Nicholas Kusnezov, MD, shares the most common mistakes new locum tenens physicians make and his advice on how to avoid them.
You get a call from your locum tenens recruiter with a new and exciting opportunity. Your natural inclination — especially if you’re new to locum tenens or just out of residency — might be to jump right in and grab it before someone else does. Before going all-in, however, you should consider the potential pitfalls. Having been actively engaged in locums for a number of years now, I have a fairly comprehensive understanding of the most common locum tenens pitfalls and how to avoid them.
1. Not giving enough attention to the travel details
First and foremost, prior to committing to any assignment, always hammer out the travel details.
Most opportunities that arise are not within immediate driving distance and often require a combination of driving and flying. Start by verifying the travel time between your home location and that facility. Some sites may appear relatively accessible when they are, in fact, not. Airports may be regional. Highways may be closed in the winter. You may end up committing to an assignment that requires a drive to an airport, a flight (possibly with multiple layovers), and then an additional and sometimes lengthy drive on the other side.
You should always factor all of this into your desired compensation package and what you think your time is worth. In my experience, travel considerations are an essential part of my desired compensation. You need to feel like your overall effort is well compensated.
2. Not understanding the compensation package
Continuing the compensation theme, make sure before you enter any locum agreement that you have a good understanding of the pay package. By this I mean not only what the compensation package is, but realistically how much you stand to make on either an hourly or daily basis.
Some assignments may throw a lot of hourly money at you — with some added gratis hours — and you may not work more than those dreaded gratis hours. Conversely, you may be offered a flat rate which may seem very financially favorable, but you end up working many more hours than you anticipated and wish that you had opted in for an hourly rate.
To attempt to mitigate this, I generally research the hours that the current or previous physicians have worked there. More often than not, you aren’t the first locum — and certainly not the first physician — of your specialty to work at that location. Your locum tenens agency should know (or be able to find out) the average number of hours a day worked and the expected patient or case volume. I would always nail this down prior to deciding what you are going to ask for. Essentially, this boils down to knowing what you are getting yourself into and ensuring that you are compensated fairly for it.
3. Not asking about holiday pay
Along the same lines, you should inquire ahead of time about holiday pay, especially since many assignments are established around holiday coverage.
Sometimes — especially if it is not a “major” holiday — the locum agency and/or hospital may not offer you any additional pay for working holidays. Do not assume you will be paid more for certain holidays. Always negotiate this ahead of time.
4. Letting yourself get steamrolled by the administration
Another cautionary note is to be wary of over-bearing administration. Unfortunately, you will often not find out what the administration is like until you have already started the assignment.
As a physician, you are extremely valuable — you are performing a real, tangible, financial service to that institution. As a trained professional, you should be treated as such. However, as you will find, we operate in the era of healthcare administrators who attempt to run medicine like a business. The patient care aspect is commonly lost on them. Hospitals may attempt to button-hole you into situations that are financially feasible for the hospital but not necessarily the best for the patient.
Remember: as a physician, your duty is first to the patient and second to the hospital. As a surgeon, I frequently run into situations where hospitals will attempt to control costs — sometimes at all costs — and try to persuade or even force you to use whatever cheaper materials or implants they have on contract. Stand your ground and advocate for the patient. Obviously, in the ideal situation you would do best both by the patient and the institution. This is often possible with tactful discussion.
5. Not considering future employment opportunities
My final recommendation is to be careful about taking locum assignments at institutions where you potentially plan to work in the near future. The same is true for being presented to institutions blindly.
Generally, if you are even presented to an institution by a locum agency, you are unable to secure independent employment with that hospital for one to two years following the presentation. This could include working through another agency or working directly for the hospital. For instance, if you are presented by a locum agency which low-balls you, you are hosing your chances of getting a more favorable price from another locum agency at the same institution.
Therefore, prior to any presentation, you should ideally figure out what a reasonable compensation package would be and what they’ve offered in the past or are looking for. I would do this through a few agencies before deciding on which one you would like to be presented through.
Additionally, if you are ultimately looking for a long-term commitment and are using short-term locum assignments to keep you fresh, be careful of the hospitals you are presented to. Locum agencies tend to want to present you everywhere (obviously after receiving your permission to do so). However, if you are looking for work in a certain area and have been presented to a hospital previously by a locum agency — or worked a locum assignment at that hospital — they may not consider you or have to buy you out of your locums contract.
In brief, do your due diligence and you can avoid the most common locum tenens pitfalls.
