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Locums Puts the World in Your Hands

Leap, Edwin MD

Author Information
doi: 10.1097/01.EEM.0000484525.31515.09

    I was anxious when I began my locums adventure in 2013. I had worked in the same place with the same people for 20 years. Was I even capable of working anywhere else? Would I know what to do? I had a longstanding and successful practice and was ABEM-certified, but I still doubted myself.

    So, I began slowly. I worked a few shifts out of town to try it. Almost immediately, I could see that my fears were unfounded. Emergency medicine is much the same job wherever one practices; it differs only in scale. This became evident to me after, oh, about one shift at another hospital. Same stories, same problems, same illnesses, same social dramas, and same staff issues but different geography.

    A Few Tips

    I recommend working with a company. People often ask me to recommend a particular one, but suffice it to say that many people have done locums before you. Ask them what companies they used. Locums companies are everywhere now because the need is so great, and you can be picky. Some are good, some are average, and some are problematic, so be cautious.

    Think about what you want before you pick up the phone. Do you want to go to a busy department in a city? A slow critical access hospital in the middle of the Mountain West? Do you want to go back to your hometown? Look online at the various organizations and the locations they represent. Keep in mind that one hospital may work with multiple companies at the same time, and each may have slightly different contracts and rates.

    You might enjoy transitioning to a slower place if you're currently in a busy ED. Or consider a gradual move to a busier location if you're in a slow facility with low acuity, so that you can get used to the faster pace and sicker patients. Truth be told, though, bigger emergency departments are really just a bunch of smaller departments co-located. Modern gridlock being what it is, you may actually move slower than you did at Small Rural Memorial.

    You should also consider how far and for how long you wish to go. Kids still in school? Locums within an hour or two of home is probably a possibility. You can drive there and come home each day or simply stay a couple of days and come home when you're finished. Single? You're the boss. Go as far as you want and work as much (or as little) as you would like.

    The World is Your Oyster

    Your imagination is the limit if you're ready for a big adventure. Jobs abound, need is great, and companies (or rather, hospitals) will pay for your travel, licensing, and malpractice. (By the way, this is true domestically and internationally.) Always wanted to work in Alaska? See what companies are advertising jobs there. Deep desire to go to South Florida ... or New Zealand? Ditto.

    A company will tell you the wonders of the job and the rate, and ask you to send them a CV. Polish up the old curriculum vitae and update the dates and work history. They will ask if they can present you to the facility after they have discussed the job with you, which means the staff will look over your information and decide if they want you to come for a certain number of shifts and rate.

    If the ED staff likes what they see, they will start the process of licensing and credentialing. It can take as little as two days when they are in a pinch (and licensing is either expedited or not an issue) or up to six months or more. A Texas license takes 12 months, but that is on the high end. Make sure you know up-front what the lead time is going to be so that you can keep your income steady while you wait.

    Ask about details because non-compete clauses lasting two years or more may come into play. Companies follow these clauses, so be careful about speaking in more than generalities. Expressing interest via email is considered for future reference, too.

    It is not uncommon for a physician to cut out the middleman and contact and work directly with a hospital. Just make sure to have someone look at the contract for you, and make certain you get what you need in terms of payment, malpractice, etc. It's probably easier when first starting out to work through a company to get a feel for things.

    There's a lot to talk about! Next month: Incorporating, contracts, merit badges, rates, schedules, EMRs, and other tips.

    Take the ‘Leap’

    Read the first part of Dr. Leap's series on locums at

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