What locums has taught me about medicine

Nicholas Kusnezov, MD, shares how his experiences as a locum tenens physician have changed the way he practices medicine.

Doing locums has given me a unique and broad perspective on the field of medicine. While we, as physicians in training, learn that medicine is fundamentally the practice of patient care, medicine is in reality much more complex and multifaceted. Medicine is an industry, and while it is undoubtedly and most importantly centered around patient care, medicine has many other quintessential components including advocacy, professionalism, and business. These are all important considerations toward being a well-rounded, versatile, and valuable physician.

The importance of continuity of care

The primary purpose of locum tenens is to ensure the access to, continuity, and quality of patient care by filling gaps in medical coverage at various institutions and across a variety of medical specialties. As a provider, you are vital to the provision of each of these components.

Participation in locums has underscored how important continuity of patient care is and how easily this may inadvertently be neglected and disrupted. Unlike your primary practice, ensuring continuity of care is more difficult in the context of locums, namely because of the constant flux in providers. Ensuring patient follow-up takes more effort — because the system is often unfamiliar to you — and this becomes an especially important consideration at the end of any assignment. The onus admittedly falls on the provider who is leaving to ensure that the patients seen during that assignment are cared for afterward.

To facilitate this, I would not only encourage open communication between you, your predecessors, and your replacements, but especially with patients regarding their future care plan. As a provider, you will also have unique insight into potential areas for improvement in care. It is up to you to advocate for your patients and use your capacity as a leader to effect positive changes in the healthcare system both locally and at large.

The value of your reputation

Professionalism is another important aspect of medicine, both to patient care and also to your own personal success. Locum physicians are often met with more scrutiny than permanent parties, because — as a stranger to the institution — there is a degree of uncertainty as to your character, professional qualifications, and technical abilities. For this reason, maintaining professionalism and a sterling reputation is all the more important as a locum physician.

Medicine is very interconnected, and as a result, you will develop a reputation quickly, by word of mouth, from patients, medical staff, and other physicians, and this reputation is paramount to your professional success in the medical field. You may get offers from other facilities or get the competitive edge over other physicians vying for similar opportunities based on your reputation.

Similarly, patients will invariably want to see physicians with the best reputations. Work to build and maintain your reputation by acting as a professional, demonstrating your knowledge and technical skill, and providing the best patient care possible.

Medicine is a business

Finally, you will learn that medicine is a business. We spend our formative years training to provide medical care, but hospitals rely on reimbursement, and this income is strongly if not sometimes exclusively influenced by how well you navigate the business of medicine.

Your first assignment will be a crash course on documentation and billing. This is the backbone of reimbursement. The quicker you get this down pat, the quicker you can focus more exclusively on the medical aspect. Moreover, the more thoughtful and thorough you are with documentation and coding, the more valuable you will in turn be to the hospital.

As I mentioned earlier, medicine is a field of constant flux, with physicians changing jobs, old physician retiring, new physicians just getting started. As a result, there is always a need for physicians, regardless of specialty — whether it’s to fill a temporary or permanent position, or to cover clinic, surgery, or call. While medicine is a “team sport”, as the physician, you are the most integral component. Know the demand and know your worth!