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Locum Tenens Physician

5 mistakes first-time locums make and how to avoid them

Physician learning to avoid common locum tenens mistakes from a colleague

Andrew Wilner, MD, FACP, FAAN, reflects on his experiences as a locum tenens physician and how newcomers can avoid making common mistakes.

My first locums job was in 1982, just after my medical internship. It’s fair to say I didn’t know anything about locums — I wanted to write a book before returning to residency and just needed a part-time job. I found a local ER through word of mouth and signed up for three night shifts a week. Since then, I’ve worked locums off and on in a variety of inpatient and outpatient settings. I’ve learned quite a bit the hard way. Here are five common locum tenens mistakes to avoid.

1. No malpractice insurance

First-time locums docs may not realize that the malpractice insurance they already have with their permanent job doesn’t cover locums. That’s a grave mistake. You must have a separate malpractice policy for each locums assignment.

In my case, I don’t even know whether that ER provided malpractice insurance. Luckily, I never got sued!

Don’t put yourself in that position! Get malpractice insurance that applies to your locum tenens job.

Malpractice insurance, also known as “professional liability insurance,” is a complex topic. For example, more than 60% of physicians 55 and older have faced malpractice suits. To learn more, check out chapters 11 and 12 in my book, The Locum Life: A Physician’s Guide to Locum Tenens.

If you arrange a locums assignment on your own, ask whether the facility provides malpractice insurance. If not, get your own. Staffing agencies routinely include malpractice insurance as part of your compensation. Just ask to make sure.

2. Inadequate skills and confidence

Make sure you have the proper training and confidence to meet the job expectations. In my case, I had just completed a medical internship at a large Veterans Hospital. I had tons of experience with end-stage heart, liver, lung, renal disease, and ICU care, but minimal ER experience. In retrospect, I was ill-prepared to assess and treat the myriad of acute medical problems that present to a community hospital ER.

It was a small hospital, and I was the only ER doc on duty. My heart was in my mouth every shift wondering what would come through the door. Memorable cases include a broken wrist, delivery of twins, a dog bite, a foreign body lodged in the eye, a ruptured hemorrhagic hepatic cyst, abdominal pain due to a grapefruit-sized testicular hydrocele, hysterical hemiparesis, and a lost contraceptive diaphragm. I muddled through these cases drawing on every shred of knowledge from medical school, a bag of reference books, and lots of help from consultants.

Moral of the story: If you are a recently graduated physician, make sure you are comfortable with your skills. You may be the only doc on site, and the patients and staff are depending on you.

Two physicians walking together

3. Low Compensation

It never occurred to me that compensation was negotiable. I just accepted the contract as a done deal.

But medicine is a business. Everyone would agree that as a physician, you provide a service and deserve appropriate compensation. However, the definition of “appropriate” is in the eye of the beholder.

While I accepted the ER contract without a second thought, subsequent locums experiences have taught me that it is sometimes possible to negotiate higher pay. Locums assignments are usually paid at an hourly rate. There may be additional compensation for overtime, holiday work, returning to the hospital after hours, carrying a pager, and hazard duty (i.e., COVID+ unit). When you get an offer, discuss with your agent whether there might be some flexibility. You won’t know unless you ask.

4. Can’t use the EMR

It may seem obvious, but you have to know how to use the facility’s electronic medical record (EMR), which may differ from the one you know.

That wasn’t an issue in 1982, but in 2013, I worked at a modern teaching hospital in Sioux Falls, SD. The experience would have been great except for one thing. I didn’t know how to use the EMR.

Despite a few hours of on-the-spot training, I couldn’t admit patients from the ER because I didn’t know how to enter their home medications and convert them to hospital orders. Finally, an on-call IT technician arrived in the middle of the night to rescue my patients and me. For more gory details, check out “An EPIC Adventure.”

5. Bad Attitude

I haven’t made this mistake, but back in Sioux Falls, SD, I witnessed one locums doctor who did. It wasn’t pretty. This young doctor had a chip on his shoulder. He believed that his medical training was superior to those around him. He also freely shared that the hospital where he usually worked was far superior. He only agreed to work in this backwoods hospital to earn some extra cash.

There’s a valuable adage: “the 3 “A’s of Success,” comprised of affability, availability, and ability. Affability is the most important. Even if you show up (availability) and have excellent skills (ability), it’s difficult to succeed if your colleagues think you’re a jerk. On the other hand, if you are reliably pleasant to colleagues, patients, and staff, success is much more likely.

After many years of locums, I’ve adopted a mindset that virtually guarantees successful assignments. First, I remember that it’s a privilege to come to work and get paid for what I love to do. (The assignment is an “opportunity,” not a “job.”)

Second, I’m a “guest in someone else’s house.” It’s not my role to comment on the facility’s glaring imperfections and inadequacies. My job is patient care.

Follow these two pieces of advice, and the facility will likely ask you to return and maybe even join the full-time staff! When you receive that invitation, you know you’ve done a great job.

A smooth beginning

Locum tenens offers physicians the flexibility to work when and where they want. Like any new endeavor, it’s easy to make missteps when starting out. If you avoid the common locum tenens mistakes discussed above, your first experience will likely go smoothly and lead to many more.

About the author

Dr. Andrew Wilner

Dr. Andrew Wilner

Dr. Wilner is a board-certified internist, neurologist and epilepsy specialist. In 1982, he discovered that locum tenens was the perfect solution to achieve work/life balance as a physician and writer. He is a prolific medical journalist and author of several books.

1 Comment

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  • I too, stumbled onto locums 20+ years ago and have had a much better life because of it; full time locums for the past dozen years. Remember you are marketing yourself. Avoid social contacts anywhere you work. Never drive a nicer car than your boss. Avoid suggestions about how things might be improved, avoid discussing dangerous situations. It is not in your interest to improve things, you will be thought of as a threat. You must never discuss politics or religion, no matter what your ethics are. Simply find some bland excuse and just quit the job and move on – telling the truth about why you are quitting can ruin your career. Blacklisting is the name of the game – expect it. Anticipate loosing your job in less than a year (although some jobs last 20 years, but when they do it is most likely you were working too cheap! ), so keep a backlog of smaller jobs (the ideal is to have between two and four jobs at any time). When your cost is 30 or 40% more than your fellow Doctors you can expect to get fired quickly. You will not be judged on the quality of work you do alone, most quality management is done in the administrative office, by non clinicians; so care for your patients because it should be your ethic (all other motivations have been stripped away). You are a cost center. Like a professional athlete; you will be bought, sold, and traded. All this ‘changing jobs’ means you will not have much of a chance at being part of a community or family outside your career (as if practicing medicine wasn’t stressful enough!). Buy a house where you want to retire, not where you work. Remain in contact with other locums. They can find work at a much better rate than you are getting now. If you are fired, do not take it personally. Listen to the suggestions and try to follow them at your next site; but remember they are not the only reasons you or your team got fired (it is usually about money, sometimes about politics outside your reach, but nobody will actually say that). The first time I got fired, I got a big raise at my next job. In fact, this has been the pattern throughout my (relatively lucrative) locums life. Finally, if you take a “permanent” position, everything I just said applies. There are no such thing as “permanent” positions, all doctors are locums to a degree; just many are not aware of it. Favorite quote: “I freed a thousand slaves. I would have freed a thousand more, if they had known they were slaves.” …Harriet Tubman.

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