You got to be careful if you don't know where you're going, because you might not get there. Yogi Berra One of the most common questions I get is about finding a locum tenens job. The second, do you use an agency? Well, yes and no. All this and more is in the following pages . . . When considering locum tenens, one of the first considerations will be just where do you want to go? Many will think initially of some idyllic location where you can lounge on the beach sipping a drink with an umbrella in it. But wait! That is a vacation we are talking about, not work. Just because you would like to take a paid vacation, don’t think that anyone will be willing to finance it. You are doing locums work for just that–work. Being able to enjoy the local culture and surroundings can be a bonus, but only that. I have heard from some hospitals who talk about previous locums who had no interest in doing the work and only asked when they could go sightseeing or deep-sea fishing. Just as at the inception of locum tenens, rural and, to some extent, underserved areas remain in need of coverage. They may not be the garden spot of their state, but they still need coverage. Depending on your motivation for doing locums, it is worth your while to take a good look at those options. Maybe you have no desire to go to Podunk, but if you go there, you may find a community that is more welcoming and more flexible than you would otherwise imagine. Of course being willing to go to a more remote area is one thing; getting there can be quite another challenge. In looking at these areas, be sure to note where the nearest airport is and determine how long it might take you to get there. All of this will factor in when figuring out your travel options: how late might you arrive, do you need to go a day earlier, and so on. There are also many practices in large cities that find a need for locums. They are likely to be more specific about their needs and less willing to pay extra as they often have a larger pool of local physicians from which to draw. So if they need locums coverage, they try to keep it to a minimum. In my own experience, I have found them less willing to pay for housing or paying a less than ideal wage if they are covering housing. However, if you live in a larger metropolitan area, take the time to contact the various hospitals and practices in your specialty about potential needs. More than once, I have been presented for a job only to find out that they had found a local candidate to fill the slot. The majority of the jobs you will hear about will be short-term assignments, usually a week to a few weeks. A good deal of this depends on your own specialty. In the case of mine, anesthesiology, jobs are usually in the weeks column. However, if you are interested in a long-term assignment covering months or a year or more, two main options exist: the Indian Health Service and the Veterans Administration (VA). Working for either the Indian Health or the VA comes with its own pluses and minuses. I have not personally worked for either, but I have spoken with those who have. The credentialing for the VA is through its own particular system called VetPro. It is the same form used for permanent hires, so expect a long lag time before actually going to work for them.

Online

When you first consider locums work, the search itself can seem daunting. Just where do you look? One of the first places to look is online. Simply typing “locums positions” will yield a plethora of choices. When you do search, it is worthwhile to put in specific filters such as specialty, whether locums or permanent, and perhaps most importantly, what states you are considering. The list is not exhaustive, but it is rather extensive just the same. Of course, there can be multiple listings for the same job, making reading through the list tedious. It is still a worthwhile jumping-off place. Your own specialty will have a jobs board often with a temporary, PRN or locums category. Anesthesiology has a site called Gaswork.com which lists jobs for permanent, locums, PRN, part-time and even fellowships. The database can be sorted using all states or specific states, and there are international listings. The upside to using your own specialty’s locums search site is that these sites are usually better maintained than some of the ones that the various locums agencies use.

Agencies

As mentioned, there are now over 25 locums agencies in the United States. Simply Googling the phrase “locum tenens” will bring up the sites of the largest ones. Again, the question becomes, just which one or ones do you choose? Certain criteria are important to your search:

• • NALTO (National Association of Locum Tenens Organizations) is a voluntary membership site for organizations recruiting locums providers. They have stringent requirements that must be met and maintained to remain a member. Most who belong will state this on their website. If an agency does not belong, I would want to know why. Belonging is a measure of integrity and a matter of pride for an organization. I would not work for an agency that does not belong.
  • Areas served: Most will tell you that they can place someone in any state, which is true. But a quick look at the jobs posted for your specialty will often reveal a geographic bias. There is nothing wrong with this; it usually reflects the location of the agency. If they are located in Pennsylvania, it makes sense that many of their jobs will be found in and around the Northeast. Of course, if you want to work in the West, it might be better to look at another agency that at least has some jobs listed near there.
  • Location of the agency: Tied to the above reason is the location of the agency. I live on the West Coast, making it difficult to communicate with an agency on the East Coast. More than once, I have had a recruiter call me in the wee hours of the morning about a potential job, not realizing the time difference. It can be difficult to find an agency that is close to your home base, but always keep the time zone difference in mind when calling them and having them call you.
  • How many agencies? When I first started doing locums, I had only signed with one agency (the one a colleague referred to me). I soon learned that you should be listed with at least two agencies–in many cases for all of the above reasons. Some agencies have contacts that others do not, and it is eye-opening to see how two agencies in the same field can operate very differently. If you are just starting, I suggest you use two agencies, and if another is strongly recommended, go with three. More than that and you will quickly find your email and voicemail inboxes inundated with solicitations for work.

Some will tell you that they never work with an agency; others will tell you that they only work with an agency. So what are the pluses and minuses of working with one?

Agency Pluses

• Numbers: First and foremost, you have a contact that has multiple contacts. They will often have established relationships with hospitals or practices. Those relationships can streamline the process for you.

In terms of numbers, there are also numbers of people who can assist you with the process of locating a position. First, there is the recruiter, who is the primary person you will be talking to as well as to the client. Ideally, they should be well-acquainted with the client and have answers to your many questions about the job. Second, there are other individuals who will be assisting you with credentialing (covered further in Chapter 4). Credentialing in the past usually took a few weeks; now, however, it can take several months. Having another person keeping track of all of those details can be a real time-saver. Third, you will have a contact number in the event that things do not go as planned. I know because I was stranded at an airport on New Year's Eve and was able to call the agency person and get another flight and hotel on short notice.

• Licensing: Check with your agency about their ability to help with the licensing process. If you do enough locums, odds are that you will have to get at least one more and likely several more state licenses to work for a certain client. Just like credentialing, the licensing process is fraught with tedium. Having someone at your agency who understands the intricacies of a certain state's regulations can save you from many headaches.
• Malpractice Insurance: Though you may have your own malpractice insurance, if you are going to another state, it may not cover you. When I first started, there was not a lot of work in my state, so I looked elsewhere. I checked with my own malpractice carrier and found that they would cover me in my home state, but not any other state.
• Getting paid on time: Having worked both agency and non-agency jobs, I have found one of the biggest hurdles with a non-agency job is getting paid in a timely fashion. Most are quite amenable to setting up a schedule and agreeing to the terms well before starting. One incident I clearly recall required multiple phone calls and emails before I finally got paid weeks after finishing the job. That was when I learned the value of an agency which gives you the exact pay date as well as the details regarding that pay.

Agency Minuses

• They work for their client. Let's be clear here. Though they may call you incessantly and bombard you with emails to get you to take that job, their loyalty is to their client. Making the client happy is their first priority; making you happy is second. That does not mean that they won't work to make your job more appealing, but never forget you’re in second place in their heart.
• They're the middleman. The client comes first with the agent because the agent works on commission, which is a cut of what their client pays. The difference between what the client pays them and what you receive can be substantial. Of course, the agency is taking care of the travel details, credentialing, licensing and malpractice. Naturally, the agents have costs to cover. And this is one of the main reasons many choose to go solo when doing locums, and perhaps more importantly, why many smaller hospitals and practices choose to deal directly with locums.
• There’s wide variance in the level of professionalism from agency to agency. Talk to those who do locums. Each of us is likely to have a story about someone at an agency who was “out to lunch,” a little less than detail oriented, or no help in clearing an inevitable hurdle. Some of the details will surface when you first talk to them (See Chapter 6 for the Recruiter Checklist). Others will come to light when you start working with them. Getting a good recruiter to work with you is a real plus; having an idiot is a real minus.

Working Solo

Working without an agency can seem like working without a net. And sometimes you'll miss having agency backup. Many full-time locums, however, are more than content to eliminate the middleman. So besides being your own boss, what are the ups and downs of this way of going solo? First, you are in control. That seems obvious enough. You decide on which jobs to pursue and when you want to work. You arrange all of your own travel. That way, things are done to your liking. Sounds good, and it is. As physicians, many of us are more than accustomed to making our own decisions, so this seems natural. Second, the money comes to you without someone else taking a cut of it. Financial considerations are one of the biggest reasons to go it alone. The difference in money can be more than enough to compensate for taking care of all the details yourself. So what makes doing non-agency work less than ideal? Well, taking care of all those details yourself can be rather tedious at times. Credentialing (See Chapter 4.) has become a byzantine path to getting privileges at hospitals, and the phone calls and faxes required before completion can eat up substantial amounts of your time. Then there's the licensing process which has a never-ending supply of annoyances to boost that blood pressure of yours. Of course, there are some fortunate folks who have a spouse or partner take care of the majority of these details. If you are thus blessed, then count yourself lucky indeed. Frequent gifts are strongly recommended by this author! In summary, where can you do locums? Almost anywhere. Do you use an agency or do you work independently? Yes and yes. In the next chapter, we get down to the nitty gritty–how to prepare for the first assignment, your first day orientation and even what to pack. Fasten your seat belts!