Road Warrior Physician
By Elizabeth Noel Lumpkin, MD
Chapter 5 Locum Tenens Hiring of the Other Side of the Coin
So let's be honest with ourselves and not take ourselves too serious, and never condemn the other fellow for doing what we are doing every day, only in a different way. Will Rogers
When it is time for YOU to hire a locums provider, who do you call, what do you ask, and how do you prepare? They may be working for you, but a few actions on your part can make life easier for both of you.
If you work in the medical field long enough, odds are you will be considering hiring a locum tenens provider at some point. While the majority of this book is devoted to the locums lifestyle, I thought it would be helpful to point out things to consider when you are doing the hiring.
Nothing is more annoying than reading through a description of a facility needing locums coverage than to read, "Quality facility with beautiful community, perfect for the lover of the outdoors!" Seriously? Reading descriptions like these is like reading a real estate ad. Be wary of descriptions containing the words: charming, quintessential and paradise. If you need help with coverage, something is missing. It doesn't mean that your hospital isn't great, but it tells a prospective physician next to nothing about your practice or hospital.
I have had recruiters tell me grossly inaccurate information, not that they were lying intentionally, but because they had not received the right information. Sit down and think about what you really need for your coverage such as:
How long do you anticipate needing the coverage? I understand that you are watching your budget, but realistically, what is the coverage covering? If it is simply a vacation, then you probably are talking about a week or two.
However, if you are looking to hire an additional physician or a replacement, the process takes an average of eighteen months. During that time, you will want to be able to function effectively and introduce prospective hires to a staff that does not look overly stressed. Hiring a locums to help out can make this process much smoother. If you think that this is your situation, say so! Not everyone is looking for a short-term assignment. So if you have potentially ongoing needs, do not be hesitant to let the agency or provider know this.
Just what do you need coverage for? This covers what the actual duties will be. I am an anesthesiologist and certainly know what an anesthesiologist does, but what does the job require? Do they do neuro, spines or also heads? Cardiac? OB? Pediatrics? Those are just a few of the areas that should be delineated, but also, is there call? Is it in-house or pager? How frequent is it? If you want to be a real friend, describe what a typical night of call is like. Is it infrequent or are they up most of the night? Do they work post call? If there is no call, what will the average day look like?
I find it intriguing that a group or hospital may be looking to hire someone and will go to great lengths to prepare for an upcoming interview, but when it comes to having a locums come to their practice, they do next to nothing to help them get oriented. Does it not occur to them that the locums might be looking to change jobs or at the very least, know those who are?
With all that in mind, it is my humble opinion that it just might make things work more smoothly if you prepare for a locums in the same manner as you would a potential addition to your staff.
Form a "your first day" checklist. It all depends on the hospital or office, but there are bound to be those ubiquitous little access codes these days. Get a list of those and give them out along with any other names, phone numbers, etc. that might come in handy.
Give a tour of your facility. While it might seem shocking to some, I have arrived at a hospital and after telling them of my status, have been told, "Oh, you're in OR 4." And that would be where, exactly? Fingers point in the general direction. While this example is extreme, it is more of the norm than you might imagine.
If at all possible, block out the first morning to give your locums a chance to get access at the pharmacy, get a badge and get a sense of the layout. This is especially true if he/she will be taking call. Have I ever arrived at a new place and been told I was on call the first night? You betcha. Don't do this. If you have any hope of hiring new staff, you have just eliminated one good source of leads by pulling this preposterously stupid stunt.
Let them know about your community. While they are not there to be entertained, give out some information about your corner of the world. What are the good restaurants? Are there any sites they should try to visit? Think about what you try to impart to those who interview. Even if they are not looking for a job, if you foresee long-term needs, letting them know more about the area will improve their chances of returning to your site.
Perhaps your group or hospital has all the answers. Maybe you never have a problem hiring new staff, and those who join never want to leave, everyone's spouse loves the community, and your administration never interferes with your job and only compliments your fine performance. If that’s the case, package some of that pixie dust and start selling it on the open market, because you're one in a million!
Now, for the rest of you, at least one of those items above is not true, and it plays a role in why you need to hire a locums. If you have a locums working with you that you enjoy and respect, take the time to ask their honest opinion of your place. They might be hesitant to be too frank, but tell them if there’s anything you would like to change and see what they might offer in response.
It's easy to think that your own facility is unique, and that all the problems you have are so different from other places, but in many cases, this is not true. Some of us have seen hospitals of all sizes in all areas of the country. While we’ve seen some real disasters, we’ve also experienced a few great places. Odds are we might have an idea or two that would help you.
While you're at it, if you truly like working with your current locums, why not share a meal with them? You might find that doing so will offer new insights into your practice and your community, not in a find-out-the-dirt way but more in the positive aspect of what you have to offer. I have found that when hospitals or groups are mired in the process of finding someone, they lose some of the enthusiasm they need to present to potential partners. So while it is beneficial to know the not so nice things, it is also good to know some of the pluses.
As I've mentioned, you do not have to entertain your locums, but in the interest of establishing a long-term relationship, think about including them in activities outside of the hospital. That long-term relationship can extend to not only returning to work at your facility but also referring other quality individuals to you or conversely, steering less than stellar ones away from you.
It may seem as though I am hammering the etiquette, but I cannot overstate what should be obvious: be polite to others, and they will usually return the favor. I have stated extreme examples of rudeness in this book, but there are less extreme ones as well. So let's cover just a few basics, shall we?
Ask them how things are going. Can this be any easier? If you take a vested interest in keeping things running smoothly, asking this question can open the channels of communication.
Offer help when necessary. Some of us are used to doing things on our own, but an offer of help is never a bad thing.
When possible, make sure that they get a breather during the day. We've all survived long hours without as much as a bathroom break. But if everyone else is getting a pause that refreshes, include your locums in the mix.
If you know that they will have to work with a difficult surgeon or patient, try and give them some warning and advice. Being thrown to the wolves helps no one and is potentially harmful to many.
Questions to Ask Your Prospective Locums
Your own hospital and the agency (if you used one) will have credentialed your applicant. But let's be honest, their questions often have nothing to do with the day-to-day practical issues that you are facing. I am never offended if a client wishes to talk with me prior to my arrival or even prior to starting credentialing; doing so can often clear up issues and questions well in advance. These are some of the questions that I have been asked in the past or perhaps some I wish that someone had asked!
● Where are you currently working?
This is rather obvious, but asking more about the current practice will elicit what cases or patients they see most often. A quick search will tell you the size of the hospital and its general volume.
● Why are you doing locums?
Some are doing it just to check out the market. Others are doing it to supplement their current income. Others like me do it full time. Certainly the motivations for each of these categories will be different. Those who are checking out the scene will be curious to know more about your practice overall as well as the community. If you are recruiting, this is definitely a prospective candidate until proven otherwise. Those wishing to supplement their income might be interested in overtime, call, etc. Ask! Naturally, anyone who tells you that they are in the market for a permanent job deserves a closer look.
● What kind of cases do you see most often?
While I have been doing nearly every type of case since residency, certain assignments do not have them or limit them to permanent staff. When it comes to staffing rooms, this should alleviate some of the unpleasant surprises like finding out that someone has not done neuro cases since the Reagan administration!
● What do you do in your free time?
Now, this is not necessarily any of your business, but as I've mentioned previously, knowing something more about the person outside of where they went to medical school and where they did residency, can add to your assessment. Plus, if you enjoy this person, knowing what they might like to do outside of work can offer you an opportunity to get to know them better, perhaps leading to a chance to recruit them or find out the name of someone who wants to be recruited.
● How many locums assignments have you done?
This should be found on their CV, but ask anyway. If it is their first assignment, it is well worth knowing this ahead of time. Doing a locums assignment for the first time can be somewhat overwhelming for both parties. If this is the case, then consider assigning a mentor for at least the first day, if possible. Both of you will be grateful in the long run. If they have been doing locums frequently or for a long time, ferret out any pertinent positives and negatives about their experiences.
Of course, there will be questions that are tailored to your area and/or hospital. Asking the candidate about their knowledge of weather, culture, and the like will help them avoid certain problems. I recall one physician from southern Georgia who was unprepared for winter weather to appear in Alaska in early October. Remember we don't all experience climate the same way!
In summary, taking the time to actually know your locums provider can lead to a mutually beneficial relationship. Even when you think it is going to be a short-term need, it never hurts to plan for contingencies. To paraphrase Mark Twain - Always be kind. This will gratify some people and astonish the rest.