The "Locums-O-Meter"

Medicine is on the brink of collapse. Has been for some time here in the US (blah, blah, blah see rest of blog). However, I think that Emergency Medicine in particular is the canary in the coal mine for medicine in general, and the canary is strangely quiet. Apparently, all that our national colleges can do is grab their collective ankles and get in line. And, with some notable exceptions, most physicians are too scared or too busy to speak up in their own defense when they are caricatured as money grubbing, spoiled, and greedy children.

What is not quiet is my telephone. I am getting four or five calls a day from locums companies who are desperate to talk to me about a 'super opporunity'. Translation, hospitals are desperate enough to pay the confiscatory fees of head-hunting companies to put a warm body in their ER who has some semblance of training in the specialty. Hence I think I can probably gauge the seriousness of the medical crisis by how many locums call I get a day. Can't staff your ER? Then you have lost 80% of your admissions so I think it's a fair gauge.

Any economics experts out there? Chime in about this because it is seems that is it at the level of locum tenens companies (medical head-hunting firms) that market forces are effective in the circus of American medicine. They certainly are not in effect at the level of a physician in training... one's salary is set for the length of one's training program... three to ten years, and it is set right now, medicine or surgeon, at around 43k.

Right out of residency with 100k-300k in debt and no equity it is tempting to jump in and sign on with the first physician group that comes to call (and this is often a short and abusive marriage). I am at the point now, however, that I can name my own price and name my conditions of work, and guess what? I am getting what I am asking for. I am my own boss. It is liberating.

So here's something to ponder all you ER residents out there, why not try locums first? Don't fall for the signing bonus 'carrot'. There is more need now than ever for Board-Certified EM physicians. Why sign on with some contract group with closed books (or even one with open books) and a partner track? Working your way in from locums to full time is the only way to really see the 'innards' of your new family. The market will efficiently place you and if you start your career by eating yet another shit sandwich (like you have done for the last seven years) then why would you ever stop? Your first job IS this important! Why not locums?

And you Docs who are simply holding on to the rails of the Titanic as it slips beneath the waves... just trying to eke out one more year... get off now! Set your schedule, set your price, and write that resignation letter you have always wanted to write. You and your patients will be happier and you will practice better medicine.

This "supply and demand" concept has, evidently been discovered before and is not complicated in a "market system". It IS complicated in OUR system, however, because in our system physician pay happens thusly; patient A pays for patient X with money from a drug bust that happened two years ago (on the Mexican border), and which was awarded him(patient A) in a lawsuit (filed by the Cochrane firm) who sued the police after they rear-ended him in said drug bust. Understand?

*** The Locums-O-Meter today is twelve out of ten (LOM=12/10)

**** From ACEP News...

 

Emergency Medicine

Number of certified ED physicians may soon fall short of staffing needs, research suggests.

HealthDay (1/9, Preidt) reported that Massachusetts General Hospital researchers are saying that the "number of board-certified emergency doctors in the United States will likely fall short of hospital emergency department staffing needs in the future." While analyzing "data from the 2005 National Emergency Department Inventories USA database," investigators "found there were 22,000 board-certified emergency physicians already in practice and 1,350 who were newly certified that year." Yet, "having at least one board-certified emergency doctor present in all U.S. hospital emergency departments at all times would require 40,000 physicians with such training, which means that only 55 percent of demand was being met in 2005." In a paper appearing in December issue of Academic Emergency Medicine, the team "said alternatives should be examined, 'such as giving the family physicians who currently staff many U.S. emergency departments extra training in key emergency procedures,'" while increasing the "reliance on nurse practitioners and physicians assistants, who can help emergency physicians of any training background better handle the continually rising number of patients."