Road Warrior Physician - Chapter 4 Get Ready, Get Set, Show Up!

August 21st, 2017 34 Min read Road Warrior Physician - Chapter 4 Get Ready, Get Set, Show Up! Blog

The Road Warrior Physician

By Elizabeth Noel Lumpkin, MD

Chapter 4 Get Ready, Get Set, Show Up!

As for any other journey, good planning will make things go more smoothly in your locums travel. In this chapter we'll cover what to ask an agency and how to find out details about your assignment. We'll also pass on ideas about creating a plan for your first day, and that all-important credentialing process.

Etiquette

Good manners reflect something from inside–an innate sense of consideration for others and respect for self. Emily Post Some of you are wondering why I would include a section on etiquette. We should have all learned basic manners at home or in school, but sadly, there are those who need a refresher course. When you are a temporary employee, there are even more subtleties that are worth remembering. Some of these will seem basic; others might give you food for thought. ● Show up–Seriously? I've been to more than one hospital where the person in charge has said to me, "Oh, good! You showed up!" After staring at them for what seems like a full minute, they usually explain that, about a third of the time, the locums provider they hire does not bother to show up. They agreed to a job only to have a better offer show up days later. Of course, I would rather have the better assignment, but an agreement is just that. Honoring your word may be out of fashion, but it will pay dividends when you are the locum. Blessed are the flexible, for they shall not be bent out of shape. Anonymous ● Be flexible–This can be a tough one. Maybe you have won a Nobel Prize for Medicine, perhaps you are editor of the New England Journal of Medicine, or maybe you've just done things a certain way and you cannot see any other way of doing them. Well, put those notions of supremacy behind you. Being flexible with your assigned tasks will put you ahead of others who refuse to do certain cases, patients, etc. One place where I had worked several times hired an additional locums in my absence for some weeks that I could not cover. “How did it work out?” I asked the head of anesthesia. “Terrible,” he told me. While she had said that she did "all" cases, when she arrived, she was assigned to one of the neurosurgeons. "I don't do neuro," she said. "Don't do neuro?" they asked. This was a place with not one, but three busy neurosurgeons. What happened to “all” cases? They managed the work for the two weeks she was assigned. Needless to say, she was not asked back. This does not mean that you should take on cases for which you are not trained or you cannot do. But making yourself adaptable to any and all situations will be considered a bonus. Of course, honesty is a plus. ● Neatness counts. Leave only footprints; take only photos, or your mother doesn’t work here–It works for camping, houseguests, and for locums as well. At your home base, perhaps you have a minion who follows you around and picks up after you. Lucky you! Even with that being the case, unless you are bringing your minion with you, please try not to leave obvious signs that you have been there. Like so much of this, it seems obvious, but trust me, it will be noticed if you leave a trail of debris wherever you go.

Getting Ready

Keep calm and fill out the next form. Anonymous You have decided to take the plunge and you are ready to make that phone call whether to a locums agency or hospital. There are certain items it will behoove you to have handy. Getting all these items prepared in advance will make the following steps in this process that much easier. ● School dates and diplomas–Fortunately, you only need from college forward, supplying the start and end dates of each school. I actually had one place ask for a copy of my college diploma. When I sent it to the requester, they responded, "I can't read it!" To which I replied, “That’s because it's in Latin." The thoughtful response? "Oh." I was tempted to say, “You asked for it,” but wisely, I think, did not. Copies of all diplomas from college forward will, however, be required. Since getting copies of all those diplomas can be tricky, once you’ve got them corralled, save lots of frustration and time by making several copies of each, keeping one set in your personal file with the rest ready for mailing. Treat all residencies, fellowships, etc. the same way with the start and end dates of all and copies of each credential. While you're at it, it will be worth your while to keep a spreadsheet or at least a cover page with all the names of heads of programs and pertinent dates on the top of this list. You will need this information more times than I care to count. ● Certifications–ACLS, PALS, ATLS–You will need a copy of each as well as their expiration date. One thing to note about ACLS in particular, while there are many online courses available telling that they offer a card, not all places will accept those and will only accept AHA certified cards. Make sure you know this before you start any other work or you may find yourself scrambling to find a course in the days before you leave for an assignment. ● Board certification–Once again, a copy of that document with the dates is necessary. Also note if you have recertified. If you are not board certified, be prepared to tell when you will be taking the exam and all of the salient details. ● Work history–If you are just coming out of residency, this should be easy enough. For the rest of us, however, this can be a rather long and detailed list. Personally, I keep a spreadsheet in Excel for this information. One important detail–get the phone numbers and fax numbers of the person(s) who will be attesting to your work at their institution. This is usually human resources, but knowing this level of detail will definitely speed up the process. Merely looking up the hospital website and jotting down the phone numbers listed is decidedly not sufficient. Drill down and find the appropriate extension so that the person handling your credentialing doesn’t have to go through that frustrating process. This is someone you'd rather not frustrate–what goes around, comes around and always at the worst time. ● Current curriculum vitae–If you have not done so already, now is the time to format your CV for all of those places you will be applying. There are standard forms in Microsoft Word, but I use a program that allows me to easily update my CV after each assignment (yes, I update after I finish each assignment). ● Photo–Nice try using that photo from your college graduation! These days, they want one that was taken within the last six months. With everyone taking selfies, this should not be a huge problem, but avoid those that are part of a group photo, and choose a neutral background if at all possible. You can also go to many of the places that offer passport photos because they will be formatted for the required size. One thing to note about the ID photo–it is easy to simply print one out, affix it to the form and think you are done with it. But this photo will likely end up in the medical directory, or even worse, on your staff badge. Make a judicious choice you won’t live to regret! ● Licenses, DEA–While this seems obvious on the surface, as you will need a license and DEA wherever you go, you will also need a photocopy and dates of any inactive license(s). As with the schools above, I recommend a master list with all of the dates (active and inactive) as this is information that you will need again and again. ● CME–You need it to renew your licenses, and now you will frequently need it for credentialing as well. There are several programs online and apps as well that can help you keep all of this information in a tidy form. I use myCME Bank. ● Case logs–If you kept a case log or some other type of log during residency, get ready to use it again! Certainly in my own specialty, case logs or at least percentages are now required for updating files, so compile some sort of document with the necessary details. ● References–Depending on the agency, hospital or practice, you will typically need anywhere from two to six references. It should go without saying that these should be in your own specialty, at least the majority of them should be. As with the schools and work history, get phone numbers with extensions if applicable, fax numbers (if they have them) and email addresses. I am usually leery of giving the personal addresses of any references, so a complete work address has always functioned for me. Naturally, you should ask each individual if they are willing to provide a reference for you. It will usually entail a phone call or an emailed form. If you are currently working, your references should be people who have worked with you in the last two years. Once you’ve gathered all of this information, you are ready to make that call. If they have questions right away about dates or license info, you'll have it right at your fingertips, and you'll look like a locums rock star! The above information will be needed to get credentialed with a locums agency, hospital, practice or new state license. I used to carry hard copies of all of the above. Later on, I put it all on a flash drive. These days, I have everything in Evernote. I highly recommend it. The basic program is free (can't beat the cost!). It will make organizing your locums life that much easier.

Tools for the Road

You survived credentialing, and now you have to get your gear in gear! What do you take with you on your assignment? Besides the obvious, what are some of the things that will make your life easier on the road? Why buy good luggage? You only use it when you travel. Yogi Berra ● Luggage–Despite what Yogi Berra thought, having good quality luggage is going to serve you well. After going through several types of luggage, I found the lighter weight, hard-shell bag with wheels that rotate in all directions a very worthwhile investment. Buy two, one for carry-on and one for checking. You will be schlepping your bags through airports and hotels, on sidewalks, and in various types of ground transportation. Be good to your back; you only have one. ● Kitchen supplies–No, I am not suggesting that you take your Mixmaster and food processor, but at a minimum take a mug, a set of flatware, and plate for eating on the road. While takeout places will offer plastic forks and knives, few give you plates. You may be a fan of eating out of those little sections in your Styrofoam container. I, for one, am not. I purchased a set of bamboo flatware (chopsticks included!) which I am able to carry with me, even on the plane. They are easily washed and have lasted for years. I also bought a plastic plate and cup which I pack in my bag. ● Laundry–If you are gone for more than a week, you will probably have to do laundry while on the road. Most hotels offer washers and dryers that typically cost $2.00 per wash and dry cycles. The hotels will also offer to sell you detergent and dryer sheets at an incredible cost. I have a small pack in which I keep rolls of quarters, Tide pods and dryer sheets. I also have a laundry bag that makes my life so much easier. ● Battery-operated alarm clock–Since every hotel has an alarm clock, why bring your own? My two-word answer is power outage. You might be thinking overkill, just how often does that happen? It only takes one power outage to make you appreciate having your own clock that laughs at fluctuations in the power grid. My travel clock has a nifty feature, an LED flashlight that’s been useful in a number of situations.

First Day Jitters

I'm a stranger here myself. Ogden Nash More than anything else, people ask me, "How do you find your way around at a new place? I could never do that." We can all identify with the anxiety that comes from going to a new place for the first time, starting a new job, etc. As a full-time locums provider, it is something that I do on a routine basis. Are there tricks to make it easier? You bet there is! Before leaving home I like to do my initial reconnaissance before I ever start to travel. If you are going to be working at a hospital, they’ll have a website, complete with photos, maps, etc. If you are going to work with a group, they’ll probably have one too. Look up the department that hired you and note the names and photos that accompany. You don't have to commit these to memory (although it's a great mental exercise), but it will help on that first day when you are trying to connect with the person or persons that are anticipating your arrival. If you’ve gotten your assignment through an agency, they will send you an itinerary and maybe even maps to get from the airport to the hotel and subsequently to the hospital. If they don't or if you’ve opted to get your position on your own, Google Maps or any of the online map apps should be able to fill in the blanks for you. Review the routes you will need to take. Often I get in late at night, and having some familiarity with the street and place names makes navigation a little less tedious. Even if you don't think this is going to be a routine for you, it will serve you well to join loyalty programs of the airline(s) and hotel(s) you’ll be using. Online check-in for airlines has been around for a while, and it saves you time and frustration when you arrive at the airport. Use your smartphone for your boarding pass. These days many airlines allow you to print your own baggage tags. I check in online for my hotel as well. This cuts the time spent at reception. Usually giving your name will result in your room cards being handed to you without any further ado. Perhaps most important, have copies of all the necessary documents, especially your state license and DEA, either as hard copies, scans on your phone or flash drive. More than once, I have needed proof. Despite having passed the required credentialing, the hospital was unable to locate my license. Thankfully, I had a copy with me. Human resources is not usually open for business when I start my day, so having this on hand prevented yet another delay. While on the road There are few things that are more frustrating than to be delayed while en route to your assignment. It happens, so be prepared for it. Keep all travel emergency contact numbers handy. This is one of my prime Evernote uses. Note any additional flights in and around yours in case of delay or cancellation. Have the main phone number of the hospital or practice. Your delay may come after hours, but you can always leave a message in the event you won’t be showing up at the appointed time. If you arrive early enough, take a test drive to the hospital or office the night before just to develop a little comfort with the route. When doing this, you can usually find where to park at least on that first day. Many hospitals will use your ID badge for parking; some require you to get a separate tag. Almost all will allow you to use visitor parking for the first day. All of this will save you time and anxiety on that first morning.

First day

Learn your lines and don't bump into the furniture. Noel Coward Your first day will give you a glimpse into the general milieu of your hospital. Orientation on that day varies greatly. Perhaps no other feature has such a range as the way hospitals or groups orient you. To illustrate this, I offer two extreme examples. Hospital 1 I arrive, prepared with everything to start my first day. "Who are you?" the person at the OR desk asked. "I am your locums anesthesiologist," I reply politely. "Another one?" she queries suspiciously. "I am looking for the anesthesiologist in charge today, if possible." "Who's in charge today for anesthesia?" she barks to those around. Puzzled faces stare back at me. "Can I at least go to the locker room and change?" I ask. Fingers point in the general direction of the locker room. Once in the locker room, I find my scrubs and am changing when another physician walks in. As luck would have it, she is one of the other locums anesthesiologists. We introduce ourselves and she fills me in on the details about the practice there. When we arrive at the OR desk, I am informed which OR I will be covering with no further information given. When I get to my room, I learn that I am doing a thoracotomy, a rather involved case, especially for someone who is still trying to figure out where everything is. Next I learn that the anesthesia tech that always helps with this is on vacation. None of the permanent staff step up to help me get started, but the other locums does. Hospital 2 Prior to my arrival, I get an email from one of the permanent staff, introducing himself and giving me details about the hospital and the usual cases covered. When I arrive at the hospital, I am greeted by name by the charge nurse. Then the anesthesiologist in charge that day gives me a sheet with all of the phone numbers and access codes that I will need to get around the hospital. He then accompanies me to the pharmacy to make sure that my Pyxis access is in order and then introduces me to the rest of the staff. I am given details and information about my first case and my surgeon. The anesthesia tech assists me with my first case to make sure I know where everything is. Later on in the day, when he is busy with another room, the anesthesiologist in charge checks on me to make sure that I have everything I need. Later that week, he and his wife have me over to their house for dinner to find out how things are going. While these two examples are extreme, they illustrate how much preparedness counts when you encounter Hospital 1. Chances are, that even there, you can find an ally who is willing to assist you, some empathetic soul who already knows the drill and is willing to share it with you. Back in the day when I first started doing locums, I would carry a blank sheet of paper and on it write names and various bits of information that I would need. I would even write descriptions of people to help me remember their names! Of course, I would also draw maps, codes I would need to remember, etc.

Say cheese!

I now use my phone camera to take pictures of people (after asking, of course) and send them to Evernote where I store all salient information needed for my assignment. This becomes invaluable if you return to a facility and helps avoid those embarrassing "I'm sorry, but I cannot recall your name" moments; in fact, you'll look like the megastar you are when you can recall someone's name and how they helped you previously. Your cell phone camera can also capture snapshots of forms that you may need for orders, etc. Much of this has been replaced by the electronic medical record (EMR), but I never fail to be amazed by how much paperwork still exists in today's hospitals.

All those tags and badges

At the very least, take a Ziploc bag with you to contain all of the tags, badges, etc. Your own bag can quickly become swamped with papers and items that you will acquire on your first day. I started using one of those zipper pouches that are in the school supply section of many stores. It is useful because the mesh will allow you to see what badges you have, and the zipper will hold any pertinent items you want to keep safer, like a locker key or a pager. This is also useful for any return trips to the facility because I keep all of the items in their own folder at home. When I am heading out, I just put the folder in my bag, and I am ready to go! Paperwork again! As I stated previously, there seems to be no end to paper use. You will most likely need a time sheet. If you are working with an agency, they will usually email you this with all of your travel information, etc., but be ready with your own. If you are working for a group directly, they may have a form to give you on the first day. It is your responsibility to fill it out and submit it in a timely fashion. Many agencies are very particular about this, so it is prudent to make note of their deadline for receiving this. Make sure you know the name and the fax number of who will be processing your time sheet. On the first day, make a point of finding out who is responsible for signing it and if you can fax it directly from the hospital, as many will want a copy of your time sheet before you leave. I always keep a copy (scanned into Evernote, naturally!) in the event that someone tries to tell me that they did not receive it. Always looking to the future, you should get names and phone numbers with extensions of individuals willing to be a reference for you at a later date. Most are perfectly agreeable to do so while some for whatever reason are reluctant to provide references, but you should be able to find a couple of people who can vouch for you later on. These should also be entered in Evernote or whatever database or folder you choose. Meanwhile, back at the ranch . . . You have survived your first day, perhaps the first week, and now that you have taken a moment to relax, you are faced with the prospect of four hotel walls staring back at you. I'll admit that initially the idea that someone is making your bed every day and cleaning your bathroom sounds pretty good, great even. However, after a couple of weeks, the sparkle starts to dull and by the third week, much less the fourth, you feel yourself going a little crazy. How do you survive living on the road and out of a suitcase? Food, glorious food! Eating out is the obvious answer when you first arrive in a new place, but this can wreak havoc on your wallet as well as your waistline. While I enjoy trying new restaurants, I prefer to have more control over what I eat. It saves me money on food and the inevitable new wardrobe. In almost every place you go, there is a grocery store, so take a trip there and buy some supplies for your stay. Assuming you have a small refrigerator in your room, I recommend buying breakfast items in particular. I often stay in a hotel that offers breakfast, which usually starts around 6:30 when I must be leaving for the hospital, so I try to have breakfast in my room. I often have yogurt and some oatmeal from the microwave that almost every hotel room has. As I mentioned previously, I travel with a set of utensils, a small collapsible bowl, a plate, and a cup. That way, I can have oatmeal or soup and make a variety of dishes that can be eaten without digging into a container. There is something more dignified about eating off of a plate rather than Styrofoam. Call me old-fashioned, but that's the way I am! If your job is similar to mine, lunch is often like a unicorn, a fantasy you hear about but never see. Taking something with you to work is going to save you on those long days. I like to carry trail bars, dried fruit and nuts. They take up a minimum of space, require no heating or cooling, and can be eaten quickly between cases or patients. Dinner can be the tricky one as your hotel room may not offer a great selection of appliances. If you want to avoid eating out, what can you do? Of course, there are microwaveable selections available, some of them quite good, but again, you can eat more calories than you want if you go this route too often. Those rotisserie chickens that you see in almost every grocery store now make sense. They're ready to eat, and will last more than a couple of meals (at least for me). I buy some frozen vegetables and microwave them, and you have a complete meal for a fraction of the cost. The leftovers will work well for lunch (assuming you get time for lunch). Staying fit Supposing you are keeping your calorie intake in check, there is still the matter of staying reasonably fit. Maybe you are in top shape, participating in Ironman triathlons all over the map, but if you are like most of us, you will need some way to maintain your fitness while traveling. The hurdles are there: limited time, limited access to gyms, disruption of your routine, etc. You get the idea. If you have a gym at home, whether in your town or your house, you obviously cannot take such things with you on the road. However, if you belong to a gym, ask if the local gym will honor your membership. Tell them your situation and many will be happy to accept you as a temporary member, sometimes for a small fee, sometimes for free! If there is not a gym handy, check to see if your hotel has one. Though often vacant throughout the day, in the early morning hours they are frequently packed. Ask the reception desk about gym options as well. They sometimes have vouchers for the local gyms. Personally, I prefer walking, the old-fashioned method of exercising. If possible, and daylight permitting, I will often walk to work. Yes, it takes a little more time, but by the end of the day, when I return to the hotel, my exercise is finished, and I can focus on other fun things instead! Walking is free, and many places now have trails marked throughout the area, so you can see a lot of the new town and get exercise to boot.

Getting out

The world is a book. Those who do not travel read only a page. St. Augustine You have the routine at work; things are going well. You're eating decently and getting some exercise, but if you really want to get a feel for all that there is, you need to leave the hospital and the hotel and get out. I was doing locums in Alaska when I talked to another locums there. After spending a weekend hiking in the local mountains and seeing all kinds of wildlife, I asked her what she did over the weekend. "I read," she said. "You read???" I asked, "Were you sick or something?" "No," she said, "I like to read on the weekend." "Don't you want to get out and see the local area? You’re in Alaska, for goodness sake!" "Nah, it doesn't really interest me." Personally, I find such an attitude perplexing. Many of us state travel as a motivation for doing locums, and I can read almost anywhere, but I can't always go hiking in beautiful mountains and experience local culture, especially somewhere like Alaska. So where do you go? Ask your fellow staff members, ask the hotel personnel, and above all, ask your patients. I find them to be the greatest sources of information about a local area. Through them, I have found amazing restaurants, great hikes, interesting museums, fantastic local scenery and the most entertaining golf course ever! The public library is also a great source of local events, many activities costing very little or maybe nothing at all. As you can see, the details involved before you even start an assignment can be overwhelming. A little preparation early on will pay off down the road.

Credentialing Game Plan

This may seem like I am beating a dead horse, but credentialing is more than likely going to be the bane of your existence if you do locums, no matter what the length of the assignment. Back in the "old days," credentialing could take as little as two weeks, even a weekend in an emergent situation. Now, it takes months, sometimes several months. Unlike nurses, who can select an assignment and go there a week later, physicians have few similar options. So steel yourself for this process. It can get ugly; I promise you. That being said, there are ways to organize things and hopefully diminish the pain. As I mentioned in Chapter 2, get all your documents together and get everything photocopied. Yes, that can mean taking your framed diplomas off the wall and bringing them to your local printing emporium. It sounds ridiculous, and it is, but you will probably need a copy of at least one of those diplomas at some point. Get the busy work out of the way early. For the sake of argument, I will assume that you have all of the necessary documentation perhaps in a manila folder or in Evernote (my recommendation). If you have it all in a folder, do yourself a favor: Scan it into a computer, tablet, or some other device that you will have with you on the road. Scanner? Yes, a scanner. If you don't have one, get one, ideally one that is portable. Many tout the ScanSnap from Fujitsu; I have found the Doxie scanner to be even more portable, which is a real bonus for me. In any case, get a good scanner and use it. Next you will need a fax. That's right, I said a fax. You may be thinking that they went out with the dodo, but change comes slowly to HR departments, especially in hospitals. You will probably be faxing weekly or even daily until this credentialing process is finished. If you are like I am, you have a printer-fax-scanner combo and can fax things from home fairly easily. However, I do recommend considering an online fax service which will allow you to fax from anywhere at any time. If you have scanned everything into your computer, you can simply upload the necessary documents to your online fax, and voila! You are faxing with ease without the use of a landline. Before you start faxing and scanning with abandon, get the names of all those folks who are going to be with you on this journey. Just who do I mean? The name of the person at your locums agency (assuming you are using one) and the person or persons in the human resources department who will be handling your file. Also, get the name of the department chair for which you will be working. Not just the names, get their phone numbers, fax numbers and cell phone numbers, if they offer them. You will feel as though you are joined at the hip to some of these people by the time you arrive at their hospital. They will be calling and emailing you, so create a file for them along with your documents. For the truly OCD (I count myself among them), keep a log of what you send and to whom you send the information. Then when person A tells you that they have not received document D, to which you reply, but I see that you received the fax on such and such a date. At the very least, it will give you smug self-satisfaction if nothing else. It will also tell them that you are on top of things. And in the best of cases, it will cause them to treat you accordingly. Naturally, in spite of your best intentions, there will be items that you send and resend. Patience is a virtue that I continue to work on, especially in this situation. Getting angry at the person on the other end of the phone is not going to help and could potentially hurt you down the road. Resist the urge to tell them that their IQ is in single digits, no matter how much evidence you may have for your assessment. When credentialing–and especially when applying for a new license–there are bound to be due dates for certain materials. Make a note of these and put them on your calendar. Use whatever system you have for reminders. If you don't have a system, get one. Despite the fact that there will be numerous individuals involved with your credentialing, you are ultimately responsible for getting all of the documentation in on time. I have heard of people who had assignments delayed for weeks or months or even canceled, all because of a credentialing glitch. Don't let this happen to you. Call, email or send smoke signals to those people above and make sure that they have everything they need. One final note, if you continue to do locums work, your first go at credentialing will not be your last. Even at places where I have worked for years, I have to re-credential every two years just like the permanent staff. Being pleasant to folks that work with you on this will pay off, just like your mother told you! If someone is particularly helpful, I have been known to send flowers or some other gift thanking them. You may feel that you have arrived and that such actions are beneath you, but trust me, such actions do not go unnoticed.

Long-Term Locums

While this idea has been briefly covered in Chapter 1, it deserves additional mention. If you choose to make locums more than temporary, a means of making more money or finding a job, you will need to make certain adjustments in your lifestyle and how you organize it. The numbers of those who do choose to do this full time are small, but that should not dissuade you from considering it. Before doing so, allow me to offer some suggestions for making the transition easier. ● Travel apps, sites, etc.–It should come as no surprise that belonging to any airline reward program can be a benefit. Love it or hate it, you will probably be doing more than your fair share of air travel, so you might as well get some points for it. There are numerous sites out there that will cover the loyalty programs in detail, but my main suggestion for you is to choose the airline that you will be flying most often and look at its airline partners. The quickest way to earn more points is by using all of the loyalty program partners. For example, I fly Alaska Airlines most often which partners with American and Delta (among others). When I fly either of those, I use my Alaska Airlines loyalty number when booking. Alaska divides the number of miles needed to attain elite status based on whether you flew on Alaska or its partners, but if you are traveling six months out of the year, you can attain elite status fairly quickly by using this method. Hotels are another way of racking up the status points, and most agencies are more than happy to book you at a hotel in your chain of choice. Again, read the sites and see if you can get points on your airline program as well. To bring all of these sites together, I heartily recommend Tripit.com as an online source for amassing all of your travel information. When you get a confirmation email, all you have to do is forward it to Tripit, and they collate everything into a tidy itinerary for you. This is especially valuable if you are booking your own travel and want to remember that confirmation number or phone number when you are on the road. ● Paperwork–Despite the influx of EMR and the promise that "We would be paperless by 2010!" there seems to be no end the paperwork involved in medicine. While credentialing covers a good deal of this, as a long-term locums, you will be responsible for maintaining your CV as well as your CME records. In the past, you may have had a department that monitored the looming expiration of your state license or DEA, but now it's on your head to keep track of it. Most states as well as the DEA will send out notices to you well in advance, but keeping track of the CMEs you have earned (as well as the various requirements for each state) can be tedious. For several years, I used the online site eeds.com. I entered the information each month and was able to produce a report at any time to cover whatever time period was necessary for a license or credentialing. All of this came at a price, but it was still a time saver, so I never complained. Now, however, I am using MyCME.com, which offers a CME bank using an app on your iPhone or Android, and get this–it's free! So, the price is quite an incentive for using this site. I put a reminder in my Google calendar each month to update my CME. It is the best way I know to stay on top of this recordkeeping. ● Immunizations–By now, you have probably been presented with the requirement of getting an annual flu shot. In the past, it was probably offered to you while working at your hospital or office. Now, if you are not around when it is offered, it will be up to you to pay for it. That goes for PPD as well as tDAP, if they ask for it. If you use an outside source, get a copy of the record, snap a photo of it with your phone or tablet and keep it with you in whatever database you have (I prefer Evernote). ● ACLS, PALS, etc.–Ah, yes, those pesky certifications and courses that you need for almost every hospital and/or office. If you are like I am, those two years between certifications seem to vanish like the wind. Keep track of all expiration dates and bear in mind that you may not be able to take advantage of any course while you are working, so you will probably have to take an online course and schedule your skills session with a local provider. This can be painful, but in looking at the AHA site, you should be able to find someone in your area who can schedule a skills session for you. Just make sure that you start looking early enough. There is nothing worse than having to scramble to find someone just to check you off on your ACLS the day before you leave for an assignment. Also, there are some hospitals that will only accept an AHA-certified card which requires you to be present for your skills session. There are several online ACLS re-certs which do not require your physical presence. But to be safe, it is probably wisest to go the conservative route and use the AHA courses. Doing so will eliminate the less than pleasant surprise of having to take the course again (at your expense, I might add). ● Life outside work–Your life at home is probably full of activities, but working on the road for six months of the year is going to drain you if you don't find pleasant diversions in the area you are working. I do not mean that you have to be going out every night, but I do suggest that you take the time to take a class or participate in some activity outside of work. I have belonged to BSF (Bible Study Fellowship) and Toastmasters, both of which have chapters all over the United States (and the world for that matter). I look up the chapters when I am traveling and try to make it to the local meetings. Doing this has allowed me the opportunity to interact with people outside of medicine and forge new friendships. In the next section, we turn the tables. We’ll address those that do the hiring. What do you ask your prospects and how do you prepare? Get out the welcome mat!