The lowdown on locum: The ins and outs of temporary assignments

Chucking the practice or employed life for locum tenens sounds like a dream come true: no office politics, no haggling with insurers, no call, flexible hours. For some, temporary work holds the promise of giving them the freedom to go where they want and concentrate solely on practicing medicine.

Then again, there is the flip side: a possible lack of steady income, lots of travel that takes you away from family and friends, a lack of collegiality. It's possible that locum tenens holds the promise of giving you an unstable professional life, hopping from lousy assignment to lousy assignment.

More physicians are deciding that locum work represents the freedom they want, rather than the instability they might fear. Staff Care, a major temporary staffing firm, estimates that 36,000 physicians worked in temporary positions in 2005 (the latest information available), up nearly 10,000 in four years. That includes doctors with established practices or employment situations who are moonlighting, which represents about one-third of locum tenens physicians.

Why do they do it? According to Staff Care, the three most popular reasons doctors gave for locum work were a flexible schedule, travel and no office politics. But the same survey said the downside was the opposite of one of its positives: travel taking time away from family and friends, uncertainty of work and lack of benefits.

Uncertainty of work might be less of an issue, depending on specialty: Staff Care estimates that the demand for temporary doctors has nearly doubled over the last three years, as hospitals and practices try to fill gaps caused by physician departures or retirements. Hospitals and practices are hiring temporaries because of greater demand from patients, and a greater demand from doctors for more work-life balance, such as manageable schedules and vacations. Doctors considering locum tenens work should be aware that, like other types of medical careers, there are factors that can lead to success and those that may have a different outcome. Here are issues to consider.

Travel

Locum tenens does not necessarily have to mean a lot of time on the road, schlepping from small town to small town as you spend weeks or months away from home.

"If I have a radiologist, I can get him or her work near home seven days a week," said Dan Groth, CEO of Locum Medical Group, a Cleveland-based temporary physician placement service.

Maurice Ramirez, DO, a family and emergency physician, said in central Florida, he can commute to most posts from home, although it might mean a two-hour drive. If you have contacts in an urban area where you practice, you might be able to keep busy moonlighting as a temporary physician.

But experts say if you're committed to working locum full time, you have to be ready to accept a lot of nights on the road to places you might not be able to find immediately on a map.

"Unless you're part of the urban network, most of your locum tenens work -- certainly the work that comes from locum tenens companies -- will be in smaller and rural areas," said Sandy Garrett, president of Jackson & Coker, a temporary placement agency.

Finding work

If traveling a lot isn't intimidating, then the next question is how do you get a temporary job?

Most doctors find work through placement agencies. There are at least 45 such agencies, according to the National Assn. of Locum Tenens Organizations, an association for placement services.

The organization requesting a physician pays the agency, which also helps take care of such issues as liability insurance (though doctors might have to buy their own tail coverage), housing and paperwork, including that related to hospital privileges. The agencies also are responsible for paying locum physicians their salary.

Recruiters say most of their clients doing full-time locum tenens have three or four agencies working for them. "It gives them a wider range of choices," said Gloria Parrish, vice president of marketing for Medical Doctor Associates.

But a recruiter doesn't need to be the sole source of temporary opportunities. Many doctors find work through word of mouth. The physician must handle the negotiation and paperwork the recruiter would handle, including fees and liability insurance.

Doctors working full time in locum say their salaries match what they made in practice. But doctors are likely to be responsible for procuring and paying for their own health insurance and any other benefits a practice or hospital might provide.

After you get on the job

Some locum tenens physicians have found out the hard way that a posting is not always what it seemed. Dr. Ramirez said a temporary doctor he knew was assigned to a "prescription mill."

"My friend showed up to find 20 charts with requests for prescriptions for painkillers attached to them. Most of those patients hadn't been seen in months." The doctor called his agency, which agreed he could leave.

But in many cases, a temporary doctor doesn't get the option to leave. While a doctor is more than welcome to refuse further assignments from organizations where he or she had a bad experience, a locum physician risks being turned down for other work if he or she leaves a position before the contract is up. "If a doctor leaves a position, he or she should have a good reason -- not that they found a better job," Groth said.

Paul Potter, MD, an anesthesiologist in the Cleveland area who works locum full time, said it can be easy as a temporary to avoid the pitfalls of a difficult assignment. "About half of my assignments are with dysfunctional organizations," he said. Either there are personality clashes or poor governance or financial problems. Dr. Potter's solution in all but the most extreme cases is to mind his own business, do his job, fill out his time sheets and go home. "As a locum, you can insulate yourself from all the craziness," he said.

Often, recruiters say, when physicians want out in the middle of a contract it's not because of life in the office. "The majority of the time ... it's because of poor housing," Groth said. Before accepting an assignment of more than a few weeks, doctors should check out housing. Many agencies or practices put up physicians in a good hotel chain or apartment. But some don't -- and it's better to know beforehand.

Also, physicians who value getting to know everyone in their work environment are probably not cut out for temporary work, experts add. "Chances are you are not going to develop long-term comradeship and relationships during a locum tenens assignment," Garrett said. That's true for relationships with other doctors and with patients.

Then there is the challenge of treating patients you don't know. Parrish said good communication between the office and the locum is one key to success. Another is the temporary doctor's ability to hit the ground running. "Doctors who do well [in locum tenens assignments] are flexible; they can jump in and learn the procedures quickly, and they ask the right question of the right people and get the right answers," she said.

Those traits are particularly important if a temporary doctor believes that a change of regimen is necessary for an established patient. That could cause problems for the absent doctor who returns to find patients treated based on a different philosophy.

But Parrish said doctors should not be afraid to use their best judgment. "If a locum doctor believes the treatment prescribed by the absent doctor is less than optimal, he or she may discuss it with other doctors in the practice. But ultimately the patient always comes first."

Still, given different reasonable therapy options, Dr. Ramirez prefers to tweak the regimen the other doctor prescribed rather than start something completely different. "I get in early, and look at all the charts of the patients I will see that day. And I try to figure out the [absent] doctor's strategy -- what he would do next -- and if possible, I continue that strategy," he said.

Locum tenens can be a good career path. Those who do it full time love the freedom it affords them. As with any medical career, there are challenges to temporary work. But with a bit of thought and consideration, doctors can overcome the pitfalls and have successful locum tenens experiences.