The Locums Litmus Test: Is Per Diem Work for You?


Family-medicine-trained hospitalist Benjamin Craig Hamilton, MD,mightrepresent the ideal locum tenens candidate. He’s single, enjoys the challenge of working in new environments, and has is licensed in six states. Currently based in Knoxville, Tenn., he values the professional and monetary rewards of per diem work.

“The beauty is that you can work three months and take three months off,” says Dr. Hamilton, one of thousands of physicians who contract to provide temporary coverage to fill staffing gaps at HM programs around the country. Dr. Hamilton works for Locum Leaders LLC, a national locums firm headquartered in Alpharetta, Ga., that focuses on hospitalists. “If you’re willing to go, you’re never without work. It’s the ultimate flexibility.”

Are You Suited?

Flexibilitytops the list of qualities locum tenens recruiters look for. “The more they [the candidates] can say ‘yes,’ the more likely that we can find a good fit for them,” says Andrea Oldendorf, physician recruiter for Nashville, Tenn.-based Cogent Healthcare. Oldendorfhandles locum tenens placements in the company’s central and western regions.

“We’re a very team-oriented company,” Oldendorf says, noting her objective is to integrate a locum physician into an HM group. “If someone comes in with a lot of limitations, such as ‘I won’t work nights’ or ‘I won’t cover ER admissions,’ that starts to narrow the pool of places where we can use them.”

Every HM program is a little different, according to Robert W. Harrington, MD, SFHM, chief medical officer at Locum Leaders LLC and chair of SHM’s Family Medicine Task Force. “Being able to work with new people, new systems, new computers, and new nursing staff is very important,” he says. Interestingly, the credentialing process provides his recruiters an avenue for gaugingcandidates’ flexibility.“There is so much paperwork, and there are certain parts of it that we can’t do. By the time they get through credentialing, we know whether they’re flexible or not.”

Temporary Work = Test Run

The monetary rewards of locums work often are cited as a major advantage. Locum physicians can gross 30% to 40% more per year (about $280,000 to $300,000) for the same number of shifts as a typical FTE hospitalist (median compensation for non-teaching hospitalists is $215,000 per year, according to the 2010 MGMA-SHM State of Hospital Medicine report). As contracted employees, locum physicians are self-employed and must report their own income and pay their own taxes; many times locum physicians need to hire an accountant.

Working locum tenens also offers a chance to sample a variety of hospital settings. “There’s a big difference between a small rural hospital and a big teaching hospital with a closed ICU,” points out Karen Belote, a physician recruiter for Locum Leaders. “[Working locums] is a great way to try some different locations and different hospitals before settling into a permanent position.”

Pitfalls and Cautions

The only pitfall Dr. Hamilton has observed is perception.“Some people have an initial gut reflex that a locums doctor is either running from something or is not of the same caliber as a permanent physician,” he says. But that notion is quickly dispelled, he says, when he or she demonstrates flexibility, competency, and eagerness to work with the team.

Dr. Hamilton has found a great fit with his current assignments and has no immediate plans to take a permanent position. “I’m learning every day,” he says. “Remember, you are the boss of your life.”

Gretchen Henkel is a freelance writer based in California.

Increase your hirability

Thinking of taking a locum tenens assignment? Consider acquiring additional procedural competencies during your third year of residency, Dr. Harrington advises.

“We are getting more and more requests for people who are comfortable with procedural skills, such as intubations, placing central lines, and vent management,” he says.

Your locum tenens agency might underwrite a procedures course, as Locum Leaders did for Dr. Hamilton. Just make sure you don’t misrepresent your abilities or your comfort level, he cautions. “Know your limits and realize that you are building your career every month,” he says.

SHM will offer a pre-course, “Medical Procedures for the Hospitalist,” at HM11 (May 9, 2011 in Grapevine, Texas), and at many of the HM regional meetings.—GH

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