, medicine has gone so abysmally corporate, with administrators installed that may or may not wish to optimize clinical care as their main goal. As locums, you are generally more expensive, and hospitals see that. So despite you being the greatest clinician since Osler, get over it. If they don’t ask you back, it’s usually because they found someone permanent, who may work for cheaper or take days you don’t want to. Rather than puffing out your chest, cursing the medical director and their next of kin, and pounding out that nasty email, just let it go. Smile, say thank you for the opportunity, and always offer to stay on PRN when they need you. Trust me, they usually will.
4. Stay out of it
I speak to my locums colleagues often about this. And simply put, I am not here to fix your broken system. I strive to function within a dysfunctional system. Now some of my other colleagues may feel the need to mend the system. If you try to do both — especially as an outsider — you can run into serious problems. Of course, if the issue involves patient safety, that’s a different story. But if CT reads take hours to come back, if hospitalists push back on admissions, and if consultant Billy Brown of Cardiology is not answering call, I notify administration and move on. Let them sort these issues out, that’s their job, and you do the right thing for the patient.
5. Hedge it out
Read that again. And again. I can’t emphasize this enough. Keep many options for work open. As my specialty’s job market faces an uncertain future — with mid-levels fighting for more rights, corporate staffing companies creating their own residency programs, and a projected oversupply of EM providers — it is more likely your job may dry up in a few months. Go back to the “don’t take it personally.” Just have other options lined up. Like a very diversified investment portfolio, switch it up with some freestanding, maybe urgent care, community ERs, maybe consulting, and telehealth to pay the groceries. I could go on. But each one of the items I listed above is usually a lesson I learned the hard way, as in being upset about not getting more shifts, or not being prepared for something I encountered. When you serve these communities, they are immensely grateful for your assistance. So take those sentiments in good faith, adhere to these principals, and you will most surely be guaranteed an outstanding experience. And who knows, you may make locums a full-time career like me.
