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Locum Tenens and Moveable Medicine

June 2002

By Bonnie Darves

Editor’s Note: “Time-limited locum tenens work can be particularly valuable in the decision-making process for those who are contemplating several different geographical and practice settings. Of critical importance is confirming that the locum tenens organization you select has a stellar reputation for successful placement and post-placement support, including malpractice coverage and housing assistance.”

— John A. Fromson, M.D., Chairman of the Department of Psychiatry at MetroWest Medical Center

Physicians find adventure, professional satisfaction in locum tenens work.

When Raphael Allred, M.D., completed her family practice residency in July 2001, she received a half-dozen good offers, but she decided she just wasn’t ready to make the “big decision” and wanted to hold out for an opportunity to do full-spectrum family medicine. So the University of Utah graduate opted for locum tenens work and accepted an assignment on The Rocky Boy Reservation in remote north-central Montana.

“I like the work and the people, and it’s giving me a chance to catch up on my personal life,” says Dr. Allred, 29. After years of tough call schedules, the Montana native is enjoying her “9-to-5” schedule at the Chippewa Cree Health Center, as well as the opportunity to work with Native Americans. An upcoming assignment will take her to a community health center in Salem, Oregon, and after that she has her sights on short-term positions in other places she has always wanted to visit — Alaska, Hawaii, the South.

“I’m pretty open to see and work in other places because I think every place has its charms,” Dr. Allred says. She says she plans to “keep traveling” while she simultaneously explores different practice settings and considers the myriad options for a long-term position.

Dr. Allred is among the growing number of physicians — usually those new to practice or those in the later, “winding down” years — who are choosing the locum tenens life. Working locum tenens (a Latin term meaning “to hold the place of”) provides an opportunity to sample not just geography but also a wide variety of practice settings — without putting down roots. The appeal is understandable: Locum tenens firms do most of the legwork to coordinate licensing and credentialing; arrange and pick up the expenses for malpractice insurance, transportation and housing; and work hard to ensure the assignment and the physician are a good match.

According to Don DeCamp, chief operating officer of the locum tenens firm CompHealth, locum tenens work is ideal for the young physician who either wants to travel or try out practice environments. The lifestyle also may appeal to physicians interested in whittling away at medical school loans without having to meet other major expenses because locum tenens companies pick up the tab for travel to the assignment, housing, professional liability coverage, and other incidentals. The firms also handle much of the paperwork and legwork involved in state licensing and credentialing, streamlining the process for locum tenens physicians.

Fair Wages, Decent Hours

Physicians working locum tenens are independent contractors and usually earn close to market wages for their specialty, when the expenses they don’t have to assume are factored in, DeCamp notes. Assignments range from a long weekend to several months or even a few years, but the average is four to six weeks. Housing varies depending on the area, from condos or single-family houses to hotels or rustic cabins. Locum tenens firms also welcome physicians who wish to travel with spouses or families and will work to find suitable housing.

The biggest draw for physicians who work locum tenens is flexibility. For physicians just leaving residency, the work style may provide the first chance they’ve had in years to avoid night call, for example, or to leave behind the stresses of big-city life. “For young physicians, locum tenens offers a wonderful opportunity to see the country and experience a wide variety of settings, but it also gives them an opportunity to take charge of their schedules,” says Katie Abby, chief operating officer for VISTA Staffing in Salt Lake City, Utah. Abby says many physicians just out of residency work for VISTA for a few months at a stretch, then take a month off to travel before accepting another assignment. Others elect to work locum tenens for several months while waiting for a desired permanent position to open up or to pick up income before starting a planned fellowship, Abby says.

Locum tenens holds appeal for some mid-career physicians as well. Orthopedic surgeon Carl Unsicker, M.D., F.A.C.S., first started taking short locum tenens assignments in the mid-1980s while he was still practicing full time, so he and his wife could travel and do volunteer work. In his three years as a traveling physician, the surgeon has worked in the wilds of Alaska, the plains of Iowa, the North Carolina mountains, and the New Mexico high desert.

“I haven’t been to a place that hasn’t been delightful,” says Dr. Unsicker, who is in his late 50s and now spends several months a year volunteering in South Africa and Tanzania with Orthopedics Overseas. “I like doing locum tenens because I enjoy visiting different practices and communities, and I think I’ve got some of the characteristics a good ‘locum’ needs — one of them being flexibility.” For example, when Dr. Unsicker regularly fills in for a surgeon in Juneau, Alaska, he takes care of the family’s horses. He prefers short assignments of one to two weeks and credits his locum tenens firm, VISTA Staffing, with ensuring that the assignments he accepts are a good match for his interests and skills.

An Expanding Reach

Locum tenens, as an employment sector, has grown rapidly since its emergence in the late 1970s, and the range of practice opportunities has expanded in tandem. Government positions, with the VA and Indian Health Services, for example, initially accounted for the majority of locum tenens spots. But today health care organizations, hospitals, and practices of all types and sizes seek “fill-in” physicians to cover sabbaticals, vacations, or maternity leave; to help out while a permanent physician is being recruited; or simply to meet patient loads during peak demand periods. As such, locum tenens physicians seeking variety might find themselves in a rural Northwest hospital one month and a large urban facility a few weeks later.

For William Walklett, MD, FACR, working locum tenens serves two personal objectives: a desire to travel and a wish to leave behind the commitments of operating a full-time practice. Now 69, the Jacksonville, Fla., resident and former radiology chief holds 19 state licenses and works about 40 weeks a year in hospitals throughout the country. “It works well for me because I enjoy traveling and meeting new people — and I’m happy being able to choose where and when I want to work,” says Dr. Walklett. A recent CompHealth assignment took him to rural Rupert, Idaho, during the height of the beet harvest season. But his preferred turf is the Eastern Seaboard, from Maine to Florida, or any place that enables him to use his time off to pursue a longtime hobby: exploring the territory once traversed by Lewis and Clark.

Potential Pitfalls

Lest locum tenens sound too good to be true, physicians considering it should be aware of some possible drawbacks: housing, internal politics, and contract terms.

While agencies make every effort to find suitable accommodations for the doctors they place, sometimes the housing isn’t satisfactory. It thus behooves locum tenens physicians to discuss their specific lodging needs with their agency in advance.

Although politics is a fact of life in every institution, the politics of locum tenens assignments can be especially dicey. The need for a “relief” physician sometimes arises in organizations experiencing turmoil, and locum tenens physicians occasionally walk into hostile work environments or end up reporting to a difficult person. Anyone contemplating a locum tenens situation should therefore ask a few pointed, politically oriented questions before accepting an assignment.

Physicians should also ensure that the contract governing the locum tenens arrangement does not disadvantage them or put them at risk legally. The contract should clearly state the sum the physician will be paid — hourly, weekly, or monthly, as the case may be — as well as the schedule and total number of hours each week. Overtime responsibilities should be addressed in detail because unspecific contracts leave locum tenens physicians open to covering for anybody and everybody who needs or wants time off. It should also explicitly state that the locum tenens agency or hiring entity will arrange and pay for travel and housing, and it should spell out the level of malpractice coverage and the carrier through which it has been arranged. The contract should also address insurance coverage for any claims made after the locum tenens physician leaves the site.

Finally, the contract should include an “exit” clause that the physician can exercise should the assignment or working conditions be substantially different than billed. Some contracts experts recommend that locum tenens physicians agree initially only to a short-term deal — one to three weeks, for example, with a one-week notice period if the physician wants to leave — and then renew or extend when the initial contract period has passed. This protects locum tenens doctors from situations like the one that occurred when a physician, sent to a clinic in rural Alaska, found he was essentially on call 24/7. The physician, who had hoped to see the Alaskan wilderness, saw nothing but the clinic walls for the entire period of the contract.

The locum tenens physician should initial any changes made in a draft contract, and those changes should be counter-signed by the locum tenens agency representative or hiring-entity official before the physician signs the final draft.

These risks and caveats notwithstanding, locum tenens is an especially viable option for young physicians starting out and for older doctors who want to keep practicing but also want ample time off.

NOTE: The author, Bonnie Darves, is an independent health care writer based in Lake Oswego, Oregon.

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