Dr. Rosevear, a member of the Urology Times Clinical Practice Board, is in private practice at Pikes Peak Urology, Colorado Springs, CO.
"While I love my partners and my staff, the chance to work with a new group of nurses and to interact with a new group of local doctors is in many ways invigorating," writes Henry Rosevear, MD.
Dr. Rosevear is a urologist in community practice in Colorado Springs, CO. Urology Times blogs present opinions, advice, and news from urologists and other urology professionals. Opinions expressed by bloggers are their own, and do not necessarily reflect the views of Urology Times or its parent company, MultiMedia Healthcare.
About two years ago, a rural hospital, not close to my hometown but not that far either, approached my practice and asked if we would be interested in doing an outreach clinic at their hospital. It had been 15 years since the hospital’s last urologist retired, and the closest practicing urologist was almost 2 hours from them, on the other side of a mountain pass. Welcome to Colorado.
We did a bit of due diligence and quickly learned that hospital’s payer mix and patient volume was typical of a small rural hospital, and it likely didn't make financial sense for us to start an outreach clinic. So we declined.
But the town, its citizens, and its obvious need for a urologist appealed to this small-town plumber. We proposed a salaried physician model, similar to a locum tenens model, and the hospital accepted. The arrangement has worked out very well. As locum work was something I did not think I would ever do, I wanted to share my experience, as I'm sure everyone else receives the same almost daily deluge of emails from the locum recruiters. I’m sure too at least a small share of us are curious about what this type of work entails. It turns out that almost 5% of all doctors do locum work and almost 90% of health care facilities use locum doctors, according to a Physicians Practice article, so it’s actually not even that uncommon.
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What is locum tenens work? The phrase is Latin for temporary work, and the concept is to allow a hospital to temporarily fill a position while it searches for a long-term solution. It doesn't mean, of course, that some doctors don't use a locum position as a way to test-drive a job, but the positions should not be understood to have any guaranteed longevity and most (including mine) have contracts with very short, very broad termination clauses. I'm pretty sure I could be let go on a 1-week notice for no other reason than the administrators don't like one of my blue button-down shirts, and I wear a lot of blue button-down shirts.
What are the advantages and disadvantages of locum tenens work? First, it pays well. These jobs exist because by definition the hospital has a need and has been unable to find a long-term solution. On the other hand, there are certainly better long-term options. Many partners in suburban single-specialty urology groups make far more than you would as a locum doctor, and honestly, work in much more desirable locations. On the other hand, the long-term salary of most hospital-employed urology positions pales in comparison to the money that can be made doing locum.
Another potential advantage is that you can avoid the hassles that come with running an office. In my day job, there are days I spend more time worrying about the administrative fire of the day than I do worrying about patients. Conversely, when I go to my locum job at the hospital, all I worry about is seeing patients. If the computer system is running slow, I don’t worry about calling the IT guy to figure things out. If the copier stops working, that’s someone else’s problem. However, if I don’t like the computer system, too bad; I really don’t have a voice in any potential replacement. If I think my clinic would be a bit smoother with another medical assistant, well, not my decision.
Next:"It’s interesting to look at these jobs from a recruiter’s perspective"Further, it’s interesting to look at these jobs from a recruiter’s perspective. Given the number of companies that try to match doctors with hospitals, they clearly do well. I understand that if you go through one of these recruiters, they will likely pay for housing and travel and even malpractice, but they clearly make a profit on top of that. I was lucky. The hospital I work for directly approached my group, and as a result, we were able to negotiate a nice contract and cut out the middle man.
This also allowed me the opportunity to tailor the contract to my needs. If anyone is considering such a position, it’s worth simply calling the local hospitals to see if they would be willing to talk to you directly, as most likely this will earn you a higher contracted rate and the hospital will pay less overall!
Lastly, don’t underestimate the psychological advantages of this kind of work. The patient population I see is incredibly kind and grateful. Many are thrilled to not have to drive 2 hours to see a doctor and they let us know that. Further, for me, the change of pace associated with this kind of work has relieved some of the sensation of burnout associated with going to the same clinic and dealing with the same office politics every day.
While I love my partners and my staff, the chance to work with a new group of nurses and to interact with a new group of local doctors is in many ways invigorating. When I talk to other physicians who do locum work, the number one reason they chose it is the flexibility it affords. You have a great deal of control over your hours and your location. Further, you are paid well from day one with no requirement to make partner and no requirement to invest in ancillary income. What you gain in flexibility you certainly lose in predictability, but for some, that is a trade-off worth making.
I love my day job and have every intention to finish my career right here in Colorado Springs, so please don’t read too much into this post. I am lucky to have great partners and wonderful staff, but traveling to my locum position in a truly rural part of Colorado and interacting with patients and local physicians there has been a great addition to my monthly routine and something that I highly recommend everyone consider.