You can forget about your overhead, say goodbye to coding and billing headaches, schedule vacations whenever you like, test drive new job prospects, travel throughout the country, and work as little or as much as you like…no wonder more neurologists seem to be taking more locum tenens jobs in recent years.
In 2008, an astonishing 36 percent of US physicians had worked in locum tenens, according to a report in the New England Journal of Medicine. It used to be that only physicians at the beginning and end of their careers would consider this type of practice, and in prior years, locum tenens doctors were primarily hired to cover for physicians on vacations, or to fill in until a permanent replacement was found. Recently, however, high physician turnover rates and shortages of providers in neurology and other specialties have increased demand for temporary coverage on a locum tenens basis.
Today's locum neurologists come at all stages of their careers. Tiffany Q. Pineda, MD, who has just finished a fellowship in electrophysiology at the University Alabama-Birmingham, thought that it would be interesting to see how neurologists practice in different places before selecting the type of practice she preferred and the geographic location. So she signed up with VISTA, a locum tenens company, and worked as a neurohospitalist at a 200-bed hospital in Vancouver, WA, for three weeks, allowing its neurologist to take his first day off in seven months. She is soon leaving for Maine to work at a regional hospital center as a general neurologist.
“If there's ever a time to do it, it's now,” she said. “In training, we don't get direction on what to look for in a practice, what to avoid, and how to evaluate contracts.”
Although Dr. Pineda would eventually like to settle down to a group private practice or multispecialty group, she thinks the experience she'll gain at short-term locums positions will help her make a decision that's more likely to be a good fit in the future. “It's scary jumping into a permanent position,” she said, reflecting on how frequently first jobs tend to fail. “This gives me time to see what kind of practice I want to join and provides me the flexibility to take time off to be with my family for the holidays.”
Jeremy N. Meisel, MD, also signed up as a locum tenens neurologist immediately after completing his fellowship in neurophysiology at Emory. Although initially drawn by the flexible lifestyle, he ended up staying because the pay was quite good. (Many companies pay a daily rate commensurate with private practice and compensate physicians for overtime hours as well). He has worked various jobs for five years, traveling to several states including Hawaii, North Dakota, and Pennsylvania, and gathering six medical licenses. He used some of his time off to study for board examinations, and in addition to passing his neurophysiology boards, he became certified in stroke and sleep.
“I ended up becoming well-known in the locums community, so I had no problem finding a job when I wanted to work,” he said. Working for several locum companies — Staff Care, Comp Health, and Medical Doctor's Associates — also increased his odds for employment.
Dr. Meisel suggests that neurologists interested in locums work keep meticulous records. “Every time you apply for hospital privileges, you need to document where you've worked in the past,” he said, explaining that a long list of locations can bog down the credentialing process. Consequently, he has preferred to go back to places he had already worked in order to minimize the red tape.
Indeed, after going back to the same hospital in Western Pennsylvania two dozen times, he decided to accept a permanent position there as a neurohospitalist. He has been working as the only staff neurologist at the 700-bed hospital over the past 18 months, but with an attractive contract limited to approximately 11 days of work a month, he has been able to keep a part-time job in New York doing electrodiagnostic testing, and another doing independent medical examinations.
Todd H. Lynn, DO, is currently in Pennsylvania filling in temporarily for Dr. Meisel while he's away. Dr. Lynn recently decided to move to Israel after having taken a sabbatical there. He's planning on working in locum positions here every two to three months, for up to two weeks at a time, until he is able to establish his own practice in Israel.
“It's by no means a vacation,” he said. “You're on call all the time, and often times you're the only neurologist covering a fairly large hospital.” Staff Care, a locum agency, has placed Dr. Lynn in positions in Texas and Florida, and has successfully negotiated with its clients guaranteed salary equivalents and other appropriate financial formulas for its locum physicians.
Faizan Hafeez, MD, took his first locum job at a hospital in Marquette, MI, two years ago when he left a university academic position to start his own practice in Toledo, OH, and wanted to supplement his income while his practice grew. He had initially intended to work a week a month for few months only, but has enjoyed the assignment so much that he has continued to take on new ones, even though his practice has been getting busier.
As a stroke-fellowship trained neurologist whose largely out-patient practice now mainly focuses on headache medicine, Dr. Hafeez has recently taken locum jobs as a neurohospitalist in Florida and Ohio, allowing him keep his in-patient skills fresh. Delta Locum tenens, the staffing company he has worked with, helped him identify a location within commuting distance from home, so that he wouldn't have to leave his family. Although he has brought his family to some distant locations for short-term assignments, he considers the time away from his family to be the only downside to the experience.
“I do like that it breaks the monotony of my work and allows me to do something different,” said Dr. Hafeez. “It's also more relaxing than my own practice. I don't have to deal with administrative headaches or worry about billing issues like the loss of consultation codes,” he added.
Neurology Today first spoke with Stephen P. Busby, MD, in 2004 when he was working at the Navajo Medical Center in Shiprock, NM. Among the many advantages already described, he liked having more free time off with his family. However, he admitted that the requirement for mobility may not suit those who want to establish a traditional family lifestyle. He also found that although the income was good and quite steady, it could be erratic.
“One must set aside a nest egg to comfortably weather through any employment droughts,” he advised. “Perhaps the most difficult aspect of the job was the flexibility of matching your practice style to the requirement of the client, or at least working with the locums company to choose a client with whom the physician is comfortable,” he said.
“Locums positions vary from extremely altruistic, university-affiliated academic positions, to average private practice positions, to practice money mills that have sacrificed all semblance of service to the patient (or even morality or legality), to publicly funded, overburdened clinics and hospitals that are doing their best to make do for too many with too little and too few,” Dr. Busby continued.
Fortunately, contracts are very flexible and allow the physician to walk off the job if he is uncomfortable with only the minimal notice necessary to provide safety to the patients usually 14-30 days. However, in order to avoid hard feelings and to stay desirable to the companies, you must understand the limits of personal compromises in professional care, ethics, etc, that you're willing to make for the sake of preservation of the continuity of the client's practice,” Dr. Busby explained.” After working four years at locum jobs, Dr. Busby decided to leave because he was concerned that the labor-intensive efforts in credentialing would make future employment increasingly difficult. He is currently working in a salaried position in a community hospital just outside of Houston.
John R. McCormick, MD, a neurologist who retired from private practice in Florida after 25 years, began working as a locum 11 years ago in order to remain qualified to keep his state medical license. He has been to eight locations over that time, often returning to prior jobs. He works as he pleases. Last summer he rode his motorcycle to Alaska taking 10 weeks off, and has enjoyed all his assignments, which have been predominantly office-based. One of his biggest challenges has been adapting to a variety of makes and models of EMG machines. He advises neurologists who want to test the lifestyle to try a two-week stint during a vacation and see if they like it. He knows they'll be welcomed. “Because you're needed, everyone is delighted to see you no matter where you go,” he said.
IS A LOCUM TENENS JOB RIGHT FOR YOU?
Gordon Stipanovich, division manager for neurology at VISTA staffing solutions, advises that the best candidates are flexible, have the ability to travel, and like to see different parts of the country. About half his requests are for specific geographic areas; a neurologist wants to be near family or a significant other. Positions vary from weeks to years. Those states consistently most in need are: Wisconsin, Florida, New Mexico, Illinois, North Dakota, and Texas.
For more information about companies mentioned in this story:
* VISTA staffing solutions www.vistastaff.com
* Staff Care www.staffcare.com
* Comp Health www.comphealth.com
* Medical Doctors Associates www.mdainc.com
* Delta Locums Tenens http://www.deltalocums.com/