Locum Tenens Tips

Preparing for a locum tenens orthopedic assignment

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Orthopedic surgeon Nicholas Kusnezov, MD, shares his tips on how to prepare for a successful locum tenens orthopedic assignment.

If you’re just getting started with locum tenens, preparation is crucial for a positive orthopedic assignment. In my experience, there are a few key considerations that will ensure a smooth and seamless process.

Align expectations with facility

One of the most important factors in preparing for your locums orthopedic assignment right off the bat is to ensure that your expectations and the facility’s capabilities are well-aligned.

In other words, make sure there is not a mismatch between the type and level of surgery that you plan to do and the capabilities of the facility and staff. Otherwise, you may overwhelm the facility with the case volume and/or complexity of cases. By doing this, you avoid the pitfall of getting into a situation where you do not have the necessary facilities, staff, or instrumentation to adequately manage a patient.

Coordinate with the OR director

Upon arrival, I recommend sitting down face-to-face with the operating room director and explicitly cover what type of cases are routinely performed there and what sets, instruments, and surgical tables the facility has on hand. Then hammer out any issues with vendor contracts prior to starting. You will find that many facilities have contracts with companies you may or may not be familiar with, but which may limit your ability to use implants that you are comfortable with.

There is usually a great degree of flexibility, and I would encourage you to optimize patient care by ensuring you have the best tools for the job. You may find that you don’t have the ideal equipment, instruments, surgical bed, or necessary staffing to perform certain procedures, and this is important to know prior to committing patients to care at that facility.

Make sure the facility is properly equipped

Beyond the operating room, you want to ensure that the floor you’ll be working on is capable of taking care of the level of acuity of patients with which you are dealing. Specifically, if you are in a smaller facility, they may not typically deal with high-acuity patients and may not have an intensive or critical care unit. If this is the case, performing more complex surgeries or operating on sicker patients — even if you are capable of doing this — may not be in the best interest of the patients, or the facility. 

Physician consulting with a patient

Ensure accommodations are adequate

The same holds true not only for call patients but for potential elective cases that are signed up from the clinic. Namely, you want to ensure — especially for elective cases such as total joint arthroplasty or other larger, complex cases — that you have the optimal accommodations, instrumentation, staffing, and postoperative care. This also goes beyond immediate postoperative care and includes follow up, which is arguably as important. This is crucial in cases where regular visits are necessary to ensure patients are progressing appropriately with postoperative physical therapy, pain control, and function.

Workflow expectations

Orthopedic surgery workflow is arguably different than the workflow for other specialties. When I arrive, I immediately orient myself with the locations of the emergency room, operating room, and clinic, as well as the facility’s emergency medical record.

Ensure you have contact information

As an orthopedic surgeon, you will always want the contacts for the house supervisor, surgical scheduler, emergency department, and whatever vendors you may use at the facility. This makes it significantly easier to optimize cases when patients come in by taking care of them in the most efficient manner possible.

As the surgeon, you are ultimately the captain of the ship. You are responsible for coordinating patient care and optimizing outcomes. That said, every component of the team is there for the same purpose — to take care of patients. So make sure to treat your team well, carry yourself professionally, and treat everyone with respect. You will be remembered for your professionalism and affability even more than your surgical skill.

What locums assignment advice do you have for other locums? Share your tips in the comments below.

About the author

Dr. Nicholas Kusnezov

Nicholas Kusnezov, MD, is a board-certified orthopaedic surgeon practicing in Tennessee who specializes in general orthopaedics with a focus on total joint replacement, sports, and trauma surgery. In addition to a decorated career in the U.S military, Dr. Kusnezov is the recipient of numerous national meritorious awards and is actively engaged in graduate medical education and clinical research, having co-authored over 95 peer-reviewed publications to date. Click the YouTube logo next to Dr. Kusnezov's name for interviews expanding on the topics of his blogs.

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