“They’re not needing to be distracted or literally taken away from clinic while they are seeing patients because they’re on call,” he said. “It has allowed these docs to have a higher quality of life [and] to decrease their feelings of burnout.”
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November 2024Using locums to cover call, he said, means physicians are less likely to be doing clinic while fatigued after handling a 2 a.m. emergency department call, or irritating patients because they get called away halfway through a clinic visit because they have to do a consult. This, he said, leads to physicians who are “just happier and more refreshed and feel good about their situation.”
One physician he works with lives in Italy, returns to the U.S. once a month to do a 10-day stretch of locums work, and then goes right back to his home overseas, he said. Doctors in the military do locums to stay sharp on trauma cases so they are ready when they are called into a battle zone.
“It gives them a lot more flexibility to really have the career and the life and work-life balance that they’re looking for that just really wasn’t available even 10 years ago,” Dr. Royer said. “It’s wild. As locums has grown and as the need for it has grown, the possibilities are pretty much endless.”
Jamie Litvack, MD, MS, who has a private ENT practice in the Seattle area, has worked a locums position at the Alaska Native Medical Center in Anchorage several times, and found the work very rewarding, she said.
There’s something very meaningful [in] taking care of a community that is typically underserved.” — Jamie Litvack, MD, MS
“There’s something very meaningful if you’re taking care of a community that is typically underserved or is different than the one that you’re working with,” Dr. Litvack said. “It makes you think harder about the way you practice, it sharpens your skills, and it’s neat to be able to provide services for people that need those services.”
The Alaskan native population has a higher prevalence of chronic ear disease, which makes it a different sort of clinical challenge and makes the work inherently interesting, she said.
“I get opportunities all over the country—there’s more work than there are otolaryngologists,” she said. “For me, I love to travel. For me, a lot of it is about the community … I think a lot of people will choose places that they’re curious about.”
Taking herself out of her routine makes her a better doctor, she said.
“The mentally interesting part is the ‘how,’” she said. “How do you practice when the resources are different, when the access is different, when the time to care is different, when there is one person on call versus a call group of five, seven, 10, 15 people? All of those things are just different.”
She said doing locums work is a great way to fend off burnout.
“You have autonomy, you have freedom, you have a lot more control over your schedule,” she said.
Ilaaf Darrat, MD, a pediatric otolaryngologist at Henry Ford Health who normally works in the Detroit area, regularly did locums work at a center more than an hour from home, farther west in Michigan. She and other physicians doing locums filled in while vacancies were being filled, a process that took six years, she said.
As a single mother, she would work during weekends when she was not with her children. It was not part of her contract, and “they paid us accordingly for that”—about a week’s pay for a weekend of work, she said.
In the locums work, she would see mostly adult patients, allowing her to work on case types she didn’t routinely see.
“The patients were so grateful to have seen you there,” she said. “I definitely sensed that.” But the job involved handling more details than she normally would in her regular work, she said. “If there is a nosebleed, I actually have to stop it,” she said. “I usually see the patient after everything is taken care of by the residents.”
But she said it has been a worthwhile experience financially and professionally.
“It keeps your skills sharp,” she said.
Do Due Diligence
Despite its numerous benefits, doctors considering these positions need to exercise due diligence before taking a position, those who’ve done locums say.
Dr. Royer said it is important to find out beforehand who will be handling post-op issues, how malpractice coverage is handled, how many patients a physician is expected to see per day, what support staff is available, and whether they have done ENT work before.
“In some states, they don’t even need to have an anesthesiologist on the premises or supervising” the certified registered nurse–anesthetist during induction and awakening, he said. “So what that means is ultimately the anesthesia responsibility falls on the operating surgeons. Some docs may feel more comfortable with that than others, but that’s always important to know.”
Dr. Litvack emphasized that regardless of the type of practice—private, employed, or locums—“We are physicians first. The grounding professional principles of ‘do no harm’ and ‘patient first’ always apply.
“As physicians, we prioritize patient care above all else. In a locums position, we have the opportunity to contribute to the quality of care by advocating for what we believe is best for our patients,” she said. “If we encounter a situation where a service isn’t meeting those standards, we always maintain the influence to work with hospital or practice leadership, a locums employer, and other stakeholders to ensure the highest level of care.”
It seems that once you put your name on a list of interested physicians, you are then open to a regular flow of messages, doctors say.
“I have recruiters texting me or calling me multiple times a day for locums work,” Dr. Darrat said. “Every day, I’m not kidding you. I don’t know what listserv I’m on, but I get a text or an email or a call every day.”
Dr. Royer said his company tries to minimize the paperwork burden on doctors doing locum jobs.
But Dr. Beatrous said there is still a fair amount of legwork. “The truth of the matter is, there are quite a few hoops you have to jump through,” he said.
He also said that physicians will sometimes be asked to commit to a set of locum stints—such as six trips over 12 months—but he recommended being careful about such arrangements.
“I would be hesitant to sign up for something like that because it could have easily been not what they said,” he said.
Still—especially after a subsequent trip to Fargo when his family accompanied him, and another one in nice summer weather suitable for golf and pickle ball—he said locum tenens positions are worth considering for many.
“Every situation is different,” he said. “I think it’s a good gig for someone fresh out who’s not super busy and wants to make a little extra cash and start paying off loans. It’s a great gig if you’re in that situation and you’re single. Personally, I would do it again, and I have recommended it to others.”
Thomas R. Collins is a freelance medical writer based in Florida.